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Background: In a small state like Tripura, a surge in prevalence of superficial dermatophytosis has been observed from April to September among the population of both tribal and non-tribal groups having different lifestyle, different food habit, and different socioeconomic status. Studies from different region reveal varying pattern of etiological distribution of the disease. But till date no research study has been initiated in Tripura on clinicomycological profile of dermatophytosis. Objectives: This study was undertaken with the objectives to estimate the proportion of different fungal species associated with dermatophytosis among the patients attending Dermatology Outpatient Department of a Tertiary care hospital of Tripura and also to determine possible association of different clinical parameters with fungal species if any. Materials and Methods: A total of three hundred and ninety-one (391) new cases of dermatophytosis attending Dermatology Outpatient Department of a Tertiary care teaching hospital of Tripura were included in this study from June, 2021 to May, 2022. All the specimens were assessed by direct microscopic examination and in vitro culture. Fungi were identified on the basis of their macroscopic and microscopic features with the help of lactophenol cotton blue staining and urease test. Results: There was a male preponderance among cases and maximum patients belonged to 21-40 years age group. Trichophyton schoenleinii was the most common fungal species (52.1%) grown in culture followed by Trichophyton rubrum (26.9%). Conclusion: In contrast to previous study results from different parts of India, Trichophyton schoenleinii was the most common isolated fungal species from this part of northeast India, and Tinea corporis (41.3%) was the most prominent clinical manifestation of dermatophytosis. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions There has been a global rise in cases of dermatophytosis and, in particular, recalcitrant and recurrent cases on tinea of the glabrous skin. This phenomenon, particularly prevalent in India, has been linked to the concerning rise of antifungal resistance. The challenge is amplified by a dearth of comprehensive, international data to understand the global scope and characteristics of such cases.This study aims to collate international insights, focusing on areas outside Europe (as this was previously published), to map the extent and characteristics of clinical and, where possible, laboratory confirmed tinea of the glabrous skin through an online survey administered to dermatologists globally.An online survey was distributed from February 2022 to July 2023 and captured data on respondents' experience of recalcitrant and recurrent tinea of the glabrous skin over the preceding 3 years.A total of 260 responses were received spreads across 36 countries, excluding Europe. In total, 91.7% reported seeing cases of recalcitrant or recurrent tinea of the glabrous skin over the preceding 3 years. Common anatomical sites affected were the trunk and groin. T. mentagrophytes and T. rubrum were the predominant species implicated, and there were low rates of laboratory confirmed dermatophyte resistance.The high rates of reported recalcitrant and recurrent tinea of the glabrous skin underscore an urgent need for global collaborative efforts and enhanced diagnostic measures. The findings advocate for the establishment of a standardized global disease registry, regulation of over‐the‐counter antifungal and steroid combinations, correlation of clinical suspicion with laboratory confirmed drug resistance and exploration of alternative therapeutic strategies to mitigate the burgeoning challenge of dermatophyte resistance. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is a fungal infection that targets the skin and its appendages, such as the nails and hair. It affects all age groups and is estimated to affect approximately 20–25% of the population across the world. There are insufficient data on the clinic-mycological pattern of dermatophytosis in Odisha, a coastal state in eastern India. The study aims to explore the clinico-mycological pattern of prevailing superficial cutaneous fungal infections and to identify the specific species as per the site of skin involvement. Methods: This is a cross-sectional study conducted in the Department of Dermatology in collaboration with the Department of Microbiology at a tertiary health care centre, Odisha, for a period of 2 years, from October 2020 to September 2022. Participants aged 18–65 years with active dermatophyte infections of the skin were included in the study. Clinical examination and mycological workup were performed, and the collected samples were divided into two parts, one for direct microscopy and the other for fungal culture. Results: According to our study, the most common isolate was Trichophyton mentagrophytes (21.7%), followed by T. rubrum (11.7%), and 5.3% of cultures showed T. schoenleinii isolates, whereas Microsporum canis and Microsporum gypseum constituted 2.7% and 0.7%, respectively. Conclusion: The present study focuses on the prevalence and clinical trends of different dermatophyte species associated with dermatophytosis in eastern India. Due to the favourable climate of Odisha, superficial mycoses are prevalent here, and according to our study, Trichophyton mentagrophytes is the predominate isolate in this region. [ABSTRACT FROM AUTHOR]

Introduction: Nonvenereal skin diseases are often confused with sexually transmitted diseases. It is responsible not only for the physician's diagnostic dilemma but also for significant patient concerns. Identifying the cause or aggravating factors can save the patient from distress. Therefore, this study was conducted to determine the clinical pattern and prevalence of nongenital diseases. Methods: All males attending the dermatology outpatient department in our hospital are included in the study after getting informed consent. Detailed history, including demographic data, chief complaints related to skin, any symptoms in genitalia, drug history, and history of sexual exposures, was recorded. Results: The prevalence of nonvenereal genital lesions during the period was 8.2% of patients attending the dermatology department. A total of 21% of nonvenereal genital dermatoses were studied in 82 patients. The most common ones encountered are pearly penile papules and tinea cruris, contributing 19.5% each. Vitiligo is the following most expected condition, involving 13.4% of patients. Among the total 82 patients with nonvenereal genital dermatoses, 65.8% had symptoms in external genitalia, and the rest of the 34.2% of patients did not have any complaints in genitalia. Conclusion: Among the 82 patients with nonvenereal dermatoses, 54 (65.85%) had symptoms in external genitalia. The study helped us understand the pattern and clinical characteristics of various nonvenereal genital dermatoses. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is very common among all age groups throughout the world. The incidence of the same is increasing on a steady basis. Aim: Estimating the clinical prevalence of dermatophytes mycoses among the patients visiting the outpatient unit and assessing its distinct manifestations. Methodology: A prospective observational study was conducted with the patients attending the Skin and STD outpatient unit of a tertiary care teaching hospital in Salem. A total of 3068 outpatients attended the department, of which 420 patients were diagnosed with dermatophytic mycoses and were taken for investigating the prevalence. Results: A total of 420 dermatophytosis patients were included giving a percentage prevalence of 13.69%. There were more female patients (n = 213, 50.71%) than males (n = 207, 49.29%). The most common afflicted age group was 31–40 years (n = 99, 50.71%). Most of the patients had an atypical lesion called tinea incognita (n = 265, 63.09%) where there was no typical classic appearance of dermatophytic infections. The most prevalent clinical manifestation was tinea corporis (n = 73, 17.38%) followed by tinea cruris (n = 69, 16.43%). There were more newly diagnosed dermatophytosis cases (n = 326) than the previously diagnosed cases (n = 94). Conclusion: This study concludes that dermatophytic mycoses were more prevalent among females than males and among the age groups of 31–40 years. The most common clinical presentation was tinea incognita followed by tinea corporis. [ABSTRACT FROM AUTHOR]

Itraconazole (ITZ) has been the mainstay of oral antifungal treatment for the current epidemic of recalcitrant dermatophytosis (RD) in India. Recently, a newer formulation of ITZ, super bioavailable itraconazole (SUBA-ITZ), is made available in the market by many pharmaceutical companies. It is important for dermatologists to understand the pharmacokinetic properties of SUBA-ITZ vis-a-vis conventional pellet formulation to use it effectively and safely. Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) has established a special interest group for recalcitrant dermatophytosis (SIG-RD) to strengthen research, continuing medical education, and industry collaboration on the subject. This position statement on SUBA-ITZ by SIG-RD is an attempt to address current pieces of evidence and the position of this new formulation in the management of RD. [ABSTRACT FROM AUTHOR]

