Indian Journal of Dermatology, Venereology and Leprology Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) ISSN: 0378-6323 EISSN: 0973-3922 Vol. 71, Num. 2, 2005, pp. 129-130

Indian Journal of Dermatology, Venereology, Leprology, Vol. 71, No. 2, March-April, 2005, pp. 129-130

Letter To Editor

A study of chronic dermatophyte infection in a rural hospital

Prasad PVS, Priya K., Kaviarasan P.K., Aanandhi C., Sarayu Lakshmi

Departments of Dermatology Venereology and Leprosy, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar - 608 002
Correspondence Address: No. 88, AUTA Nagar, Sivapuri - Post, Annamalai Nagar - 608 002, Tamil Nadu
prasaderm@hotmail.com

Code Number: dv05041

Sir,

Chronic dermatophytosis is a refractory condition, which runs a course of more than one year with episodes of exacerbations and remissions.[1] Factors responsible for chronicity are the site of infection, poor penetration of the drug in the nail keratin, and drug resistance. Some associated conditions are atopic diathesis, disorders of keratinization, diabetes mellitus, Cushing′s syndrome, immunosuppression following renal transplants and AIDS.[2] This work was undertaken to study the clinical and cultural characteristics of patients with chronic dermatophyte infection.

Seventy-five adult patients who had tinea corporis for more than one year, attending the outpatient department of Dermatology Venereology and Leprosy at the Rajah Muthiah Medical College and Hospital were included in the study. Skin scraping was done and stained with 10% potassium hydroxide solution (KOH). Culture was undertaken using Sabouraud′s Dextrose Agar (SDA) medium and incubated at 26-28°C for a period of 3 weeks. Fungal colonies were identified according to the standard procedures. The results were analyzed using the chi-square test.

Onychomycosis was present in 28% of patients, which was found to be a major cause of chronicity, a statistically significant finding (P value < 0.01). An earlier study also postulated that onychomycosis was a cause of chronic dermatophytosis at any site. In our study, chronic dermatophyte infection was associated with more than 40% body involvement, a correlation not observed in earlier reports. We also found that 13.3% of patients were atopics, which was higher than previous reports, however, we did not observe a higher incidence of onychomycosis among these patients. On the contrary, chronicity was definitely correlated with exposure to sunlight in 80.1% of our patients who had excessive exposure for more than three hours per day. Excessive sun exposure precipitates sweating, which favors the growth of dermatophytes. This finding was similar to earlier studies.[3],[4],[5] Overcrowding and poor socioeconomic status were correlated with chronicity. Early lesions were neglected and went unnoticed by many patients whereas chronicity compelled them to seek medical advice. The presence of diabetes was confirmed in 13 patients (17.3%) and chronicity was attributed to uncontrolled diabetes in all these patients.

KOH preparation was positive in 88% of cases, similar to the 86% positivity in an earlier study.[3] The negative KOH in 12% could be correlated with the minimal scaling in the lesion. Positive culture was obtained in 41.3% cases. This also correlated with studies done by Gupta et al. Culture negativity could be due to bacterial contamination or delay in processing the specimen in the laboratory. Trichophyton rubrum was the commonest organism, isolated in 17.3% of the cases. Most Indian and western studies have also proved T. rubrum as the commonest offending agent.[3],[4],[5],[6]

Hence, the factors found responsible for chronicity were (1) onychomycosis (2) body surface area of involvement (3) prolonged sun exposure and (4) diabetes mellitus.

REFERENCES

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