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Background India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross‐sectional comparative study to determine the difference in Th1 (IFN‐γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. Methods Patients (18–60 years) were divided in two groups—group A (n = 114, BSA <5%, single anatomic site, duration <6 months, n = 118) and group B (n = 107 BSA >10%, > one anatomic site, duration >12 months, n = 118). Clinical parameters along with serum levels of IgE, IL‐4 and IFN‐γ and expression of IL4 and IFN‐γ in dermal infiltrate were compared between group. Results Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A‐539.2, B‐2901.0, p < .001) whereas levels IL‐4(median A‐21.3, B‐20.4, p < .001) and IFN‐γ(median A‐9.6, B‐5.1, p < .001) were significantly lower in chronic cases. Expression of IL‐4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN‐γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p < .001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p = .001), ↓IFN‐γ (OR:4.683, CI:1.634, 13.418; p = .004) correlated significantly and independently with chronic dermatophytosis. Conclusion Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN‐γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN‐γ cannot be established in our study.

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Infectious diseases can clinically present as vesiculobullous disorders. Direct immunofluorescence (DIF) study of skin biopsy helps distinguish true autoimmune blistering disorders from other conditions. In many situations, even DIF findings in infections disorders imitate autoimmune process. Here, we describe a case of 29-year-old female with extensive dermatophytosis having presentation mimicking bullous pemphigoid both clinically and histopathologically including DIF findings.