Background: The present epidemic of dermatophytosis in India is marked by an increase in chronic, recurrent and disseminated cases. A combination of oral itraconazole and topical luliconazole is being increasingly utilised by dermatologists in India. The superiority of this combination is not supported by robust clinical trial data. Objective: We conducted this randomised, open-label, two arms, parallel assignment intervention trial between November 2022 and May 2023 to determine the superiority of topical 1% Luliconazole over bland emollient as adjuvant to systemic Itraconazole therapy in the management of dermatophytosis. Method: In this study, 135 patients of either sex were randomised to two study cohorts. Major exclusions being concomitant medical illness, use of concomitant medication and substance abuse. Participants were randomly assigned to receive topical bland emollient, (Cohort I, n = 67) or topical luliconazole, (Cohort II, n = 68). Both cohorts received oral itraconazole 200 mg/day (100 mg BID) and levocetirizine 5 mg twice a day as a systemic regime. Clinical and mycological cure at the end of 6 weeks and clinical relapse among cure patients during 10-week follow-up were observed. Results: The cure rates for Cohorts I and II at 6 weeks were 50 (74.62%) and 56 (82.35%), (p = .46), respectively. During the 4-week follow-up period, clinical relapses were observed in 16 (32%) of the 50 patients in Cohort I and 12 (21.43%) of the 56 patients in Cohort II (p = .18). Luliconazole cohort shows a significantly higher medical cost (p < .05). Conclusion: Our study shows a similar cure rate and relapse rate for patients receiving topical Luliconazole versus topical bland emollient as an adjuvant to the systemic itraconazole regime. [ABSTRACT FROM AUTHOR]

Background: Pityriasis Versicolor (PV) is a chronic superficial fungal infection of skin caused by lipophilic yeast Malassezia species. Its prevalence, predisposing factors and clinical presentations varies in different geographical locations around the world. Despite being a common disease, its diagnosis and treatment remain a challenge. The aim of this study was to document the clinico-epidemiological characteristics of the participants diagnosed with PV. Materials and Methods: A descriptive crosssectional study was carried out on 104 consecutive participants attending the Outpatient Department of National Research Institute of Unani Medicine for Skin Disorders, Hyderabad during 1st July, 2020 and 31stJuly, 2021. Their demographic data, risk factors, clinical features, and temperament were recorded in the case record form. The participants were diagnosed clinically and confirmed by direct microscopy. The data were analysed retrospectively. Results: In this study, 75 participants (72%) were males and the ratio of male to female was 2.6:1. The most frequently affected participants were in 20-40 years of age group. The mean age was 29.14 (±10.52) years. PV was present in 28.8% students, 21.15% workers, 31.7% employees, 11.5% housewives and 6.7% businessmen. The most common affected site was back followed by neck and chest. PV was found prone to the Fitzpatrick skin types 4 (49.03%) and 3 (27.8%). Hypo-pigmented lesions were more common. The Malassezia species was present in multiple lesions of all the participants. Conclusions: This study documented the clinico-epidemiological profile of PV. The findings of this study may provide us current understanding of PV in India. [ABSTRACT FROM AUTHOR]

The prevalence of Dermatophytosis is similar in several continents of the Asian country. The varied state of weather is favourable for mycosis that may lead to various clinical symptoms and infection spreads speedily if left untreated with time. The aim of the present study is to determine the clinical and mycological pattern of dermatophyte infections in patients arriving at our dermatology outpatient department and also to correlate the formal clinical diagnosis with KOH positivity and culture positivity. This descriptive observational study was conducted among 300 patients presenting with dermatophyte infections who came to the dermatology outpatient Department of SRM Medical College and research centre, Kattankulathur, Chengalpattu. The clinical specimens were put through direct microscopy by Potassium Hydroxide (KOH) mount and with the culture on Sabouraud's Dextrose Agar (SDA). The study showed males were affected mostly and most of the participants were students. The common symptoms observed were Itching, Scaling and Discolouration. Commonly, patients had a primary diagnosis of Tinea corporis infection followed by T. cruris. Trichophyton mentagrophytes were the commonly isolated organism followed by Trichophyton rubrum and Trichophyton violaceum. This study indicates the need for personal hygiene and the disadvantage of as only few participants had zoophilic infections of Tinea species. These methods of diagnosing and identification will further aid in better patients management. [ABSTRACT FROM AUTHOR]

Dermatophytosis is a prevalent infection in tropical and subtropical countries, including India. This study aims to investigate the epidemiology and clinical aspects of chronic and recurrent dermatophytosis, identify the clinical isolates, and assess the effectiveness of different microscopy and staining methods for diagnosis. The objective of the study is to study the epidemiology and clinical aspects of chronic and recurrent dermatophytosis and to identify the clinical isolates. Attempts to improve the diagnostic outcome by implementing different microscopy and staining methods have also been performed. Adult patients with chronic and recurrent cases and positive direct microscopy were included, and clinical details were recorded. The mycological culture was performed. Fifteen isolates were selected randomly and subjected to 0.9% NaCl, Chicago sky blue staining, Calcofluor white staining, and Congo red staining in addition to the standard lactophenol cotton blue (LPCB) preparation. Among the 178 patients in the study, females (56.7%) and patients aged 25-45 (50%) were more frequently affected. Tinea corporis was the most common clinical type (89.32%). Recurrent cases (56.1%) were more prevalent than chronic cases (43.9%). Culture positivity was seen in 60.1%, with Trichophyton mentagrophytes being the most common isolate (86%). Among the staining methods used on 15 selected isolates, Lactophenol Cotton Blue (LPCB) was scored as the most effective, scoring 2.6 out of 3. The study revealed several clinical and epidemiological findings related to dermatophytosis in India, including a high degree of communicability, inadvertent therapies including topical steroid misuse, and a persistent nature requiring an extended duration of therapy. Trichophyton mentagrophytes was the most frequently isolated pathogen. Of the staining methods evaluated, Lactophenol Cotton Blue (LPCB) was found to be the most effective. The findings suggest a need for continued research into effective treatments and diagnostic methods for dermatophytosis in India. [ABSTRACT FROM AUTHOR]

In a tropical country like India, the warm and humid climate plays an important role in the increased incidence of superficial fungal infections. This is a study to identify the causative fungi of dermatophytosis and their in vitro antifungal susceptibility pattern among patients reporting to multiple tertiary care hospitals. Skin scrapping, nail clipping, and hair follicles were processed for microscopy, culture, and antifungal susceptibility testing as per standard guidelines. Antifungal susceptibility was performed as per published by Clinical Laboratory Standards Institute for yeasts (M27–A3) and filamentous fungi (M38–A2). The study sample had a predominantly male population with the commonest age group being 21–30 years (39.57%) followed by 31–40 years (31.46%). Tinea corporis (57.30%) was the most common clinical presentation followed by tinea cruris (20.85%) and onychomycosis (14.73%). Microscopy positivity was 43.19%, while culture positivity was 23.97%. Dermatophytes accounted for the majority of isolates. All fungal isolates had high minimum inhibitory concentration (MIC) to fluconazole, suggesting that dermatophytes are possibly resistant to this drug. Trichophyton mentagrophytes is confirmed as the dominant pathogen of dermatophytosis in all three tertiary care hospitals. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of cutaneous mycoses has been on the rise worldwide with an increased incidence of recurrent and recalcitrant infections. This study was conducted to assess the clinical patterns and etiological agents of dermatophytosis, at a tertiary care hospital in western India. Material and Method: One hundred clinically diagnosed cases of dermatophytosis attending the OPD of a tertiary care hospital were included in this cross-sectional study. Thorough history taking and detailed clinical examination were done for each patient. For studying the mycological profile, direct microscopy for fungal elements in KOH and fungal culture on Sabouraud dextrose agar (SDA) was done for each patient. The growth on SDA plates was further mounted on lactophenol cotton blue mounts for species identification. Results: Our study found a male preponderance, and the majority of infections (36%) were in the 21–30 years age group. The most common clinical pattern was the mixed type of infections followed by T. corporis. Direct microscopy for fungal elements was positive in 71% but the culture positivity was only 35%. The most common species isolated in our study was T. mentagrophytes (62.8%). Conclusion: The present study highlights the bearing of factors like socioeconomic status and occupation on the clinical profile of dermatophytosis and reveals a changing trend in the etiological agent of dermatophyte species in this part of western India. [ABSTRACT FROM AUTHOR]

Itraconazole is now being used as the first line drug for dermatophytosis. Complete clinical and mycological cure are not achieved in some cases. The Super Bioavailable (SB) formulation is being marketed as a better formulation of drug in terms of bioavailability. To compare the efficacy and safety of SB and conventional Itraconazole in treatment of dermatophytosis. We compared the efficacy and safety of conventional itraconazole 100 mg twice daily with SB itraconazole 50 mg twice daily in dermatophytosis for two weeks. A convenient sample size of 30 was taken in each group. There was no significant difference in clinical parameters like erythema, scaling, number of papules between the two groups. Change in mean haemoglobin, total leucocyte count, platelet count, liver enzymes SGOT and SGPT and ALP did not differ significantly between the groups. There was no significant difference in the change in KOH status between the groups. There was no significant difference in clinical and mycological clearance between the conventional and the Super Bioavailable itraconazole at the end of two weeks in case of dermatophytosis of glabrous skin. [ABSTRACT FROM AUTHOR]

