Epidemiology of cortico-steroid-modified tinea: study of 100 cases in a rural tertiary care teaching hospital of Western Uttar Pradesh, India

Abstract

Introduction: Dermatophytic infections are very common superficial fungal infections, which have been reported worldwide. Once considered to be easily treated may become recalcitrant and extensive. The three genera of dermatophytes involved for causing infection are Trichophyton, Epidermophyton and Microsporum. Some of the dermatophytes are cosmopolitan in distribution, while others can be geographically restricted. The epidemiology of dermatophytes may keep on changing due to migration, tourism, war, association with pets and also socioeconomic status. Material and methods: We conducted a study to find out the causative dermatophytes and clinical types associated with them. The clinical samples in the form of skin scrapings, plucked hair and nail scrapings and subungual debris were collected in the microbiology department of the tertiary care centre. The samples were subjected to 20% potassium hydroxide (KOH) mount and later inoculated on Sabouraud's Dextrose Agar (SDA) supplemented with chloramphenicol and cycloheximide. The plates were incubated at 25°C and observed for growth every week for four weeks. Results: We found that tinea corporis was the most common clinical type (61.20%) and was due to Trichophyton interdigitale (T. interdigitale) except one case, which was due to Trichophyton rubrum (T. rubrum). The next in frequency was tinea cruris (24.34%) due to T. interdigitale. Most of the cases of dermatophytosis were extensive without central clearing and with involvement of multiple anatomical sites. There was only one case of tinea capitis (0.65%) due to Trichophyton violaceum (T. violaceum). We did not find any inflammatory lesions or involvement of lymph nodes. Conclusion: To curb this epidemic like scenario of dermatophytosis in India will be a great challenge to the medical fraternity. Teamwork of dermatologist, mycologists, pharmacists, drug regulatory authorities, government and patients is essential.

Clinicoepidemiological profile of steroid modified dermatophytosis following abuse of irrational combination of topical corticosteroid containing preparations (ICSP)

“…Whereas it was striae in a study conducted by Lakhani J et al 3 Most common KOH and culture results were negative i.e 54.55% and 78.18% due to repeated application of topical steroid combination preparations. Whereas KOH and culture results were positive in study conducted by Thakur R et al 5 Most common organism isolated was Trichophyton rubrum (12.72%) in our study. Whereas Trichophyton interdigitale was the most common organism isolated in a study conducted by Thakur R et al 5…”

“…Whereas KOH and culture results were positive in study conducted by Thakur R et al 5 Most common organism isolated was Trichophyton rubrum (12.72%) in our study. Whereas Trichophyton interdigitale was the most common organism isolated in a study conducted by Thakur R et al 5…”

“…3 Ives and Marks in 1968 coined the term Tinea Incognito but later in 2002 Houlbar and Male pointed out the grammatical error but has been sadly ignored. 4 Females (54.54%) predominated males in our study .Whereas male predominated female in a study conducted by Lakhani J et al, 3 Thakur R et al, 5 Kothiwala R et al 6 This discordance in our study is because of inhibition of female to go to hospital particularly in private parts and so they purchased the easily available over the counter preparation and come to the hospital once it become severe. Most common age group was 15-30 years (29.09%).This was in concordance with the study conducted by Thakur R et al, 5 Kothiwala R et al, 6 Most of them resides in rural areas(45.45%).…”

The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features

“…43 Double-edged tinea, tinea pseudoimbricata and tinea "rings within rings" lesions are all highly suggestive of steroid abuse, especially erratic use of steroid-containing fixed-dose combinations. 44 Another uncommon entity is tinea recidivans that describes the appearance of lesions at the periphery of a healed lesion [Figure 10a and b].…”

Epidemiology and Diagnostic Perspectives of Dermatophytoses

“…Another example are countries on the African continent, where particularly Ethiopia, has a high number of cases of dermatophytosis, not only due to the climatic factor, but also because it is a country with low socioeconomic status, low level of hygiene and health care, and overcrowding [ 28 , 29 , 30 ]). India is also a country from which several articles are published, and which goes through the same problems as Ethiopia [ 31 , 32 , 33 ].…”