# Emerging Antifungal Resistance in Dermatophytosis: A Clinicomycological Study From North India

## TL;DR

This study from North India finds rising antifungal resistance in skin fungal infections, with common drugs like fluconazole and terbinafine showing reduced effectiveness.

## Contribution

The study provides new clinicomycological data on antifungal resistance patterns in dermatophytosis in a North Indian population.

## Key findings

- Trichophyton mentagrophytes was the most common fungal species isolated.
- High resistance rates were observed for fluconazole (85.6%) and terbinafine (60%).
- Recurrent infections were common despite mild severity scores.

## Abstract

Introduction

Dermatophytosis is a common superficial fungal infection affecting the skin, hair, and nails and is increasingly being recognized as a public health challenge. In recent years, there has been a noticeable increase in chronic and recurrent cases, possibly due to changing patterns of antifungal resistance, misuse of medications, and host-related factors. This study aimed to assess the demographic and clinical characteristics of patients with dermatophytosis, evaluate treatment history and recurrence, and analyze antifungal resistance patterns.

Material and methods

A total of 130 patients clinically diagnosed with dermatophytosis and attending the Dermatology Outpatient Department were included in this observational study. After obtaining informed consent, detailed data on demographic factors, clinical presentation using the Dermatophytosis Severity Score (DSS), treatment history, and recurrence were recorded. Fungal cultures and antifungal susceptibility testing were performed on positive isolates to evaluate resistance patterns.

Results

The most affected age group was 31-45 years (38; 42.2%), with a male predominance (52; 57.8%). Most patients were rural residents (72; 80%) and uneducated (58; 64.4%), with homemakers (32; 35.6%) and students (19; 21.1%) forming the major occupational groups. Disease duration was mostly one to two years (40; 44.4%), and recurrent infections were common (83; 92.2%), even with mild severity scores (DSS 1-10 in 79 individuals; 87.8%). Tinea corporis (79; 87.8%) was the most frequent clinical type. Poor hygiene correlated with higher DSS. Potassium hydroxide mount was positive in 115 (88.5%) patients, with culture showing Trichophyton mentagrophytes (87; 75.7%) as the predominant species. Resistance was seen to fluconazole (77; 85.6%) and terbinafine (54; 60%), while itraconazole, ketoconazole, and griseofulvin were sensitive.

Conclusion

Dermatophytosis continues to be a significant public health concern due to its chronicity and recurrence. Irrational use of medications and emerging resistance to commonly used antifungals highlight the need for better treatment compliance and periodic monitoring of resistance patterns.