Dermatophytosis is one of the leading causes of visits to the dermatology department, especially in India, where the hot and humid climate favours fungal acquisition and perpetuation. Usual modalities of treatment include the use of either oral or topical antifungals or a combination of both, depending on the severity and extent of infection as well as the type of causative organism. But recently, steroid-modified dermatophytosis, an iatrogenically perpetuated dermatophytosis caused by the indiscriminate use of topical corticosteroids has emerged as a troublesome epidemic. We planned a cost-of-illness analysis of superficial dermatophytosis comparing the direct healthcare costs in steroid-naive and steroid-modified dermatophytosis. In our study, the average total cost of treatment for steroid-naive and steroid-modified dermatophytosis was found to be rupees (Rs) 2172.42 and Rs 3770.61 respectively, meaning that the cost for patients who used topical steroids is an additional 40% on average for treatment, when compared with the cost for patients who are steroid naive. The need for more consultations, investigations (relating to atypical presentation) and extended duration of treatment with higher-grade antifungals were found to contribute to the increased financial burden in steroid-modified dermatophytosis. [ABSTRACT FROM AUTHOR]

Objective We aimed to study and define "difficult dermatophytosis" encountered frequently; as well as examine demography, patient practices and clinico-etiological pattern among these patients. Methods A prospective, cross-sectional study was conducted to include 93(n) cases (after informed consent) from the patients attending the outpatient department in the Department of Dermatology, Venereology and Leprology between August 2019 and August 2020. The inclusion criteria were: - age >12 years and fulfilling one or more criteria defining "difficult dermatophytosis" i.e. multiple/large lesions, multifocal, recurrent therapy, multiple relapses, clustering and chronicity. The clinico-demographic data was recorded in a pre-designed pro forma, a KOH examination for skin scraping and fungal culture was done for all cases. Data was analysed with SPSS version 20. Results Males outnumbered females (M: F =1.2:1) and majority (67.8%) of patients were <40 years (Mean=34.13±11.5; Median=31yrs.). Body Mass Index (BMI) was higher than 25 in 55.9% cases; mean BMI seen in the study was 25.17±4.60. Multiple/large lesion (90.3%) was most common inclusion criteria followed by multifocal lesions (84.9%). All patients had tinea cruris; tinea corporis was most commonly associated followed by tinea faciei lesions. A significant proportion (76.3%) of cases had =4 family members cohabiting with them (Mean=5.07±0.03); more than half (56.98%) had an affected family member (Mean=0.90±1.00). The most common co-morbid condition seen was atopy seen in 16 (17.2%) patients. Presentation for dermatology consult was delayed by >1 month in 81.7% cases; >6 months in 47.3% cases and >1 year in 26.9% cases. A strong statistical association was found of multiple relapses with „delay in dermatology consults" (p value=0.002). A significant association of delay was also seen with chronicity (p value=0.046) was also seen. Nearly three-fourth study participants (72%) reported prior use of topical corticosteroid; oral (11.8%) and parental (20.4%) use were also reported. Prior use of luliconazole (40.8%) was most commonly reported among topical drugs, whereas itraconazole was used by 46% patients previously. Irrational use of anti-fungals was seen in 75%; including inappropriate doses (18%), inappropriate duration (34%), poly-pharmacy (6%) and non-compliance (1%). A statistically significant association of irrational use was found with multiple/large lesions (p value=0.008). Conclusion We propose this definition for the unusual presentations of the disease, particularly in the Indian sub-continent. Better access to clinical dermatology services and rational use of systemic anti-fungals as a means to mitigate difficult dermatophytosis. [ABSTRACT FROM AUTHOR]

Introduction: Dermatological manifestations are common manifestations of human immunodeficiency virus (HIV) disease, seen in 80% to 95% of HIV-infected patients. Dermatological manifestations are considered clinical indicators to predict and assess the underlying immune status. Aim: This study aims to document the dermatological manifestations in relation to CD4 count in people living with HIV (PLHIV). Materials and Methods: Cross-sectional study in 250 PLHIV fulfilling inclusion–exclusion criteria was conducted. Variables including sociodemographic profile, recent CD4 count (data from antiretroviral therapy center), and dermatological manifestation (physical examination) were collected. Clinical diagnosis was established, and patients were grouped according to the World Health Organization immunological staging Results: Majority of PLHIV (39.6%) were in the age group of 31–40 years. Males were affected more than females (1.6:1). A total of 364 dermatoses were observed; dermatological manifestation per patient ranged from 1 to 4. 32.80%. PLHIV had CD4 count >500 cells/mm3, 15.60% had CD4 count between 200–349 cells/mm3. Majority of dermatosis had infectious etiology (77.6%), out of which dermatophytosis (27.2%) was the most common infectious condition, whereas pruritic papular eruption was the most common (11.6%) noninfectious condition. A statistically significant association of CD4 count was found with dermatophytosis (P ≤ 0.001) and candidiasis (P = 0.001). Conclusion: The study showed a significant association between the number of dermatological manifestation and CD4 count as majority of study participants (67.2%) had CD4 <500 cells/mm3 at the time of episode of dermatosis. [ABSTRACT FROM AUTHOR]

Infections affecting the superficial keratinized layer of the skin, nails, and hair are referred to as dermatophytosis and dermatomycoses, which constitute the most common type of fungal infection that affects people. This clinical ailment has a prevalence of between 30 and 60% and is more common in India's hot, muggy, tropical climate. Examining the prevalence of superficial mycoses (SM), their clinical symptoms, and the fungal species that were identified as the disease-causing agents were the main objectives of the current study. This study comprised 250 clinically confirmed patients with SM who visited our dermatology department over the course of a year. Skin scrapings, nail clippings, and hair samples were gathered, mounted, and cultured using KOH. Macroscopic examination of culture, tease mount, and phenotypic tests were used to identify the species. The age group of 11–20 years (29%) had the highest prevalence of SM out of the 250 clinically verified cases of the condition that were included in our study, followed by 21–30 years (20%) and 31–40 years (18%). Candida albicans, dermatophytes, and non-dermatophytic moulds were the three most prevalent fungal isolates. The most typical dermatophyte isolate was T. rubrum, which was primarily found in Tinea corporis (TCo), Tinea cruris (TCr), and Tinea faciei (TFa). T. mentagrophytes was the second most frequent isolate. According to our investigation, it was determined that non-dermatophytic moulds constitute a significant contributor to the development of SM in addition to dermatophytes. [ABSTRACT FROM AUTHOR]

