A Study on the Clinical and Mycological Impact of Topical Corticosteroid Abuse in Dermatophytosis

Abstract

The abuse of topical corticosteroid has become one of the leading causes of the growing occurrence of chronic and renal dermatophytosis, leading to dissimilar clinical presentations and even resistance to treatment. In this study, the clinical and mycological outcomes, which are obtained with maltreatment of the topical corticosteroids, were compared in dermatophytic patients. An observational cross-sectional comparative study that took place in a hospital was carried out, involving 120 patients who were clinically diagnosed with dermatophytosis. They were divided into two groups of respondents: 60 patients who had a history of abusing topical corticosteroids and 60 patients who never used corticosteroids. Clinical observation, microscopy of potassium hydroxide (KOH), fungus culture and species identification were done. Statistical analysis was carried out using SPSS version 26.0 and p value of differing significant level of p < 0.05. Corticosteroid abusers were found to have much larger proportions of the duration of the disease more than six months (61.7 vs. 30.0), the presence of lesions in multiple body areas (71.7 vs. 40.0), abnormal lesion morphology (65.0 vs. 16.7), tinea incognito (51.7 vs. 6.7), and recurrent infection (58.3 vs. 26.7) relative to non-users (p < 0.05). Positivity of fungus culture was lower in corticosteroid users (68.3 vs. 88.3, p = 0.009) and positivity of KOH in 90.0% of corticosteroid and 95.0% of non-corticosteroid users. The isolate dermatophyte species was the most common which happened to be trichophyton mentagrovetytes. Topical corticosteroid abuse was found to be the best predictor (independent) of severe dermatophytosis (AOR = 4.21; 95% CI: 2.018.82; p < 0.001). There is a close connection between topical corticosteroid abuse and overwhelming, repetitive, and cortistone modified dermatophytosis and negatively impacts the mycological results. In order to improve the state of treatment and prevent increasing the price of chronic dermatophytosis, one will need to encourage the culture of rational prescribing, stricter regulation of available corticosteroid preparations, and popularize the early diagnosis of mycology.