Therapeutic management of psychological morbidity and impaired quality of life in patients with persistent dermatophytoses

Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.

Impact of chronic and recurrent dermatophytosis on quality of life and psychologic morbidity-a cross-sectional study

BACKGROUND

Chronic and recurrent dermatophytosis is adversely effecting the psychosocial well-being of patients.

AIMS

To assess the impact of chronic and recurrent dermatophytosis on quality of life and psychological well-being of patients.

METHODS

We performed a cross-sectional study on patients of chronic and recurrent dermatophytosis aged >12 years. Clinical diagnosis was done, followed by appropriate investigations when required. The patients were made to fill up the questionnaires on Dermatology Life Quality Index, Hospital Anxiety and Depression Scale, and Perceived Stress Scale in English and local languages. The responses were coded with 4-point Likert scale. Statistical analysis was done using MedCal^® V.125.0.

RESULTS

Data of 123 patients were analyzed. Mean DLQI score was 21.4 ± 5.6 and main domain affected was "symptoms and feelings." CRD had an "extremely large effect" on QoL (DLQI score 21-30) in 55.3% patients. Mean HADS-A(anxiety) score was 10.1 ± 3.6, and mean HADS-D(depression) score of participants was 7.8 ± 3.2. Mean perceived stress scale (PSS) score was 18.8 ± 4.3. Involvement of >1 site was a risk factor for higher DLQI score suggestive of "extremely large impact" on QoL (OR 34.02,95% CI 5.7-203.2,p = 0.0001), higher/worsened HADS-A score (OR 5.4, 95% CI 1.2-22.9, p = 0.02), and higher/worsened PSS score (OR 6.1, 95% CI 1.1-34.1, p = 0.04). Persistent disease >1 year (OR 11.5, 95% CI 1.9-67.8, p = 0.007) and male gender (OR 0.3, 95% CI 0.1-0.8, p = 0.01) were significant risk factors for anxiety while BSA involvement >10% was a significant risk factor for moderate to severe perceived stress(OR 13.9, 95% CI 1.5-130.7, p = 0.02).

CONCLUSION

Chronic and recurrent dermatophytosis requires a multidisciplinary approach involving psychiatrists, to reduce the psychological burden.