Onychomycosis (OM) is the commonest cause of dystrophic nails, responsible for upto 50% of cases. Apart from significantly damaging the nails, quality of life, and self-image of the sufferer, it also acts as a reservoir of fungal infections carrying important implications for emerging recalcitrant dermatophytoses. Treatment of OM is based on guidelines released almost a decade back, in addition to published literature and personal preferences. Hence, an expert group of nail society of India (NSI) worked towards drafting these guidelines aimed at compiling recommendations for pharmacologic treatment of OM, based on scientific evidence, along with practical experience. The group did an extensive analysis of available English language literature on OM published during the period 2014-2022. The evidence compiled was graded and discussed to derive consensus recommendations for practice. Special focus was placed on combination therapies and adjunct therapies, including experience of members, to improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: In spite of the availability of multiple consensus statements on dermatophytosis management, different treatment approaches have been experienced in India and require more scrutiny to further update guidelines and improve patient care. Aim: To determine the different approaches in dermatophytosis diagnosis and management among dermatologists in India. Materials and Methods: A web-based questionnaire was created and validated by five panelists with experience of >15 years in dermatophytosis and then circulated to about 2,000 dermatologists in India in September 2021 for a real-world management scenario. Results: Out of 2,000 dermatologists, 459 responded. About half of the dermatologists (51%) routinely conduct potassium hydroxide mount (KOH) at the initiation of therapy. Similarly, about 53% of dermatologists initiate the management of dermatophytosis with combination therapy in all types of dermatophytosis for 4-6 weeks depending upon severity. Different types of combinations are being practiced, such as either two systemic and one topical, two topicals and one systemic, but the combination of one systemic and one topical (69%) is the most commonly practiced. Itraconazole (100 mg twice a day) and luliconazole are the most commonly prescribed antifungal medications. In case of non-response to routine dose of systemic anti-fungals, about 72% of dermatologists up dose them. Most of them continue these drugs for additional 1-2 weeks after clearance of the disease. Additionally, keratolytics and moisturizers are commonly prescribed. Additionally, 62% advise liver function tests (LFTs) at the initiation of therapy, whereas 72% advise monitoring adverse effects due to systemic antifungal drugs during treatment. Conclusion: Combination therapy stood out as the need of the hour in the current menace of dermatophytosis with timely monitoring of laboratory tests for adverse events due to the use of systemic antifungals for a longer duration. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis have assumed epidemic proportions in India. Antifungal drug resistance solely cannot explain disease magnitude and changing epidemiology. Objectives: Aim of this study was to analyse clinical-mycological aspects of dermatophytosis, and estimate contribution of drug resistance in clinical recalcitrance. Methods: This single-centre observational, cross-sectional, descriptive study was done in tertiary centre of western India after ethical approval, enrolling dermatophytosis patients of all ages and sex. After history and examination, KOH mount and culture in modified SDA medium was done. Culture positive isolates were subjected to E-strip antifungal susceptibility method to test MIC for Terbinafine, Itraconazole, Fluconazole and Griseofulvin. Results: Total 300 patients were included, with mean age of 33.83±27.5 years and male-to-female ratio of 1.22:1; tinea corporis et cruris being commonest, 39.33% (n=118). Only 11.67% (n=35) were treatment naïve, having classical annular morphology. History of topical steroid abuse was found in 81.67% (n=245), with pseudoimbricate lesions in 70.61% (n=173). 86.67% (n=260) had KOH positivity while 83.33% (n=250) had culture positivity: Trichophyton mentagrophytes 45.6% (n=114), followed by Trichophyton rubrum in 34.4% (n=86). A total of 265 patients fit into definition of recalcitrance, from which 12.45%, i.e., 33 isolates showed in-vitro fluconazole resistance. 14.33% (n=43) cases were chronic, 37% (n=111) persistent, 46% (n=138) recurrent while 17% (n=51) had relapse in their disease course. Steroid abuse was the commonest denominator. Conclusion: Role of antifungal resistance in recalcitrant dermatophytosis remains debatable. Stopping steroid abuse, which is often the commonest culprit, with adherence to standard antifungal therapy remains the paradigm in management. [ABSTRACT FROM AUTHOR]

Introduction: Dermatophyte infection has become extremely resistant and widespread in all parts of India during the past decade. A change in the major causative organism has been identified to be a major factor behind the change in the character of the infection. The epidemiological shift has been accompanied by large scale antifungal resistance. This review aims to take a look at the current status of evidence regarding the effectiveness of major antifungal molecules, with particular reference to the current epidemic-like scenario of resistant dermatophytosis in India. Methods: We have searched and included the relevant literature on "Dermatophytosis" from the PubMed, Scopus, and Google Scholar. Results: The current situation has also brought into focus the glaring lack of evidence-based guidelines for the management of dermatophytosis. The guidelines available previously had mostly been based on the western literature with the scarcity of studies from tropical countries such as India. Conclusion: The current guidelines of the management of dermatophytosis have lost their relevance in the present scenario and need to be replaced. However, without adequate studies we do not have robust data to formulate the new guidelines. [ABSTRACT FROM AUTHOR]

Background: An increase in the number of recurrent and recalcitrant dermatophytoses calls for a tool to guide the clinician to correlate in vitro minimum inhibitory concentration (MIC) data, antifungal treatment with clinical outcomes. This systematic review aims to explore a possible correlation between one aspect of this, previous antifungal exposure, and clinical outcomes. Methods: A systematic literature search for articles on previous antifungal treatment, treatment outcome, susceptibility methods used, organism (genus/species), and MIC values was conducted. Results: A total of 720 records were identified of which 19 articles met the inclusion criteria. Forty percent of the cases had contact with or travel to India, 28% originated from or had traveled to other countries where treatment unresponsive tinea infections had been reported. Tinea corporis was the most common clinical presentation and the species involved were Trichophyton (T.) indotineae and T. rubrum, followed by T. mentagrophyte/interdigitale complex and T. tonsurans. Nearly all patients had previously been exposed to one or more antifungals. The studies were too heterogeneous to perform a statistical analysis to test if previous antifungal exposure was related to resistance. Conclusions: Only a few studies were identified, which had both sufficient and robust data on in vitro susceptibility testing and clinical treatment failure. Further research on the value of susceptibility testing to improve clinical practice in the management of dermatophyte infections is needed. [ABSTRACT FROM AUTHOR]

Objective Dermatophytoses, one of the most ancient diseases, is becoming a menace in recent times. This has made the knowledge of antifungal susceptibility a priority in today's times. Material and Methods This is a prospective study conducted over 18 months including all dermatophytes isolated during the period. Dermatophytes were identified by routine phenotypic methods. Antifungal susceptibility testing was performed for griseofulvin, terbinafine, and itraconazole as per the Clinical Laboratory Standard Institute M38 A2, and minimum inhibitory concentrations (MICs) were read after 5 days. Results Patient details and associated risk factors were recorded. Fixed dose combinations with steroids were associated with 79.3% (46 out of 58) of patients with dermatophytosis of skin. Among the 72 dermatophytes isolated during the study period, 58 (80.5%) were isolated from skin scrapings and 14 (19.4%) from nail samples. Tinea corporis with cruris was the most common presentation. The most common dermatophyte isolated from skin scrapings was Trichophyton mentagrophytes complex (70.6%, 41 out of 58), while from nail samples it was Trichophyton rubrum complex (78.57%, 11 out of 14). Based on the MIC 50 and MIC 90 results, itraconazole showed the lowest MICs, followed by terbinafine and then griseofulvin. Conclusion With the changing epidemiology of species distribution and antifungal resistance, there is a need for continuous surveillance of these parameters of dermatophytes. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is a common dermatological condition in children. Recent trends indicate increasing occurrence of dermatophytic infection in the paediatric age group and with growing anti-fungal resistance; however, more studies describing clinic-epidemiological and mycological pattern in paediatric population are needed. Aims and Objectives: The present study was undertaken to assess the clinical pattern and mycological isolates from the lesions of dermatophytosis involving the glabrous skin and to assess the association of fixed dose combinations creams with clinical and mycological pattern of cutaneous dermatophytosis. Materials and Methods: Paediatric patients (ages 1 -14) with suspected tinea infections presenting in the Department of Dermatology at a tertiary care medical college hospital in South India for a duration of four months, in 2020, were included in this study. Samples were collected and tested for potassium hydroxide (KOH) positivity. Additionally, the scales were also sent for fungal culture. Results: Out of 45 patients, 29 (64.4%) were male and 16 (35.6%) were female. The groin was the most common site affected in 89.65% patients. Around 57% of the study participants (21/45) have used corticosteroid-containing creams. Out of the 45 study participants, KOH mount was positive in 39(86.7%). Fungal Culture revealed Trichophyton mentagrophytes (55.6%) as the most common species isolated. Conclusion: Our study illustrates a major epidemiological shift of dermatophytosis causing species from Trichophyton rubrum to Trichophyton mentagrophytes among paediatric patients akin to that observed in adults. It is also observed that there is an increase in an atypical presentation owing to topical steroid use. The present study provides evidence that a high index of suspicion in needed to effectively curb the rising incidence of dermatophytosis in paediatric patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Dermatophytoses refers to superficial fungal infection of keratinized tissue caused by keratinophilic dermatophytes. It is most common superficial cutaneous infection of stratum corneum affecting hair, nail, and skin. Aims and Objective: The aim of this study was to study the clinico-mycological profile of dermatophytic infection that are prevalent in this region. Materials and Methods: Samples were collected from 104 patients which included skin, nail, and hair samples after the detail history and examination of patients. The samples were subjected to direct microscopy and culture. Further identification was done by microscopic and macroscopic characteristics of fungal pathogens. Results: A total of 104 cases were positive for dermatophytic infection. Among the dermatophytic infections, Tinea corporis (63.4%) was most common clinical type followed by Tinea cruris (18.3%). Males (66.3%) were affected more than females (33.6%) and the age group moset affected was 31-45 yrs (46.2%) followed by 16-30 yrs (32.7%) in the current study. Of all the dermatophyte isolates T.rubrum was the most common (77.4%) cause of infection, followed by T. mentagrophytes (12.7%). Conclusion: The present study reveals the varying trend in the incidence of dermatophyte species which is important to implement treatment regimens and to recommend control measures. [ABSTRACT FROM AUTHOR]

