The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive?

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

“…A veritable epidemic of alarming superficial dermatophytosis (tinea), predominantly tinea corporis, tinea cruris and tinea faciei has swept through India in approximately past 5 years or so. [1][2][3] Dermatologists and academic departments from across the nation observe that between 20% and 40% of patients attending the outpatient department seek treatment of tinea. A large number of these patients have recalcitrant disease.…”

“…4 Overcrowding, heat, humidity, global warming, migration and tight clothing have always been causative factors, and the easy availability and widespread abuse of irrational combination creams containing potent steroids, antifungals and antibacterials are thought to be one of the most significant culprits to be blamed for this phenomenon. [1][2][3] An overwhelming majority of patients report having used them without medical supervision before visiting a dermatologist. Multiple permutations and combinations of irrational formulations containing topical steroids, commonly potent ones, antifungals and antibacterials are freely available.…”

“…Many are widespread, are chronic, recur and defy conventional treatment guidelines. [1][2][3] Multiple household contacts are affected as seen in scabies. Even little children present with tinea cruris and tinea corporis which was previously uncommon.…”

“…The most common are eczematous and lichenoid reactions, followed by granulomatous reactions and pseudolymphomas. 3 Although an allergic mechanism has been implicated, 1 showing tattoo skin allergy by cutaneous tests can be challenging. Obtaining ink details and samples is difficult.…”

Effectiveness of modified Whitfield’s ointment with oral griseofulvin in the treatment of dermatophytosis poorly responsive to standard antifungal therapy: a randomized, double blind, within patient placebo control

“…6,7 Patients with immunocompromised status, diabetes mellitus, atopy, and intake of systemic corticosteroids are also predisposed to chronic dermatophytosis. 8 Clinical resistance has been defined as the persistence or progression of an infection despite in vitro activity against the organism. Such failures can be attributed to incorrect diagnosis, immunosuppression, suboptimal dose or duration of therapy and hygienic practices among patients are responsible for spread and persistence of the infection despite of treatment.…”