A group of closely related fungi known as dermatophytes can infiltrate human and animal keratinized tissue, including skin, hair, and nails, and cause dermatophytosis, also known as ringworm. They are members of the genera trichophyton (T), microsporum (M), and epidermophyton (E). These dermatophytes are also referred to as fungi imperfect because they reproduce asexually1. Different age groups have varying prevalences of different clinical types of dermatophytic infections. For example, school-age children are more likely to have tinea capitis, followed by tinea corporis, and finally tinea pedis2.

However, the etiology of dermatophytic infections has recently changed, with T.schoenleinii,

3. audouinii, E. floccosum, and M. ferrugineum once being highly common, they are now vanishing from the majority of nations and are only found in a few less developed ones. Additionally, the popularity of petting has led to an increasing isolation of zoophilic dermatophytes from human hosts, such as M. canis, which causes inflammatory tinea. In addition to etiological factors, dermatophytic infection clinical and epidemiological patterns have changed, resulting in an epidemic of the infection, particularly in tropical nations, such as India. In tropical and subtropical nations, the prevalence of yeast and yeast-like organisms causing skin infections is gradually rising3.

These dermatophytes reproduce asexually, hence are also known as fungi imperfecti. The prevalence of various clinical types of dermatophytic infections varies among different age groups, for instance, children are more commonly present with tinea capitis followed by tinea corporis and then tinea pedis. Adults commonly present with T.Corporis and T.Cruris. Dermatophytic infection of the nails known as T.Unguiumis  also commonly seen in adults.

Despite the fact that dermatophytes are the primary microorganism causing superficial mycotic  infections, which affect 20% to 25% of the world's population, there is a lack of research  on many facets of the issue. Other regions of the world, especially the tropics, have also reported an increase in complicated dermatophytosis, which is currently on the rise in India4.

Because dermatophytosis is primarily a tropical dermatosis, it likely does not receive the attention it merits in terms of scientific research, despite its extreme prevalence. This is demonstrated by the fact that even common terms like "chronic dermatophytosis" and "recurrent dermatophytosis" lack definitions. The lack of well-defined terminology makes it difficult for us to precisely define the parameters of the current issue: Is chronic dermatophytosis the only cause of the epidemic? Or is it recurrent or relapsing tinea?

Alternatively, does it indicate genuine resistance to several topical or systemic antifungal medications? In spite of treatment, chronic dermatophytosis has been define darbitrarily as a condition that persists for more than six months to a year, with or without recurrence5.

Similarly, recurrent dermatophytosis has been defined, without validation, as “cutaneous dermatophytosis in which the infection reoccurred within 6 weeks of stopping the adequate antifungal treatment with at least two such episodes in last 6 months6.  We simply do not know whether  the  spectra that we are viewing with such alarm is chronic, relapsing or resistant tinea. Theoretically, it may well be relapse since the fungus may not have been eradicated due to an unnoticed nail involvement or the rarely documented tinea of vellus hair. It may, on the other hand, be a reinfection because of untreated family members, infected clothing and other fomites harboring the fungi. It is difficult to discount the possibility of secondary or primary resistance too without adequate studies. In the absence of such characterization, we have to simply term these as unresponsive dermatophytosis.

Recent years have seen the emergence of its atypical forms like T.Incognito, T.Facei and its erythrodermic forms. This can largely be attributed to the injudicious widespread use of topical steroids. These forms have usually lost their typical lesional morphology, i.e an annular lesion with central clearing. The use of steroids results in telangiectasis,skin atrophy and development of striae at the site of application. Multiple contributory factors like hot and humid climate, poor hygiene, unfavorable clothing, noncompliance to treatment and use of steroids has made this infection an epidemic, especially in India. The atypical presentation of dermatophytosis  poses a threat to clinicians in its proper diagnosis and treatment.

Despite the large number of studies on superficial dermatophytosis, the lack of community-based surveys makes it challenging to determine the precise incidence and prevalence. In India, the reported prevalence currently ranges widely (6.09%6–61.5%7).Studies from south India have reported a prevalence of 6.09% to 27.6%, while those from north India have reported a high prevalence of 61.5%7. Our goal is to thoroughly address all facets of patients' knowledge, attitudes, and behaviors related to dermatophytoses.

AIM AND OBJECTIVE:

To study the knowledge, attitude and practices in patients with Dermatophytosis at a tertiary care centre in Lucknow.

This was a cross sectional observational study inpatients visiting the outpatient department of dermatology in a tertiary care centre in Lucknow over a period of three months (Nov 2024 to April 2025). The study was conducted after approval of the ethical committee of Prasad Institute of Medical Sciences, Lucknow (IEC/PIMS/04/2024-25 - DATED-28-06-2024). A total of 172 patients above the age of 18 who visited the OPD during the duration of study were included after obtaining written consent. Proper history and demographic details were taken from the patients, entailing the prepared questionnaire. A detailed clinical examination was done to determine the morphology, site and type of infection in each patient. A KOH examination was done to diagnose cases with atypical morphology. Patients having other concurrent diseases were excluded. Data so collected was expressed in percentage (%).

