Table 1.
Salient clinico-epidemiological features in the current scenario of dermatophytosis in India[1][2][3][4][5][6][7][8][9]
| Parameters | Probable reasons |
|---|---|
| Epidemiological | |
| Greater occurrence of dermatophytosis | Highly contagious infection, poor public awareness and inadequate access to healthcare facilities, inadequate/faulty treatments, rampant abuse of topical corticosteroid antifungal combination creams |
| Increasing frequency of chronic dermatophytosis | Abnormal host cell-mediated immune (CMI) response, inadequate/faulty treatments, fungal species related factors, fomites, rampant abuse of topical corticosteroid antifungal combination creams |
| Increasing frequency of recurrent dermatophytosis | Inadequate/faulty treatments, fungal species related factors, fomites, lifestyle related host factors |
| Higher incidence of infection among family members | Highly contagious infection, poor hygiene, sharing of fomites, sharing of prescriptions |
| Higher incidence among infants and children | Highly contagious infection, poor hygiene, high fomite transmission, inadequate and faulty treatment, topical corticosteroid abuse in the affected family members. |
| Changing fungal species - emergence of T mentagrophytes/T interdigitalecomplex as the predominant or codominant pathogen | Environment-related factors, host immunity related factors, topical high-potency corticosteroid-antibacterial-antifungal combination cream abuse, altered cutaneous flora, virulence of the fungal species |
| Clinical | |
| Extensive dermatophytosis | Topical corticosteroid usage, inadequate/faulty treatments, host immunity |
| Frequent involvement of uncommon sites like face and scalp | Autoinoculation from another site, fomite transmission, topical corticosteroid use on the face, misdiagnosis and faulty treatments |
| Inflammatory lesions, bullous/pustular lesions | Abnormal host response, fungal virulence, intermittent topical corticosteroid usage |
| Steroid modified tinea/tinea incognito, Tinea pseudoimbricata, Majocchi granuloma | Topical high potency corticosteroid usage-self-treatment, easy over the counter availability of topical poly-combinations, treatment by unqualified healthcare personnel, lack of awareness and inadequate knowledge of treating physicians |
| Atypical presentations (resembling psoriasis, eczema, impetigo, lupus, rosacea etc.) | Host immunity related factors, agent-related factors, misdiagnosis, corticosteroid application, trauma, secondary infection |
| Inadequate/no response to topical/systemic antifungals | Changing fungal species, poor host immunity, poor compliance, poor quality of drugs, antifungal resistance |