Therapeutic management of psychological morbidity and impaired quality of life in patients with persistent dermatophytoses

Dear Editor, Skin diseases have a profound impact on the quality of life (QoL) and psychosocial well-being of the patient. This is attributed to not only the symptoms of the disease, but also because of the visibility of the disease to others and associated psychosocial comorbidity. This impact is more pronounced in chronic and recurrent dermatoses. The psychological burden of chronic dermatoses such as psoriasis, vitiligo, acne, atopic dermatitis and chronic urticaria has been well documented. Social ostracism and discriminative attitudes also add to the psychological morbidity of chronic infective dermatoses. However, as we face an epidemiclike situation of superficial dermatophytosis, the impact of this menace of psychological well-being and QoL needs further attention. Dermatophytoses were once considered easy to manage and could be cured within a few weeks of judicious treatment. But, in recent years, dermatophytoses have emerged as a public health problem, attributed to misuse of topical corticosteroids, use of fixed drug combination creams, predominance of Trichophyton mentagrophytes as the causative organism and emergence of terbinafine resistance. Chronic dermatophytosis refers to “patients who have suffered from the disease for more than 6 months to 1 year duration, with or without recurrence, in spite of being treated.” Recurrent dermatophytosis is described as the reoccurrence of dermatophyte infection within few weeks after the completion of treatment. Superficial dermatophytoses have become a persistent disease lately, the predominant reasons being chronicity and recurrence. A study in northern India revealed a significant impact of chronic and recurrent dermatophytosis on QoL (mean DLQI, Dermatology Life Quality Index = 13.41 ± 7.56) and psychological morbidity (mean GHQ-12, General Health Questionnaire = 16.98). Another study in 2018 from eastern India assessed the DLQI score and the 5-D pruritus scale to study the impact on QoL by dermatophytosis. The effect on QoL (DLQI scoring) ranged from moderate (males, ≤10% body surface area involvement, ≤6 months duration, low and medium socioeconomic status) to very large (females, >10% body surface area involvement, >6 months duration, high socioeconomic status) and the DLQI scoring correlated with the scoring of 5-D pruritus scale. 36.57% of patients with dermatophytosis were found to have depression and 40.28% had altered social behavior. Tinea capitis is more common in children, and it is known to affect the QoL. In a study by Fienemika et al, 58.2% of children affected with tinea capitis had mild-to-severe psychosocial impact (measured by Children Dermatology Life Quality Index instrument). There are multiple studies outlining the impact of onychomycosis on QoL and psychosocial life of the patient. Besides posing as a cosmetic defect and causing low self-esteem and social withdrawal, onychomycosis interferes with normal nail function and disrupts daily activities. Previous studies have shown that psychological and social support for patients with chronic dermatoses help to improve coping skills and reduce disorders such as anxiety and depression. Patients with infections like dermatophytoses, which were earlier considered easily manageable with adequate antifungal therapy, have significant bearing on patients' QoL, feelings and interpersonal relationships. QoL issues and psychosocial aspect should be considered while managing dermatophytoses as education about the disease, its management and prognosis may go a long way in improving the adherence to treatment and overall outcome in these patients. However, there is a lack of similar studies on dermatophytosis. Hence, there is a need for more original work on the psychological impact by dermatophytosis. Understanding the impact of dermatophytosis on QoL and psychological morbidity will help in a more patient-centered approach in the management of these disorders. Recognition, addressal and adequate treatment of the unmet psychological needs would better alleviate the sufferings of these patients.