The various types of steroid preparations seen in our patient cohort were administered by unqualified medical professionals primarily for the patient's cutaneous disease, rather than for any suggestion of an underlying medical condition for which the steroid use could be justified. Clinical examination and biochemical derangement in the hypothalamic-pituitary axis were suggestive of iatrogenic hypercorticolism in 4 of 17 patients (23.5%); we referred these cases (Patients 12, 13, 15 and 17) to an endocrinologist for specialized management. A pilot study to evaluate the patient adherence to antifungal therapy in dermatophytosis: a possible contributory factor to the current epidemic-like situation in India. [Extracted from the article]

Background: Dermatophytosis is a major public health concern in India, especially in recent years, with an alarmingly rising trend, particularly in relation to recurrent and chronic infection. The number of studies examining the relationship between an individual's glycemic status and the development of dermatophytosis, and a comparison of the evolving species trend between diabetic and non-diabetic patients infected with dermatophytes, is limited. Aims and Objectives: To study and compare the clinical and mycological aspects of dermatophytosis among diabetic and non-diabetic patients and to compare the culture isolates in both groups. Materials and Methods: The study included 378 patients of clinically suspected dermatophytosis, divided into two groups of 189 known diabetics and non-diabetics each. We subsequently analysed and compared the demographics, clinical data, potassium hydroxide (KOH) mount, calcofluor white (CW) staining and fungal culture results of all patients in both groups. Results: Among the 378 patients, diabetic patients had a significantly greater extent of involvement and higher rates of recurrence when compared to non-diabetics. The overall positivity rate was higher in CW staining (77.8%) as compared to KOH (57.7%) in both non-diabetics and diabetics. Trichophyton mentagrophytes was the most common isolate (47.6%) in both diabetic (55.0%) and non-diabetic (61.4%) patients, followed by Trichophyton rubrum (31.8% and 29.6%, respectively). The positivity percentages of fungal culture, KOH and CW staining increased to 100%, 77.9% and 95.7%, respectively, when scrapings were taken from ≥2 sites. Conclusion: The pattern of dermatophytosis is comparatively more chronic and severe in diabetics compared to non-diabetics. T. mentagrophytes was the most common culture isolate in both groups. CW staining can potentially be used as the initial method of choice for the diagnosis of dermatophytosis as it has significantly outperformed the conventional KOH mount. Scrapings can regularly be taken from ≥2 sites to avoid false negative results. [ABSTRACT FROM AUTHOR]

Background: Telemedicine has emerged as an important tool in providing patient care during the COVID-19 pandemic. Hence, we aimed to study the clinico-epidemiological profile of patients seen in the teledermatology outpatient department (OPD) during the COVID-19 pandemic. Material and Methods: Retrospective data analysis of records of patients, who consulted in telemedicine OPD from 20 April 2020 to 5 Feb 2021 was done. Results: Out of 2524 patients registered for teledermatology consultation, 2117 completed the process of teleconsultation. The mean age of patients was 35.59 ± 15.60 years. There was a male preponderance with 1372 (64.81%) patients while females were 745 (35.19%). 1773 (83.75%) patients were managed on telemedicine alone and 344 (17.42%) patients required face to face physical consultation. The most common disorder was dermatophytosis seen in 316 (17.82%) followed by hair disorders like androgenetic alopecia and telogen effluvium in 239 (13.48%), acne in 238 (13.42%) and dermatitis in 196 (11.05%). Blood investigations were advised in 365 (17.24%) patients and skin biopsy was advised in 23 (1.09%) patients. The major causes for incomplete teleconsultation procedure were no response to telephone calls in 207 (8.2%), 76 (3.01%) patients had taken a prior consultation and 60 (2.37%) patients didn't give consent for teleconsultation. Conclusion: Common dermatological diseases like tinea, acne, hair disorders and dermatitis can be managed on telemedicine alone. In India, there are fewer dermatologists per population, therefore telemedicine can be continued even after the pandemic is over in cases where diagnoses and treatment are straight forward. [ABSTRACT FROM AUTHOR]

Background/Objectives: There has been a recent explosion in the incidence of dermatophytic infections globally, especially in tropical countries including India. This increase is associated with a change in the clinical pattern and mycological profile with poor response to treatment, in adults and children. Limited studies in India have focused on pediatric dermatophytoses. Our study’s primary objective was to assess the clinicomycological profile of pediatric dermatophytosis in our region and secondarily to understand the association of lifestyle factors with poor response to treatment. Methods: This was an observational study including children ≤16 years of age, clinically diagnosed with tinea. Clinical and lifestyle data regarding site, affected surface area, duration of infection, previous treatment, possible sources of infection, overcrowding, and bathing practices were collected. Samples were collected for potassium hydroxide mount and fungal culture. Results: A total of 183 children participated in our study. The most common diagnosis was tinea corporis. Tinea cruris was more frequent in preadolescents, where males were more affected. Positive associations were seen between increased duration of infection, increased household infection, infection among playmates, irregular bathing, and use of steroid creams. The most common organism isolated was Trichophyton mentagrophytes/interdigitale (55.19%) followed by Trichophyton rubrum (14.75%). Conclusions: There is a change in the mycological profile of pediatric dermatophytosis with an increase in Trichophyton mentagrophytes/interdigitale infection. Important sources of infection in children must be identified in chronic and recurrent cases. Misinformed and ignorant use of steroid creams is an important reason for recurrent infection. [ABSTRACT FROM AUTHOR]

Wolf isotopic response is the occurrence of new dermatoses on areas of the skin with previous but still active dermatoses. Vitiligo is an acquired disorder characterized by the loss of functional melanocytes which manifests as circumscribed depigmented macules and patches. Dermatophytoses are superficial fungal infections caused by three genera of fungi (Microsporum, Trichophyton, and Epidermophyton) that have the unique ability to invade and multiply within keratinized tissue (skin, hair, and nail). The appearance of dermatophyte infection on previously present vitiligo lesion is an uncommon example of Wolf response. We describe a case series of five vitiligo patients that presented to our OPD over 1 year period. [ABSTRACT FROM AUTHOR]

Background: There has been an alarming increase in the prevalence of chronic, recurrent and steroid modified dermatophytosis of the glabrous skin in the recent years in India. There is paucity of literature on the magnitude of this major public health problem. Objective: To estimate the prevalence of dermatophytosis and clinico‐epidemiological features of chronic and recurrent dermatophytosis (CRD) across India and to evaluate the associated risk factors. Methods: This is a multicentric descriptive cross‐sectional study conducted in 13 centres situated across India in two phases during dry and rainy seasons. All consecutive patients presenting with dermatophytosis were screened during the study period of 14 consecutive working days. Patients with CRD of the glabrous skin as per the case definition were included after exclusion of isolated hair and nail infections. Demography, clinical findings and results of potassium hydroxide wet mount were recorded. Results and conclusion: A total of 41,421 patients were screened, out of which 7174 (17.31%) patients had glabrous dermatophytosis. CRD was observed in 1999 (27.86%) patients with 78.08% and 21.95% of chronic and recurrent dermatophytosis, respectively. Family history was present in 50.03% of patients. History of sharing of fomites was present in 50.37% of them. Synthetic tight clothes were worn by 43.47%, while 50.9% gave history of misuse of topical corticosteroid creams. Multiple site involvement was common (69.58%) with tinea cruris (79.99%) and tinea corporis (75.69%) being the most common clinical types. CRD is associated with sharing of fomites, topical corticosteroid misuse and involvement of multiple sites. [ABSTRACT FROM AUTHOR]

