|Year : 2020 | Volume
| Issue : 2 | Page : 160-164
Cross-sectional study on assessing quality of life of patients diagnosed with superficial dermatophytosis in South-West India
Bhavana Doshi, Vijaya Sajjan, BS Manjunathswamy, Anisha P Bindagi
Department of Dermatology, Venereology and Leprosy, KLE Academy of Higher Education and Research's JN Medical College and Dr. Prabhakar Kore Hospital, Belagavi, Karnataka, India
|Date of Submission||22-Oct-2019|
|Date of Acceptance||16-Apr-2020|
|Date of Web Publication||23-Jun-2020|
Dr. Vijaya Sajjan
Department of Dermatology, Venereology and Leprosy, KLE Academy of Higher Education and Research's JN Medical College and Dr. Prabhakar Kore Hospital, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: Dermatophytosis is a common skin infection, having recurrent and persisting course because of topical steroid abuse, irregular treatment, and poor hygiene. The aim of this study was to assess the quality of life (QoL) of patients diagnosed with superficial dermatophytosis.
MATERIALS AND METHODS: Patients (n = 100) diagnosed with superficial dermatophytosis were recruited in the study. A pretested, structured questionnaire was used for recording patient's details. The observing dermatologist simultaneously assessed the clinical severity of the disease. Data were collected by a single examiner and recorded in a case record pro forma. Clinically doubtful cases were included after examining samples with 10% KOH. Correlation analysis was performed between the Dermatology Life Quality Index (DLQI) score and the study variables.
RESULTS: Out of 100 patients, 42 had DLQI scores with moderate effect (score 6–10). A total of 19 patients had a very large effect on QoL and four patients had DLQI scores bearing an extremely large effect on QoL. Both males and females had similar mean DLQI values. A moderate correlation was found between DLQI scores and the use of topical steroids (r = 0.0002), and a slight correlation was found between duration of the disease and DLQI scores (r = 0.006).
CONCLUSION: A high prevalence of the disease was found in males, and prolonged disease duration with use of topical steroids was observed. A significant impact was found in the QoL of the patients. Hence, proper counseling and treatment, along with early detection, is needed.
Keywords: Dermatologists, dermatophytosis, Dermatology Life Quality Index, steroids, tinea
|How to cite this article:|
Doshi B, Sajjan V, Manjunathswamy B S, Bindagi AP. Cross-sectional study on assessing quality of life of patients diagnosed with superficial dermatophytosis in South-West India. Indian J Health Sci Biomed Res 2020;13:160-4
|How to cite this URL:|
Doshi B, Sajjan V, Manjunathswamy B S, Bindagi AP. Cross-sectional study on assessing quality of life of patients diagnosed with superficial dermatophytosis in South-West India. Indian J Health Sci Biomed Res [serial online] 2020 [cited 2021 Jun 17];13:160-4. Available from: https://www.ijournalhs.org/text.asp?2020/13/2/160/287414
| Introduction|| |
Dermatophyte infections are common, with the most infective cases observed in the dermatology outpatient clinics., The causative organisms include species of Trichophyton, Microsporum, and Epidermophyton. The frequency of chronic and recurrent dermatophytosis over the recent years has increased alarmingly. The prevalence rate of superficial mycotic infection around the world is 20%–25%, and in India, it ranges from 36.6% to 78.4%. Although its incidence is advancing, no measures have been taken in India for the control of dermatophyte infections. The study chose to cover the region of North Karnataka as it falls in the tropics, with epidemic proportions in areas having high rates of humidity with excessive sweating, making people prone to skin infections.
Superficial mycosis is a disease of the skin and its appendages, caused by fungi, and includes dermatophytosis, candidiasis, and pityriasis versicolor. Transmission of this infection is through the infecting fungus; factors influencing its spread include the site of the body infected, the keratinization at that site, and the immune status of the host in addition to socioeconomic factors, which is a result of poor hygiene facilities, overcrowding, and malnutrition. Chronic and recurrent dermatophytic infections cause significant distress to the patients socially, emotionally, and financially. Skin infections have less effect on the mortality rate as compared to other diseases, but they impair the quality of life (QoL) of the patients, due to social embarrassment.,,
In India, there are medicines such as topical steroids in the form of creams, gels, and lotions and fixed-dose combination drugs, which are available as over-the-counter medicine for symptomatic relief from skin infections. Indiscriminate use of these topical steroids and irrational topical fixed-drug combinations, alters the clinical presentation, evokes an irritant response, and contributes to the resilience of fungi, resulting in recurrences, chronicity, and probably resistance to antifungal agents, leading to chronicity, often affecting the QoL. In the past few years, measuring QoL has become an important aspect of medical research into skin disorders. Hence, the current study was undertaken to assess the QoL in patients suffering from superficial dermatophytosis. Furthermore, the effect of irrational use of topical steroids in superficial dermatophytosis and its effect on chronicity, has been assessed.
| Materials and Methods|| |
Sample size justification
A total of 165 tinea patients were collected, out of them, 105 were KOH positive and five did not consent for the study. Hence, the total sample size considered for the study was 100.
