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SPECIAL ISSUE ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 502-519

Indian association of dermatologists, venereologists and leprologists (IADVL) task force against recalcitrant tinea (ITART) consensus on the management of glabrous tinea (INTACT)


1 Department of Dermatology, Venereology and Leprosy, Madras Medical College, Chennai, Tamil Nadu, India
2 Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Deralakatte, Deralakatte, Mangalore, Karanataka, India
3 Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Dermatology, Venereology and Leprosy, Government Medical College, Thrissur, Kerala, India
5 Department of Dermatology, Venereology and Leprosy, Dr Ram Manohar Lohia Hospital and Postgraduate Institute of Medical Education and Research, New Delhi, India
6 Department of Dermatology, Venereology and Leprosy, K. J. Somaiya Hospital and Research Centre, Mumbai, Maharashtra, India
7 Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
8 Consultant Dermatologist, Harganga Mahal Annexe, Dadar TT, India
9 Hanuma Skin Center, Doctors Plaza, Kothapeta, Guntur, Andhra Pradesh, India
10 Department of Dermatology, Venereology and Leprosy, SBKS Medical College, Piparia, Vadodara, Gujarat, India
11 Consultant Dermatologist, Masab Tank, Hyderabad, Telangana, India
12 Department of Dermatology, Venereology and Leprosy, Grant Medical College, Mumbai, Maharashtra, India
13 Department of Dermatology, Venereology and Leprosy, University College of Medical Sciences and GTBH, New Delhi, India
14 Department of Dermatology, Venereology and Leprosy, Assam Medical College and Hospital, Dibrugarh, Assam, India
15 Consultant Dermatologist, Dr. Kaushal's Skin Clinic, Agra, Uttar Pradesh, India

Correspondence Address:
Manjunath M Shenoy
Department of Dermatology, Venereology and Leprosy, Yenepoya Medical College, Deralakatte, Mangalore - 575 022, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/idoj.IDOJ_233_20

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Background and Aims: Dermatophytosis has always been a common superficial mycosis in India. However, the past 6-7 years have seen an unprecedented increase in the number of patients affected by recurrent, chronic, recalcitrant and steroid modified dermatophytosis involving the glabrous skin (tinea corporis, tinea cruris and tinea faciei). Importantly, there has been a notable decrease in clinical responsiveness to commonly used antifungals given in conventional doses and durations resulting in difficult-to-treat infections. Considering that scientific data on the management of the current epidemic of dermatophytosis in India are inadequate, the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task force Against Recalcitrant Tinea (ITART) has formulated a consensus statement on the management of dermatophytosis in India. Methods: Seventeen dermatologists with a focussed interest in dermatophytosis participated in a Delphi consensus method, conducted in three rounds. They responded as either “agree” or “disagree” to 132 statements prepared by the lead experts and gave their comments. Consensus was defined as an agreement of 80% or higher concurrence. Statements on which there was no consensus were modified based on the comments and were then recirculated. The results were finally analysed in a face-to-face meeting and the responses were further evaluated. A draft of the consensus was circulated among the participants and modified based on their inputs. Results: Consensus was achieved on 90 of the 132 statements. Direct microscopy using potassium hydroxide mount was recommended in case of diagnostic difficulty on clinical examination. Counselling of patients about strict adherence to general measures and compliance to treatment was strongly recommended as the key to successful management of dermatophytosis. A combination of systemic and topical antifungal drugs was recommended for the treatment of glabrous tinea in the current scenario. Topical corticosteroid use, whether used alone or in combination with other components, was strongly discouraged by all the experts. It was suggested that topical antifungals may be continued for 2 weeks beyond clinical resolution. Itraconazole and terbinafine were recommended to be used as the first line options in systemic therapy, whereas griseofulvin and fluconazole are alternatives. Terbinafine was agreed to be used as a first line systemic agent in treatment naïve and terbinafine naïve patients with glabrous tinea. Regular follow-up of patients to ensure compliance and monitoring of clinical response was recommended by the experts, both during treatment and for at least 4 weeks after apparent clinical cure. Longer duration of treatment was recommended for patients with chronic, recurrent and steroid modified dermatophytosis. Conclusion: Consensus in the management of dermatophytosis is necessary in the face of conventional regimens proving ineffective and dearth of clinical trials re-evaluating the role of available antifungals in the wake of evolving epidemiology of the infection in the country. It needs to be backed by more research to provide the required level of evidence. It is hoped that this consensus statement improves the quality of care for patients with dermatophytosis, which has emerged as a huge public health problem, imposing considerable financial burden on the country.


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