Background Pityriasis rosea (PR) is an acute, self-limited papulosquamous disorder. The incidence of PR is around 0.5-2% and is commonly seen in young healthy persons, between 10 to 35 years. In paediatric age, prevalence is between 8% to 12% below 10 years and 4% below 4 years. The common differential diagnosis of PR is syphilis, tinea corporis, pityriasis versicolor, guttate psoriasis and pityriasis lichenoides. Objective The aim of this study was to find out the demographic and clinical profiles of pityriasis rosea among paediatric (less than 18 years) patients. Methods The study was carried out over a period of twelve months at Dermatology Out-patient department at tertiary care centres of East India and a total of fifty paediatric (less than 18 years) cases of PR were recruited for the study. The diagnosis was made clinically with the details of history, examination and relevant investigations being recorded in case record form, after getting consent from patient or guardian. Results Fifty pityriasis rosea (PR) patients in paediatric age group were recruited from Dermatology out-patient department during study period. The mean age of presentation was 12.45 years with range being 2 to 18 years. Females outnumbered males (Female: Male ratio 1.27:1) in our study. Classical herald patch was seen in 42 (84%) cases. Atypical morphology was seen in 12 (24%) cases. Pruritus was the only symptom which was noted in 31 patients (62%). Conclusion PR is usually diagnosed clinically but atypical presentation of PR is not uncommon. So high degree of clinical suspicion is needed to diagnosis the atypical form. [ABSTRACT FROM AUTHOR]

Background: With rising resistance to terbinafine, and consistently high MICs to fluconazole and griseofulvin, itraconazole is being increasingly used as a first line drug for tinea corporis/cruris. However, inadequate clinical responses are often seen with it in spite of in vitro susceptibility. This is possibly related to a variable pharmacokinetic profile of itraconazole. The drug serum levels associated with the therapeutic outcome have not been defined in dermatophytic infections. Methods: Forty treatment naïve patients with tinea corporis/cruris were randomised to one of the three dose groups (100, 200 and 400 mg/day) of itraconazole. The drug serum levels of 21 of these patients were obtained after 2 weeks of treatment and correlated with the final clinical outcome and in vitro antifungal susceptibility data. Results: Trichophyton indotineae was identified by sequencing of ITS region of rDNA and TEF1α. All isolates were sensitive to itraconazole (Minimum Inhibitory Concentration (MICs) range: 0.06–0.5 µg/ml), while MICs to terbinafine were uniformly high (range 8–32 µg/ml). Thirty‐seven patients (92.5%) achieved complete cure, while three failed treatment. Serum levels achieved with 400 mg/day were significantly higher than levels with 100 or 200 mg dose. All patients with itraconazole serum levels of >0.2 µg/ml were cured, while two out of the 10 patients with serum levels <0.2 µg/ml failed treatment. Conclusions: Therapeutic failures are uncommon with itraconazole, and the prevalent strain in India has low itraconazole MICs. Treatment failure is likely with itraconazole serum levels of <0.2 µg/ml, while levels >0.2 µg/ml are consistently associated with a positive therapeutic outcome. [ABSTRACT FROM AUTHOR]

Background: Recurrent and clinically unresponsive dermatophytosis is being increasingly observed in India. However, there is little information regarding the extent of the problem and the factors responsible for these difficult to treat superficial fungal infections. Aim: To identify factors contributing to difficult to treat recurrent superficial fungal infections. Materials and methods: This prospective cross‐sectional study enrolled 105 patients of all age groups presenting with either recurrent or long‐standing dermatophyte infection attending the outpatient department of Dermatology, Venerology and Leprosy of Bharati Hospital, Pune, India, between September 2018 and March 2020. Patients were clinically examined, clinical history was taken and questions were asked regarding their current complaints and recorded in a proforma. Data were analysed using the SPSS software package. Results: The males outnumbered females (74.3% vs 25.7%). A strong association was observed between the presence of past history and duration of disease (p =.007). The association of use of topical steroids or keratolytic agents with the duration of disease was statistically significant (p =.022). There was a statistically significant inverse association of duration of disease with dermatologist consultation (p <.001). The association between consultation with non‐dermatologist and the duration of disease was statistically significant (p =.035). Conclusion: Hyperhidrosis, obesity, positive family history, tight clothing and chronic diseases may be considered important factors in acquiring dermatophytic infection. However, when it comes to difficult to treat tinea infections, irrational usage of topical steroids, treatment from non‐dermatologists and a past history of tinea appear to be more critical causative factors. Treatment of dermatophytosis by dermatologists/ trained physicians and increasing general awareness of the public regarding the current situation about tinea in the country would help to alleviate the current crisis. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dermatophytes varies with season, geographical area, socio-economic factors and effective management strategies.Aims: The aim of the study was to assess the prevalence of pathogenic dermatophytes, clinical types of dermatophyte fungal infection, and in vitro antifungal drug susceptibility testing against dermatophytes.Methods: Three hundred and ninety five patients with dermatophytosis were enrolled from five cities (Mumbai, Delhi, Lucknow, Kolkata and Hyderabad) across India. All patients were subjected to clinical examination and investigations, including potassium hydroxide microscopy, fungal culture and antifungal drug susceptibility testing.Results: Trichophyton rubrum was the most common species identified (68.4%), followed by T. mentagrophytes (29.3%). Within species, T. mentagrophytes was prevalent in humid environmental conditions (Mumbai and Kolkata), whereas T. rubrum was prevalent in noncoastal areas (Delhi, Lucknow and Hyderabad). Tinea corporis (71.4%) and tinea cruris (62.0%) were the common clinical types observed. antifungal drug susceptibility testing data indicated that minimum inhibitory concentration required to inhibit the growth of 90% of organisms (MIC-90) was lowest for griseofulvin (0.25-3.0 μg/mL). Among oral antifungals, the mean MIC of itraconazole was within the range (0.84 [0.252] μg/ mL), whereas high mean MIC values were reported for terbinafine (0.05 [0.043] μg/mL). Among topical agents, lowest mean MIC values were reported for luliconazole (0.29 [0.286] μg/mL), eberconazole (0.32 [0.251]) μg/mL and amorolfine (0.60 [0.306]) μg/mL.Limitations: Lack of correlation between in vitro antifungal susceptibility and clinical outcome and absence of defined MIC breakpoints.Conclusion: T. rubrum was the most common, followed by T. mentagrophytes as an emerging/codominant fungal isolate in India. Tinea corporis was the most common clinical type of dermatophytosis. Mean MIC of terbinafine was above the reference range, while it was within the range for itraconazole; griseofulvin had the lowest mean MIC. Luliconazole presented the lowest mean MIC values across cities. [ABSTRACT FROM AUTHOR]

In the current study, we report the genome sequence of two different clinical isolates from India, Trichophyton indotineae UCMS-IGIB-CI12 and Trichophyton indotineae UCMS-IGIB-CI14. The resulting genome assembly achieved a 143-fold coverage in 824 contigs for T. indotineae UCMS-IGIB-CI12 and a 136-fold coverage in 904 contigs for T. indotineae UCMS-IGIB-CI14. Both the clinical isolates contain a c.1342G>A mutation corresponding to Ala448Thr amino acid substitution in erg1 and exhibit an intermittent drug response to terbinafine. Comparative genomics analysis with available genomes of Trichophyton interdigitale/Trichophyton mentagrophytes species complex revealed a similar genome architecture and identified large number of genes associated with virulence and pathogenicity, namely, lipases, proteases, LysM domain-containing factors, carbon metabolism enzymes and cytochrome P450 enzymes, in all the genomes. An analysis of single amino acid polymorphisms (SAPs) in the protein sequences of subtilisin and lipase enzyme families identified a higher frequency of SAPs in functionally important proteins, Sub3 and Sub6 and their possible use in multilocus phylogenetic analysis of T. interdigitale/T. mentagrophytes species complex. The whole genome sequences of T. indotineae clinical isolates provided in this report will, hence, serve as a key reference point for investigation of clinical strains and emerging drug resistance among dermatophytes originating from different parts of the world. [ABSTRACT FROM AUTHOR]

