Clinical and mycological features of recurrent dermatophytosis: A hospital-based observational cross-sectional study

Background: Dermatophytosis has changed its facets. The prevalence, clinical features, and causative organisms are changing leading to recurrent, recalcitrant, and chronic dermatophytosis. The misuse of potent topical steroids is further aggravating the problem. The risk factors, clinical features, and mycological nature of recurrent dermatophytosis are sparsely documented. Objectives: To know the epidemiological and clinical features, and to identify the organisms causing recurrent dermatophytosis. Materials and Methods: Patients attending to our OPD with dermatophytic infections from December 2017 to June 2019 were scrutinized and those, who had recurrence within 6 weeks after treating with 4 weeks of systemic antifungal treatment were recruited into our study. Demographic data and clinical patterns were documented after informed consent. KOH smears were taken, and the scrapings were cultured in Sabouraud's dextrose agar with 0.05% chloramphenicol and 0.5% cycloheximide. Results: Ninety-six patients were recruited to the study after following the inclusion and exclusion criteria. The most common age group was 21–30 years, and males were slightly more. A total of 66.7% (64/96) had used topical corticosteroids or steroid combinations. KOH positivity was seen in 67.7%, and the culture was positive in 58.3% of cases. The most common organism isolated in culture was the Trichophyton rubrum (27.1%), followed by Trichophyton mentagrophytes (22.9%). Recurrences were early in those who used topical potent corticosteroids like clobetasol. Limitation: Minimum inhibitory concentrations (MIC) levels of the antifungal drugs were not done to know the relation between MIC levels and recurrence. Conclusion: Recurrent dermatophytosis is increasing and presenting with modified clinical patterns. Topical steroid use, mainly with potent clobetasol or its combinations, seems to be the main culprit for recurrences.