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Treatment approach for superficial dermatophytosis infections and factors contributing for noncompliance to antifungal therapy in India: An epidemiological survey

Background: The prevalence of superficial dermatophytosis has ascended in India over the past 6–7 years. Chronic, recurrent, and steroid-modified tinea with nonresponse to the conventional treatment regimens are being commonly reported. This can be attributed to a complex interplay of factors related to environment, host, and virulence of the organism and a rampant use of topical corticosteroid, antifungal, antibacterial, and irrational combination creams. Host factors such as living conditions, immunity, poor adherence to general measures, and non-compliance to treatment may affect the spread of infection and clinical presentation. Objective: The objective of this study was to understand the prevailing treatment approach for superficial dermatophytosis in India and the host factors contributing to noncompliance to antifungal therapy. Materials and Methods: This was a cross-sectional qualitative knowledge, attitude, and practice study conducted with 220 dermatologists who participated in DERMACON national conference held at Kochi in 2018. Results: Of the 220 dermatologists, 87.3% stated that there was a rise of tinea fungal infection clinical cases in India. About, 42.3% reported that recalcitrant tinea infection attributed to 10%–30% of increase in the number of clinical cases per week. The treatment of choice for superficial dermatophytosis, as per majority of the surveyed dermatologists is a combination of oral azole and topical azole. For recalcitrant fungal infections, 37.3% of the dermatologists stated that at least 4 weeks of antifungal therapy would be the optimal duration for new tinea cases. Overall, 30%–50% of the patients were noncompliant to the prescribed treatment as per 35.5% of the dermatologists. Almost all (97.7%) dermatologists agreed that there is a need for treatment consensus on treating superficial fungal infection. Conclusion: Majority of the dermatologists agreed that there is an increase in the prevalence of superficial dermatophytosis in India. Appropriate use of oral (optimal dosage) and topical antifungals are considered vital for the successful management of this infection. Appropriate use of topical and systemic antifungal agents for the right duration along with proper counseling is considered vital for the successful management of this infection.