Indian irrational skin creams and steroid‐modified dermatophytosis – an unholy nexus and alarming situation

Verma, Shyam; Zouboulis, Christos C.

doi:10.1111/jdv.15025

Cited by 26 publications

(25 citation statements)

References 7 publications

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“…History of potent topical steroid application steroids prior to appearance of lesions was present in all our patients. Our findings of this demographic data is similar to the finding by Singal et al, Verma et al, Verma et al, Jakhar et al and Kakkar et al [4][5][6][7][8] This suggests that many women are seeking treatments in order to have fair skin. Lack of resources, wrong notion among the general population and especially the pharmacists that steroid application helps in brightening of skin, supply of drugs by pharmacists without prescription has lead to steroid misuse.…”

Section: Discussionsupporting

confidence: 91%

“…Erratic use of topical steroids leads to periods of active inflammation and apparent remission with the appearance of multiple rings and inadequate clearing of the fungus. 5,6 A ring effect similar to that described here can be explained by the fact that although host reaction occurs in response to actively metabolizing fungal cells, these are only partially inhibited as a result of concomitant topical steroid treatment. When local immune responses decline below a key threshold, the fungal genes are switched on again and instigate another zone of host-induced inflammatory response.…”

Section: Discussionsupporting

confidence: 56%

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Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

et al. 2020

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Background: Topical steroid-modified tinea corporis and tinea cruris is on the rise due to the ease of availability of over-the-counter potent topical corticosteroid preparations and their inappropriate use, alters the true morphology of lesion. As there is paucity of literature about increasing prevalence and varied presentation of this condition, we aimed to study the clinical profile and dermoscopic features of Tinea pseudoimbricata due to topical steroid abuse. We present a case-series of 77 cases of a distinct morphological pattern with central erythematous, scaly, pruritic concentrically spreading plaques with raised and scaly borders known as Tinea pseudoimbricata.Methods: We evaluated 77 clinically diagnosed patients of Tinea pseudoimbricata with positive 10% potassium hydroxide examination and culture. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma.Results: There were 52 male and 25 female patients with a mean age of 28.66 and a mean disease duration of 7.6 months. There was a history of application of potent or super-potent topical steroid for varying durations. Culture isolates were Trichophyton rubrum species. Dermoscopic analysis showed features of steroid abuse.Conclusions: Injudicious and inappropriate use of topical steroid causes Tinea pseudoimbricata; a special subset of tinea incognito, which is very common now a days. This should alert the dermatologist about the steroid abuse and requires systemic anti-fungal treatment for prolong time.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 56%

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

et al. 2020

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“…Anecdotal evidence is quickly building up regarding the increasing prevalence of this menace, albeit in a much smaller magnitude, in neighbouring Asian and African countries, owing to the large Indian expatriate workforce carrying such medicines, widespread travel, migration and importantly, exports of such creams from India. Investigations are ongoing on this topic It is only a matter of time before this problem is witnessed in Germany and other countries in EU where visitors and migrants carrying both the fungus as well as the combination creams spread the infection inadvertently.…”

Section: Discussionmentioning

confidence: 99%

“…An alarming pan Indian increase in the incidence of superficial dermatophytosis has been noticed over the past 5‐6 years in India . Studies from Kolkata, Ahmedabad and Chennai during different time frames have revealed an increasing trend .…”

Section: Introductionmentioning

confidence: 99%

The current Indian epidemic of superficial dermatophytosis due toTrichophyton mentagrophytes—A molecular study

Nenoff¹,

Verma²,

Vasani³

et al. 2019

Mycoses

199

216

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Summary The disease burden of chronic‐relapsing and therapy‐refractory superficial dermatophytosis dramatically increased in India within the past 5‐6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and a PCR‐ELISA directly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)‐1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte‐positive culture result. Out of this, 138 (92.62%) samples were identified as Trichophyton (T.) mentagrophytes and 11 (7.38%) as Trichophyton rubrum. The PCR‐ELISA revealed similar results: 162 out of 201 (80.56%) samples were dermatophyte‐positive showing 151 (93.21%) T mentagrophytes‐ and 11 (6.79%) T rubrum‐positive samples. In this study, we show for the first time a dramatic Indian‐wide switch from T rubrum to T mentagrophytes. Additionally, sequencing revealed a solely occurring T mentagrophytes “Indian ITS genotype” that might be disseminated Indian‐wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents.

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“…[8] Similar hypothesis has been put forward to explain the concentric rings of T. pseudoimbricata . [910] Fungal invasion initially activates the host immune response leading to suppression of the fungal cell growth. Topical application of potent steroid causes local immunosuppression which may diminish the host responses, specifically the cellular immune responses, against the fungus.…”

Section: Discussionmentioning

confidence: 99%

Tinea pseudoimbricata as a unique manifestation of steroid abuse: A clinico-mycological and dermoscopic study from a tertiary care hospital

Singal

Jakhar

Kaur

et al. 2019

Indian Dermatol Online J

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Background: Tinea pseudoimbricata , characterized by concentric scaly rings simulating Tinea imbricata is caused by dermatophytes other than Trichophyton concentricum . It is reported to occur in patients with steroid abuse and in immunocompromised individuals. Aim: To study the clinico-mycological profile and dermoscopic features of T. pseudoimbricata in immunocompetent patients. Methods: We have evaluated 14 consecutive, clinically diagnosed patients of T. pseudoimbricata with positive 10% potassium hydroxide (KOH) examination and culture, seen over a period of 6 months. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma. Results: There were seven male and seven female patients with a mean age of 27.6 years and a mean disease duration of 3.8 months. All patients gave a history of application of potent or super-potent topical steroid with or without oral/injectable steroid for varying duration. Culture isolates were Trichophyton mentagrophytes complex and Trichophyton rubrum in 11 and 3 patients, respectively. Dermoscopic analysis showed features of steroid abuse in majority of the patients. Limitation: A small sample size was the limitation of our study. Conclusion: T. pseudoimbricata is a special subset of Tinea incognito caused by injudicious and inappropriate use of topical steroid. The typical appearance should alert the dermatologists regarding the possible abuse of steroids. Most common species isolated on culture was T. mentagrophytes complex.

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Indian irrational skin creams and steroid‐modified dermatophytosis – an unholy nexus and alarming situation

Cited by 26 publications

References 7 publications

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

The current Indian epidemic of superficial dermatophytosis due toTrichophyton mentagrophytes—A molecular study

Tinea pseudoimbricata as a unique manifestation of steroid abuse: A clinico-mycological and dermoscopic study from a tertiary care hospital

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