Epidemiology, Mycological Profile, And Predictors Of Recalcitrant Dermatophytosis In Paediatric Patients: A Cross-Sectional Study Highlighting The Emerging Burden Of Trichophyton Indotineae In India
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Abstract
Background: Dermatophytosis constitutes the most common superficial fungal infection in children in India, with an epidemiological transformation driven by increasing prevalence of Trichophyton mentagrophytes complex—particularly the emerging species Trichophyton indotineae, characterised by high terbinafine minimum inhibitory concentrations (MICs). This study characterised the clinical and mycological profile of paediatric dermatophytosis and identified predictors of recalcitrant infection. Methods: A cross-sectional study enrolled 150 paediatric patients (aged 2–14 years) attending a tertiary dermatology clinic with clinically diagnosed tinea infections. KOH microscopy and fungal culture on Sabouraud Dextrose Agar (SDA) with antifungal susceptibility testing (AFST) were performed. Recalcitrant dermatophytosis was defined as treatment failure at ≥6 weeks of appropriate antifungal therapy. Multivariable logistic regression identified independent predictors of recalcitrance. Results: T. mentagrophytes complex was the predominant isolate (58.5%), with T. indotineae identified in 15.3% of culture-positive cases. Prior topical steroid-antifungal combination misuse was documented in 47.3%. Recalcitrant infection occurred in 36.0% (n=54). Independent multivariable predictors of recalcitrance: prior steroid combination misuse (aOR 3.8; 95% CI 1.8–8.1), untreated family contact (aOR 2.6), and incorrect antifungal duration (aOR 2.1). All T. indotineae isolates had terbinafine MIC ≥4 mg/L; itraconazole susceptibility was preserved in 81.4% of isolates.
Conclusion: Paediatric dermatophytosis in India is characterised by a high burden of T. mentagrophytes/T. indotineae, rampant topical steroid combination misuse, and alarming rates of treatment failure. Strict regulatory enforcement against over-the-counter topical steroid-antifungal combinations, family contact treatment, and adequate antifungal duration are the most actionable interventions to reduce recalcitrance in this population.
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References
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