A cross-sectional study was conducted at a tertiary care hospital from January 1, 2018, to June 30, 2018. Patients with suspected superficial dermatophytosis attending the outpatient department of dermatology were screened and recruited, based on the inclusion criteria, whereas, pregnant women and patients aged <16 years and >60 years were excluded from the study. Informed consent was obtained from all the patients, prior to the initiation of the study. Detailed notes of the history of the patients along with general physical, systemic, and clinical dermatological examination with 10% KOH examination of the scales for diagnostic confirmation were undertaken.
A pretested, structured questionnaire was given to the patients to fill simultaneously; assessment of the clinical severity of the patient's disease was performed by the observing dermatologist, by measuring the percentage of the body surface area (BSA) involved. The data were collected and recorded in a case record pro forma by a single examiner.
Dermatology quality of life (Dermatology Life Quality Index)
The QoL was measured using the Dermatology Life Quality Index (DLQI) questionnaire – a validated questionnaire was completed by the patients independently, which grades the QoL by assessing the following domains: (a) physical symptoms and feelings (questions 1 and 2), (b) daily activities (questions 3 and 4), (c) leisure (questions 5 and 6), (d) work/school (questions 7), (e) personal relationships (questions 8 and 9), and (f) treatment (question 10). Each question is scored as “very much” (score 3), “a lot” (score 2), “a little” (score 1), and “not at all” (score 0), keeping in mind the problems faced by the patient in the previous week, due to the disease. The scoring with different range of points was summarized as 0–1 (no effect), 2–5 (small effect), 6–10 (moderate effect), 11–20 (very large effect), and 21–30 (extremely large effect). The final DLQI score is the sum of all scores (range 0–30); high scores indicate poor QoL.
Data analysis was performed using Microsoft Excel using R i386 3.5.1 statistical software developed by R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. The demographical variables were summarized as percentages, and the correlation coefficient was calculated. A two-tailed test with P < 0.05 was considered statistically significant.
| Results|| |
A total of 100 patients with dermatophyte infections were included in the study, with a female-to-male ratio of 0.92:1. The result also showed that a greater number of males (52%) were affected with the infection than females (48%), which indicated its high prevalence in males. The mean age of the study population was 29.09 ± 10.37 years. The other demographic details of the study population are represented in [Table 1]. Majority of the study population were students, followed by employees and homemakers.
|Table 1: Sociodemographic data and clinical characteristics of the patients|
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Topical steroids were used by 77% of the patients. Majority of the patients (64%) involved 1–2 family members. Most patients had 3%–10% of BSA involvement, but extensive lesions (>10% BSA) were observed in 29% of the patients.
A total of 42 patients had DLQI scores with moderate effect, 19 patients had a very large effect, and four patients had an extremely large effect on QoL [Table 2]. The age group between 31 and 60 years showed an extreme effect on the DLQI scores, showing no correlation between the DLQI score and the age [Table 3].
|Table 3: Correlation of age, duration of dermatophytosis, topical steroids' application, and body surface area with Dermatology Life Quality Index scores|
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| Discussion|| |
Dermatophytoses are superficial fungal infections, which are caused by keratinophilic dermatophytes. The current study highlights the effect of the disease in certain parts of North Karnataka, using DLQI method, and measures the QoL of the patients suspected of having dermatophytic infections.
DLQI is one of the most widely used dermatology-specific QoL instruments, by both clinicians and the researchers as it is short, simple, and easy for the patients to understand, without requiring any external assistance. There are other well-validated methods to measure the impact of QoL of the dermatology patients which include health-related QoL (HRQoL) inventories such as Skindex, DLQI scales, and the latest Impact of Chronic Skin Disease on Daily Life.,, However, DLQI was chosen as a reliable HRQoL for this study as it provides assessment of new therapies of patient-orientated and outcome-relevant measures. The method compares the impact of different skin diseases and diseases affecting other organs; however, in the present study, it only focused on dermatophytosis. In addition, a published survey related to the widely preferred DLQI states that the information generated from the survey can be beneficial for the current users, with opinion on whether or not the DLQI should be used.
In this study, dermatophytosis was found to be more common in men. Similar findings were reported in a study by Sentamilselvi, where males were affected at least three times more frequently than females. In contrast, another study reported a higher prevalence in women than in men. With regard to age, the maximum number of cases were encountered in the age group between 31 and 60 years, with a mean age of 29.09 years. It is to be noted that the average age of patients with a diagnosis of dermatophytosis varies widely with the study and region. A study by Araújo Gde et al. observed that patients aged 0–20 years accounted for nearly half of all cases of dermatophytosis in Paraíba, Brazil. In the case of the population considered, students were the most common group of age group (16–30 years) affected than the employees and the homemakers. In a study conducted by Myfanwy et al., students were the ones who were most commonly affected. In a study conducted by Patro et al., the mean DLQI score of the BSA of the patients was found to be 10.06 ± 5.34 (≤10% patients) and 12.60 ± 5.01 (>10% patients). The usage of topical steroid application was comparatively high, where a moderate correlation was found between DLQI scores and use of topical steroids in our study; similarly predicted in a study done by Dabas et al., an alarming majority (77%) of cases also revealed using topical corticosteroid combination creams for the same. In a study conducted by Dogra et al., infection from the contacts having multiple, affected family members significantly impaired the QoL. In the present study, the data of how total number of family members of the patient as well as those affected were collected, however we did not come across a significant correlation between DLQI and the number of family members affected.
