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Characterization of Recalcitrant Dermatophytosis in a Multicenter Study in Sri Lanka
ABSTRACT.
A changing clinical scenario of dermatophytosis has been observed in Sri Lanka during the past few years. In keeping with the trend described in India, an increase in the number of chronic, relapsing, and recalcitrant infections has been noted. The objective of our study was to assess the therapeutic response of dermatophytosis to standard antifungal treatment in Sri Lanka and to identify possible contributory factors in cases showing inadequate therapeutic response. A descriptive, observational, cross-sectional study was carried out in nine hospitals, representing each province. Over 6 months, patients with dermatophytosis on glabrous skin were included. All subjects underwent skin scrapings for mycological studies and were treated with a standard course of antifungals for a specific period. In those patients who achieved complete clearance, recurrences were noted. The study included 796 patients, of whom 191 (24%) had symptoms for more than 3 months at presentation. A total of 519 patients (65.2%) had multiple-site involvement, and 503 (63.2%) had evidence of prior use of topical steroids. Skin scrapings were positive for fungal elements in the direct smears of 659 patients (82.8%), and the predominant dermatophyte isolated was Trichophyton mentagrophytes (65.6%). Partial responders after 10 weeks of treatment and recurrences after complete clearance were significantly greater in the group that used topical steroids before presentation (P < 0.001). This study highlights the magnitude of the threat of an inadequate therapeutic response in dermatophytosis in Sri Lanka, and identifies steroid misuse, and the shift of the predominant fungal species to T. mentagrophytes as possible causative factors.
Author Notes
Financial support: The continuous supply of oral antifungal drugs was maintained by the financial support of the Sri Lanka College of Dermatologists.
Authors’ addresses: Nayani P. Madarasingha, National, Institute of Infectious Diseases, Colombo, Sri Lanka, E-mail: nayanimadara@yahoo.com. Surammika Eriyagama, Base Hospital, Gampola, Sri Lanka, E-mail: surammikae@gmail.com. Primali I. Jayasekera, Medical Research Institute, Colombo, Sri Lanka, E-mail: jayali_jaya@yahoo.com. Shreenika de Silva Weliange, Faculty of Medicine, Colombo, Sri Lanka, E-mail: shreenika@commed.cmb.ac.lk. Saman Gunasekera, Colombo South Teaching Hospital, Colombo, Sri Lanka, E-mail: samangunasekera@yahoo.com. D. M. Munasingha, Teaching Hospital, Kandy, Sri Lanka, E-mail: dmmunasingha@yahoo.com. Premini Rajendran, Base Hospital, Chilaw, Sri Lanka, E-mail: preminir@yahoo.com. S. M. B. Ekanayaka, General Hospital, Kegalle, Sri Lanka, E-mail: sandeepa75@yahoo.com. Janani Liyanange, Base Hospital, Mahiyanganaya, Sri Lanka, E-mail: jnnliyanage@gmail.com. N. Thamilvannan, Teaching Hospital, Batticaolo, Sri Lanka, E-mail: nthamilvannan@yahoo.com. Buthsiri Sumanasena, Teaching Hospital, Anuradhapura, Sri Lanka, E-mail: jam.buth@yahoo.com. Felicia Srisaravanabavanathan, Teaching Hospital, Jaffna, Sri Lanka, E-mail: srifeli@yahoo.com. Binari Wijenayake, Teaching Hospital, Karapitiya, Galle, Sri Lanka, E-mail: binarisilva@yahoo.com.