ATYPICAL AND UNUSUAL PRESENTATIONS OF DERMATOPHYTOSIS—RISK FACTORS, CHRONICITY, AND RECURRENCE RATES AT A TERTIARY CARE CENTRE IN BIHAR.
Main Article Content
Keywords
Dermatophytosis, chronic tinea, recurrent tinea, steroid misuse in tinea, and antifungal resistance
Abstract
Dermatophytosis, a superficial fungal infection caused by keratinophilic fungi, has evolved from a self-limiting infection to a chronic, relapsing disease in India. The rising trend of atypical morphologies and treatment resistance has become a major public health concern. Data from Eastern India, particularly Bihar, remain scarce.
Aims:
To document atypical and unusual clinical presentations of dermatophytosis and to identify risk factors associated with chronicity and recurrence in patients attending a tertiary care centre in Bihar.
Methods:
A hospital-based, cross-sectional study was conducted over six months (February–July 2025) in the Department of Dermatology, Venereology, and Leprosy. All consecutive patients with clinically diagnosed dermatophytosis were included. Clinical data regarding lesion morphology, duration, recurrence, comorbidities, and risk factors such as topical steroid use and hygiene practices were recorded. Fungal confirmation was done by 10% KOH and culture in doubtful cases. Statistical analysis was performed using the Chi-square test and logistic regression, with p < 0.05 considered significant.
Results:
Of 788 enrolled patients, the mean age was 32 ± 7 years, with a male-to-female ratio of 3:2. The predominant forms were tinea corporis (55.7%) and tinea cruris (37%), while 26% showed atypical morphologies such as steroid-modified (21%), pseudoimbricata-like (3%), and follicular variants (2%). Chronic dermatophytosis (>6 months) was seen in 44%, and recurrence within six weeks occurred in 23%. Significant risk factors for chronicity included topical steroid misuse (p < 0.01), diabetes mellitus (p < 0.05), and positive family history (p < 0.05). Recurrence correlated with poor adherence, short treatment duration, and the presence of infected household contacts.
Conclusion:
Dermatophytosis in Bihar exhibits a high burden of chronic, recurrent, and atypical cases. Misuse of topical corticosteroid combinations, metabolic comorbidities, and familial clustering contribute significantly to persistence and relapse. Early diagnosis, regulation of steroid misuse, patient education, and antifungal resistance monitoring are essential to control this emerging epidemic.
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Dr Prem Prakash Pravakar
Associate professor (HOD), Dept of Skin and V.D., Anugrah Narayan Magadh Medical College and Hospital, Gaya
Dr Md Mobarak Hussain,
Senior Resident, Dept of Skin and V.D., Anugrah Narayan Magadh Medical College and Hospital, Gaya;
Dr Deepak Kumar
Senior Resident, Dept of Skin and V.D., Anugrah Narayan Magadh Medical College and Hospital, Gaya