The present study focuses on the impact of QoL of patients suffering from superficial dermatophytosis, also covering the prevalence of this disease in the region of North Karnataka.
The study had a small sample size, which does not reflect the overall status of QOL in patients with superficial dermatophytosis and the need for multicentric studies. However, with respect to future scope, studies can focus on the type of microbiological agent (Trichophyton rubrum and Trichophyton mentagrophytes) and factors affecting superficial dermatophytosis with assessment of adherence to standard treatment regimen, as most of the patients stop the treatment as soon as improvement in health is observed. Furthermore, the impact on social, psychological, and economic burden on the society can also be explored.
| Conclusion|| |
Our study found a significant impact of dermatophytosis on QoL. A statistically significant number of patients had a large effect on the QoL. Majority of the patients complained of moderate-to-severe itching and embarrassment. There was no statistical significance in the DLQI scores based on age, sex, duration, and extent of involvement of recurrence. Hence, the study reinforces the need or increasing awareness, early detection, and appropriate treatment of superficial dermatophytosis in order to control the spread and discourage the use of topical steroids.
All authors contributed equally in the development of the manuscript. We would like to acknowledge the help of the staff at KLE hospital and Jawaharlal Nehru Medical College for their help with this research.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dabas R, Janney MS, Subramaniyan R, Arora S, Lal VS, Donaparthi N. Use of over-the-counter topical medications in dermatophytosis: A cross-sectional, single-center, pilot study from a tertiary care hospital. Indian. J Drugs Dermatol 2018;4:13-7.
Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive?. Indian Dermatol Online J 2016;7:73-6.
] [Full text]
Basra MK, Fenech R, Gatt RM, Salek MS, Finlay AY. The dermatology life quality inde×1994-2007: A comprehensive review of validation data and clinical results. Br J Dermatol 2008;159:997-1035.
Siddappa K, Mahipal OA. Dermatophytoses in davangere. Indian J Dermatol Venereol Leprol 1982;48:254-9.
] [Full text]
Rajashekar TS, Nandigonnanavar S, Kumar Kuppuswamy S, Shruthi Madhavi G. Dermatology life quality index in patients with persisting and recurrent dermatophytosis. Int Res Dermatol 2019;5:139-43.
Pathania S, Rudramurthy SM, Narang T, Saikia UN, Dogra S. A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India. Indian. J Dermatol Venereol Leprol 2018;84:678-84.
Degreef H. Clinical forms of dermatophytosis (ringworm infection). Mycopathologia 2008;166:257-65.
Tejada CD, Mendoza-Sassi RA, Almeida HL Jr., Figueiredo PN, Tejada VF. Impact on the quality of life of dermatological patients in Southern Brazil. Anna Bras Dermatol 2011;86:1113-21.
Hazarika N, Rajaprabha RK. Assessment of life quality index among patients with acne vulgaris in a suburban population. Indian J Dermatol 2016;61:163-8.
] [Full text]
Anderson RT, Rajagopalan R. Development and validation of a quality of life instrument for cutaneous diseases. J Am Acad Dermatol 1997;37:41-50.
Chren MM, Lasek RJ, Quinn LM, Mostow EN, Zyzanski SJ. Skindex, a quality-of-life measure for patients with skin disease: Reliability, validity, and responsiveness. J Invest Dermatol 1996;107:707-13.
Lewis V, Finlay AY. 10 Years' Experience of the Dermatology Life Quality Index (DLQI). J Investig Dermatol Symp Proc 2004;9:169-80.
Sentamilselvi G, Kamalam A, Ajithadas K, Janaki C, Thambiah AS. Scenario of chronic dermatophytosis: An Indian study. Mycopathologia 1997;140:129 35
Bhatia VK, Sharma PC. Epidemiological studies on Dermatophytosis in human patients in Himachal Pradesh, India. Springerplus 2014;3:134.
Araújo Gde M, Araújo ND, Farias RP, Cavalcanti FC, Lima Mdo L, Braz RA. Superficial mycoses in Paraíba: A comparative analysis and bibliographical revision. An Bras Dermatol 2010;85:943-6.
MJ D'Souza, Kamath GH, Hundi G. Awareness of risk factors for dermatophytoses and its impact on quality of life among adults in Mangalore. A cross sectional study. J Dent Med Sci 2018;17:64 70.
Patro N, Panda M, Jena AK. The menace of superficial dermatophytosis on the quality of life of patients attending referral hospital in Eastern India: A cross-sectional observational study. Indian Dermatol Online J 2019;10:262-6.
] [Full text]
[Table 1], [Table 2], [Table 3]