Background: Dermatophytic infections are one of the most common skin infections encountered by dermatologists. A recent increase in incidence has been seen over the last few years with substantial change in the clinical profile of patients. Recently a group of dermatology experts published Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). The group agreed upon various definitions with respect to current dermatophytosis epidemic as well as gave recommendations for investigations and management. Clinical profile of dermatophytosis was done in present study on the basis of definitions agreed upon by ECTODERM consensus group. Aims and Objective: To assess the clinical profile, prevalence and severity of dermatophytic infection in study population. Materials and Methods: Cross-sectional observational study was conducted at out-patient department of Dermatology in, Sharda hospital, Greater Noida. A total of 317 patients presenting with clinical diagnosis of dermatophytosis were included in the study. Results: A total of 317 patients were recruited in the study, out of which 213 were males (67.2%). The most common age group presenting with superficial dermatophytosis was 21-30 years. Majority of the patient presented with chronic dermatophytosis with duration more than 6 months (76.6%) while more than 3 lesions of tinea were observed in 76.6% cases. 191 patients (60%) had moderate to severe involvement with more than 3% of BSA involved. Family members presenting with similar complaints were seen in 39% cases. Majority of patients (76 %) studies had received previous treatment topical, systemic or both. 62 patients presented with recurrence of disease within 6 weeks of complete antifungal treatment (19.6%). Conclusion: Our study concludes that dermatophytosis still remain a challenging issue for dermatologists. Chronicity of infection, moderate to severe BSA involvement and involvement of family members in a good proportion of our study cases were the main findings of our study. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis has recently emerged as a major public health problem in the Indian subcontinent, most cases becoming chronic and recurrent. Aims: Assessing the clinico-epidemiologic and mycologic profile of treatment naïve, chronic, recurrent and steroid-modified dermatophytosis. Materials and Methods: We conducted across-sectional study involving 111 cases of dermatophytosis. Detailed epidemiology, clinical parameters, treatment history and other host factors were assessed along with scraping for potassium hydroxide (KOH) and fungal culture. Results: Among 111 patients,(F: M 1.7:1; mean age 44.4 ± 18.2 years), 51.4% were treatment naïve, while 34.2% and 14.4% presented with chronic and recurrent tinea respectively. Family history and sharing of fomites among infected family members was commoner in the latter groups (P = 0.001). Topical steroid application was reported in 49.5%, however only 7.2% presented with steroid modified tinea. Tinea corporis et cruris (41.4%) was the predominant clinical type followed by tinea corporis (34.2%) and tinea cruris (27.9%). KOH mount and culture were positive in 62.2% and 39.6% cases respectively; commonest isolates being Trichophyton rubrum, and Trichophyton mentagrophytes complex in 15.3% cases each. Trichophyton rubrum was the commonest etiology for treatment naïve and recurrent cases, while Trichophyton mentagrophytes was the commonest isolate from chronic and steroid-modified cases (P = 0.0003). Interestingly, T.mentagrophytes complex and T. rubrum were the commonest causes of tinea corporis and tinea cruris respectively (P = 0.07). Conclusion: Trichophyton rubrum was the commonest organism in treatment naïve and recurrent cases, while Trichophyton mentagrophytes complex accounted for most cases of chronic and steroid modified tinea. The difference in predominant species seems to be a major contributory factor for chronicity and recurrence. However, several host factors like topical steroid use and sharing of fomites also play additional roles. [ABSTRACT FROM AUTHOR]

Background: The study pertaining to the prevalence of diseases plays a valuable tool in the planning and implementation of health care facilities. The prevalence of skin diseases in Andaman and Nicobar islands, which is rightly called "Little India" considering the heterogeneity of the people living here, will serve as an indispensable tool. Methodology: The data from the outpatient records of the Dermatology Department of 2 consecutive years were collected retrospectively, the study duration being January 2017 to December 2018. The diagnoses were classified as per the International Classification of Diseases (ICD 10). The quantitative variables are expressed as numbers and percentages. Results: Cutaneous infections namely dermatophyte infection, tinea versicolor, impetigo, scabies, molluscum, and warts were the most commonly encountered disorders. Hansen's disease was witnessed in 42 patients. Among the tribals, scabies, dermatophytosis, and pyoderma were the commonly encountered cutaneous disorders. Conclusion: Thus, the data presented in the present study can be extrapolated on the mainland considering the diversity of the population in the Andaman and Nicobar (A and N) Islands. [ABSTRACT FROM AUTHOR]

Purpose: A new oral formulation of itraconazole, called super bioavailable itraconazole (SBITZ), has been launched in India, exhibiting greater bioavailability than conventional itraconazole (CITZ). No clinical studies on its effectiveness and safety in dermatophytosis in comparison with CITZ have been conducted in India. Hence, the aim of this clinical study was to compare the effectiveness and safety of SBITZ capsules and CITZ capsules in dermatophytosis. Patients and Methods: This was an open-label, randomized, double-arm clinical study in which 70 patients (≥ 18 years of age) of either gender and diagnosed with tinea cruris, tinea corporis, and/or tinea faciei were included. The study was divided into two parts, the first part comprising a treatment period of 4 weeks and the second part an observation period for recurrence, comprised of another 4 weeks, thus making an entire study duration of 8 weeks. Results: Of the 70 patients enrolled in this study, 59 (33 patients in the CITZ group and 26 patients in the SBITZ group) were included in the final analysis. In both groups, most patients were diagnosed with tinea cruris et corporis, with five or more lesions. At week 4, 11 patients (33.33%) and 17 patients (65.38%) had achieved complete cure (p< 0.05), whereas 22 patients (66.67%) and 22 patients (84.61%) had achieved mycological cure (p=0.14), in the CITZ and SBITZ groups, respectively. During the observation period, recurrence was seen in 1/11 and 4/17 completely cured patients in the CITZ and SBITZ groups, respectively (p=0.15). A significant difference was noted in resolution of symptoms as well as lesions of dermatophytosis in the SBITZ group (p< 0.05). Both treatments were found to be safe and well tolerated. Conclusion: In the light of real-world evidence on effectiveness and safety, SBITZ should be considered as a potent therapeutic choice to effectively control the current menace of dermatophytosis in India. [ABSTRACT FROM AUTHOR]

• Dermatophytes in cats were identified by RFLP-PCR. • Lime sulphur in combination with oral itraconazone gives expeditious recovery. • Topical treatment with biocides will reduce dependence on specific antifungals. The surge in domestic cat adoption across India, particularly the rising preference for high-pedigree cats, coupled with environmental factors, has resulted in increased incidence of dermatophytosis among feline companions. Despite this growing concern, there is a noticeable scarcity of studies in India delving into the etiological factors contributing to dermatophytosis in cats. This disease is a threat to animal health and carries public health significance, given that cats are recognized reservoir hosts for Microsporum canis , a common dermatophyte affecting humans and animals. This study endeavours to identify the dermatophytes affecting cats and establish a standardized therapeutic regimen while accounting for the local stigma surrounding the regular bathing of cats. The study involved the examination of 82 cats presenting dermatological lesions, when subjected to cultural examination in dermatophyte test medium revealed 36 afflicted with dermatophytes. Isolates were presumptively identified by staining using lactophenol cotton blue, Chicago sky blue 6B, and Calcofluor white stains. Molecular-level identification of the isolates was confirmed through PCR-RFLP, amplifying the Internal Transcribed Spacer Sequence of 16 s rDNA, followed by restriction digestion using the Mva1 enzyme. Among the thirty-six isolates, 29 were identified as M. canis , while the remaining 7 were M. gypseum. The cases were categorized into five groups and treated with Lime Sulphur dip, 4 % chlorhexidine shampoo, a shampoo containing 2 % miconazole and 4 % chlorhexidine, oral itraconazole alone, and a combination of oral itraconazole with lime-Sulphur dip. Statistical analysis revealed that the response was notably swifter with lime Sulphur dip when considering only topical therapy. Moreover, the mycological cure was most expeditious when combining Lime Sulphur dip with oral itraconazole. These findings underscore the pivotal role of topical biocides in feline dermatophytosis treatment, potentially reducing the reliance on specific antifungals and thereby contributing to the mitigation of antimicrobial resistance emergence. [ABSTRACT FROM AUTHOR]