A total of 172 patients visiting the OPD were administered the test and the responses were recorded. Out of 172 patients 78 were males and 94 were females. All patients were above the age of 18, with the minimum and maximum age being 22 and 63 respectively. The mean age was 32. The most common site involved was the groin region in both sexes followed by lower abdomen and then nails. 134 patients had a rural background while only 38 had an urban background.

More than half of the study subjects believed Dermatophytosis to be an allergic condition (72%) and had no knowledge about its spread from sharing articles like towels, clothes (76.74%) and sexual contact (88.95%).

A significant number of study subjects were unaware of precipitating factors like poor hygiene and excessive sweating (84.88%).

Though only 53 subjects out of 172 had knowledge of the long duration of treatment required, only 38 patients showed hesitancy in taking oral treatment.

More than 50% of subjects claimed to take baths daily (75%), change clothes daily (88.37%) and dry clothes under the sun after washing (94.67%).

A total of 123 subjects responded negatively to wearing cotton clothes with synthetic being the popular choice although only 31 subjects responded affirmatively to wearing closed foot wear.

Out of 172, 114 patients admitted to taking medication from unregistered medical practitioners’ with125 patients admitting to the use of topical steroids. Application of mustard oil and kapur are part of indigenous practices in many parts of Uttar Pradesh but only 23.83 % of Subjects admitted to their use. No relief was reported from their application. According to this study the most common clinical type was T.Corporis followed by T.Cruris and T. incognito. The least common type was T. Capitis.

Age/Gender distribution of study subjects:

Geographical distribution of study subjects

Type of infection:

KNOWLEDGE

Table1: Assessing the knowledge among study patients about Dermatophytosis

ATTITUDE

Table2: Assessing attitude of study patients towards Dermatophytosis

PRACTICES

Table3:Assessing practices amongst study patients towards Dermatophytosis

Patients who have experienced the disease for more than six months to a year are said to have chronic dermatophytosis, and those who experience a dermatophytic infection recurrence within a few weeks of finishing treatment are said to have recurrent dermatophytosis.

In this study, ages 29 to 38 accounted for the largest percentage of patients i.e (35.5%). More indulgence in both indoor and outdoor pursuits, such as farming, factory work, manual labor, and domestic tasks like cooking and cleaning, can be blamed for this. In contrast to a study by Mary Vineeta et al. that found a higher male preponderance at a tertiary care center in Kerala, this study revealed a 1.2:1 female preponderance.

KNOWLEDGE:

Out of 172 patients, a mean percentage of only 37% of study subjects showed adequate knowledge about the mode of spread and precipitating factors like sweating and poor hygiene. This is in accordance with a KAP study published by Preeyati Chopra et al. on dermatophytosis at a tertiary care centre in Punjab where more than 72% patients (out of 227) did not know about the infective nature of disease. Our study showeda mean percentage of 32.5% males had adequate knowledge as compared to only12.5%females. This knowledge gap can be attributed to higher illiteracy rates amongst women in Uttar Pradesh and many parts of India.

ATTITUDE

A mean percentage of 36.7 % of study subjects showed bad practices with material of clothing and taking medication from unregistered medical practitioners being the major concerns. In total only 28.5% of patients responded ‘yes’ to wearing cotton clothes. Synthetics emerged As a common choice in the rest, especially in females where only 13.8 % compared to 48.6% males preferred to wear cotton. This is not in accordance with the study conducted by Preeyati Chopra et al. in Punjab where 89%of subjects chose cotton as their choice of clothing.

PRACTICES

More than 50% of study subjects claimed to have good practices. The major concern was the use of topical steroids which was reported in 72.7% patients. There was no significant difference observed between males and females. This is in accordance with a study by Dutta et al. in 2017 in which they concluded Betamethasone as the most common topical steroid. Indigenous practices like application of kapur and mustard oil were seen more commonly in females (31.9%) than males (14.1%).

This study outlines the extensive knowledge gap in patients of Dermatophytosis visiting a tertiary care centre in Lucknow. This results in patients visiting unregistered medical practitioners rather than seeking proper treatment from dermatologists. These quacks often prescribe topical steroids formulations and sometimes steroidal injections are also given which provide a very brief relief but prolong the disease course, and lesion morphology which eventually bears a financial burden on patients. This whole scenario of poor knowledge about spread, self-treatment, non-compliance, increased petting, unhygienic lifestyle and synthetic clothing patterns can jeopardize the health of the entire community as a whole. Addressing these knowledge gaps and making an effort towards correcting. The attitude of patients could help in better management.

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