Background: Treatment‐resistant dermatophytosis caused by Trichophyton mentagrophytes/interdigitale complex has emerged as a global public health threat, particularly in endemic countries like India and has spread to many other countries. This veritable spread is alarming due to increase in resistance to terbinafine, which targets the ergosterol biosynthetic pathway by inhibiting the enzyme squalene epoxidase (SQLE). About two third of studies worldwide have reported amino acid substitutions Phe397Leu and Leu393Phe in the SQLE protein to be responsible for high terbinafine MICs. Objectives: We evaluated the efficacy of the newly developed DermaGenius® Resistance real‐time PCR assay to rapidly identify Trichophyton isolates harbouring most common SQLE mutant (Phe397Leu and Leu393Phe) conferring high terbinafine resistance from wild‐type susceptible isolates. Methods: A total of 97 Trichophyton isolates confirmed by ITS sequencing as T. mentagrophytes/interdigitale (recently named T. indotineaen = 90), T. rubrum/T. soudanense (n = 3), Tmentagrophytes (n = 2) and Ttonsurans (n = 2) were analysed to evaluate DermaGenius® Resistance real‐time PCR assay. All 40 T. indotineae isolates exhibiting amino acid substitutions Phe397Leu or Leu393Phe identified by SQLE gene sequencing were evaluated for detection of non‐wild‐type strains by real‐time PCR. Antifungal susceptibility testing for terbinafine was done by CLSI microbroth dilution method. Results: All terbinafine‐resistant isolates harbouring amino acid substitutions Phe397Leu or Leu393Phe in SQLE gene were correctly recorded as SQLE mutants by the DermaGenius® Resistance real‐time PCR assay. Conclusions: The DermaGenius® Resistance real‐time PCR assay effectively identified Trichophyton species and distinguished wild‐type from SQLE mutant genotype that harbour Phe397Leu and Leu393Phe amino acid substitutions. [ABSTRACT FROM AUTHOR]

Introduction: The last few years have seen a significant rise in the incidence of dermatophytosis across India. Vulnerability of children to this disease is more than adults due to multiple factors. However, limited data are available regarding clinical and mycological variants of dermatophytosis in children. Materials and Methods: A cross-sectional observational study was designed at the dermatology outpatient department in Mumbai. The aim of the study was to assess the clinical profile and identify the causative fungal species in pediatric dermatophytosis. Sixty-seven children below 14 years of age with a clinical diagnosis of dermatophytosis were included by the simple random sampling method. A detailed history (duration of lesions, topical creams used, similar lesions in contacts, contact with pets, and other comorbidities/comedications) was taken and clinical examination (sites of involvement, number of lesions, associated erythema/scaling, morphology, and extent of lesions) was done followed by fungal mount preparation (potassium hydroxide (KOH) and KOH with Chicago Sky Blue stain) and culture of the scrapings on Sabouraud's agar medium containing chloramphenicol and cycloheximide. Microsoft Excel and SPSS-20 software were used to analyze the data. Results: A total of 42 male and 25 female children (mean age – 6.2 years) were included in the study. Prior topical applications of steroids±antifungal combinations were used in 57 cases (85%) before presenting to the dermatologist. About 76.12% (n = 51) of cases had positive family/contact history. Thirty-five children (52.2 %) had extensive disease. Multiple atypical clinical patterns were observed: tinea incognito, irregular geographic plaque, tinea recidivans, tinea pseudo-imbricata, penile tinea, and annular plaques on scalp. Trichophyton mentagrophytes complex was the most common isolate from cultures grown from scrapings, in 14/19 cases (73.7%). Conclusion: This clinico-mycological study highlights the changing clinical patterns (including Tinea pseudoimbricata, geographically patterned plaques) and shift in the etiological agent in childhood dermatophytosis. The study brings into focus the increasing proportion of T. mentagrophytes, high percentages of topical steroid abuse by parents in children, and positive family/close-contact history in children. [ABSTRACT FROM AUTHOR]

Background: Dermatophytosis is a common infection seen in tropical countries like India. With the onset of the 21st century, cases of antifungal resistance in dermatophytoses began to emerge as a therapeutic challenge. While tinea capitis, the predominant presentation in pediatric age group, has been extensively studied, the current scientific literature lacks in articles that assess the antifungal susceptibility patterns in pediatric dermatophytosis particularly involving the skin. Objective: This study attempts to identify and assess the changing clinico-epidemiological trends in the profile of pediatric dermatophytosis involving the skin, and its antifungal susceptibility patterns. Materials and Methods: Thirty subjects of 0–18 years of age with clinically diagnosed dermatophytosis were evaluated with history, examination and followed by a potassium hydroxide wet mount. Skin scrapings were also taken for fungal culture and antifungal susceptibility test against 10 commonly used antifungal agents using Broth Microdilution method as per Clinical and Laboratory Standards Institute (CLSI) M38-A2 guidelines. Results: Trichophyton rubrum was the most common dermatophyte isolated. Recurrent dermatophytosis was seen in 20% subjects. Tinea corporis was the predominant presentation. Steroid-modified Tinea was observed in 33.33% cases. Based on in vitro antifungal susceptibility testing, terbinafine and luliconazole were found to be the most effective systemic and topical agents, respectively. Conclusion: The rampant use of over-the-counter medications containing topical steroids is a rising issue in the treatment of both adult and pediatric dermatophytosis. Education and counseling of patients are very important for correct treatment of the condition and also to prevent the rise of recurrent infections. [ABSTRACT FROM AUTHOR]

One of the canonical features of the current outbreak of dermatophytosis in India is its unresponsiveness to treatment in majority of cases. Though there appears to be discordance between in vivo and in vitro resistance, demonstration of in vitro resistance of dermatophytes to antifungals by antifungal susceptibility testing is essential as it may help in appropriate management. The practical problem in the interpretation of antifungal susceptibility testing is the absence of clinical breakpoints and epidemiologic cutoff values. In their absence, evaluation of the upper limit of a minimal inhibitory concentration of wild type isolates may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility. In the current scenario, most of the cases are unresponsive to standard dosages and duration of treatment recommended until now. This has resulted in many ex-cathedra modalities of treatment that are being pursued without any evidence. There is an urgent need to carry out methodical research to develop an evidence base to formulate a rational management approach in the current scenario. [ABSTRACT FROM AUTHOR]

Background: The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome. Methods: This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma. Results: There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml). Conclusions: Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome. [ABSTRACT FROM AUTHOR]

Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei. [ABSTRACT FROM AUTHOR]

Itraconazole, is the most commonly prescribed oral antifungal agent in India, and has a low minimum inhibitory concentration as compared to other oral antifungals, and in conjunction with the markedly high skin levels, the drug should have a predictably good clinical response which is not the consistent experience of clinicians. Probably the variation in pelletization parameters might affect the bioavailability of the drug and consequently affect the serum levels. The maximum bioavailability of conventional itraconazole is 55 percent, which is neither consistent nor predictable. However, the novel itraconazole (Super bioavailable Itraconazole) with targeted drug release in the small intestine has predictable serum levels with minimum interindividual variability, which could make it a potentially useful drug in recalcitrant dermatophytosis. [ABSTRACT FROM AUTHOR]

Aims and Objectives: (1) To determine the level of awareness among patients, pharmacists and general practitioners about commonly available topical steroids and its combinations.(2) To determine the source of recommendation/prescription of topical steroids and its combination creams.(3) To know and create awareness about the side effects of topical steroids in all the study groups.Methods: This was a prospective questionnaire-based study where three study groups, namely patients, pharmacists and general practitioners, were included. This study was approved by the institutional ethics committee. after ethical clearance. The patients who used topical steroids for dermatoses where it is an absolute contraindication, as well as those who developed side effects, were included in the study. ThoroughComplete cutaneous examination was done specifically to detect the side effects of steroids. Seminars were conducted and questionnaires were given to both the pharmacists and general practitioners of nearby areas. The questionnaire consisted of questions regarding their prescription and dispensing practices of topical steroids and its combinations.Results: Out of 95 patients seen, the most commonly used steroid molecule was clobetasol propionate 0.05% in 44 (46.3%) patients, the common source of recommendation was general practitioners in 36 (37.8%), the common indication was superficial dermatophytosis in 85 (89%) and the most common adverse effect was recurrence/increase in the extent of the infection in 72 (75.78%) patients. Out of total 44 general practitioners enrolled in the study, 22 (50%) were qualified allopathic medical practitioners and22 (50%) were homeopathic/ayurvedic doctors. Superficial dermatophytosis [19 (43.18%)] was the common dermatosis seen by them. While 29 (65.90%) preferred prescribing topical steroids or its combination, rest of them preferred plain steroid creams. Out of 179 pharmacists, 74 (41.34%) did not have appropriate knowledge of topical steroids, 35 (19.55%) were not aware that steroids are isschedule "H" drugs. Commonest molecule sold over the counterwas clobetasol propionate 0.05% by 74 (41.89%). The limitations of our study were small study group and short duration.Conclusion: As dermatologists, it is our responsibility, to correctly educate the society, particularly the non-dermatologist medical fraternity, about ethical and rational use of topical steroids. [ABSTRACT FROM AUTHOR]