TO COMPARE THE EFFECTIVENESS OF DIFFERENT REGIMEN IN MANAGEMENT OF DERMATOPHYTE INFECTION AT TERTIARY CARE CENTER BIKANER RAJASTHAN

210 | P a g e TO COMPARE THE EFFECTIVENESS OF DIFFERENT REGIMEN IN MANAGEMENT OF DERMATOPHYTE INFECTION AT TERTIARY CARE CENTER BIKANER RAJASTHAN Anil Babani, R D Mehta, B C Ghiya, Prasoon Soni 1 Resident Doctor, 2 Senior Professor & HOD, 3 Associate Professor, 4 Assistant Professor Department of Dermatology, Venereology and Leprosy, S.P. Medical College and A.G. of Hospitals Bikaner, Rajasthan Article Info: Received 30 April 2019; Accepted 30 May. 2019 DOI: https://doi.org/10.32553/ijmbs.v3i5.268 Corresponding Author: R D Mehta, Senior Professor & HOD, Department of Dermatology, Venereology and Leprosy, S.P. Medical College and A.G. of Hospitals Bikaner, Rajasthan Conflict of interest: No conflict of interest. Abstract: Background: The dermatophytoses are caused by a group of fungi known as ringworm or Tinea. These are from genera Microsporum, Trichophyton and Epidermophyton. Amongst Five to six species which are prevalent globally, Trichophyton rubrum happens to be the commonest. Methods: A hospital based comparative prospective study included 600 patients of dermatophytoses having Tinea cruris and Tinea corporis attending the outpatient department of Dermatology, Venereology and Leprosy in PBM hospital Bikaner. Patients randomly divided into 3 groups Group A received Tablet Fluconazole 150 mg per week plus Tablet Griseofulvin 10mg per kg bodyweight daily in two divided doses. Group B received Tablet Fluconazole 150 mg per week. Group C received Tablet Griseofulvin 10mg per kg body weight in two divided doses daily. Treatment to all groups was given for a period of 4 weeks. The data were analyzed on EPI-Info-6 Software. Results: There were no statistically significant difference noted among three groups at 1, 2 & 3 weeks and statistically significant difference in three groups was observed at 4 & 8 weeks follow-up. Conclusion: The combination of Fluconazole and Griseofulvin is a bettar treatment option to treat tinea cruris and corporis as compared to mono therapy with Fluconazole or Griseofulvin. Keywors: Fluconazole ,Griseofulvin, Mono Therapy, Dual therapy, Tinea Cruris and Tinea Corporis.


Introduction
The dermatophytoses are caused by a group of fungi known as ringworm or tinea. These are from genera Microsporum, Trichophyton and Epidermophyton. 1 Amongst Five to six species which are prevalent globally, Trichophyton rubrum happens to be the commonest 2 . It is estimated that superficial fungal infections affect roughly 20-25% of the world population 3 Clinical manifestations may vary depending on the causative agent and on the immune response of the host; they may last for months to years and may be asymptomatic or manifest as pruritus only. 4 In the majority of cases, however, infection manifests itself as erythematous annular lesion with central clearing and some times as fissures, blistering and scales. 5 The varied clinical presentation of tinea is often confused with other skin diseaes. It may be due to misuse of combination creams containing steroid that lead to misdiagnosis and mismanagement and probably the reason for clinical resistance to available topical and oral antifungal drugs hence any such clinical diagnosis needs to be supported by laboratory diagnosis. 6 The choice of treatment is determined by the site and extent of lesions, the fungal species involved and the efficacy, safety profile and pharmacokinetics of the available antifungal agents. 7 Nowadays we have observed that patients with dermatophytoses do not respond to conventional treatment regimens. So in the present study we have compared the different drug regimen for trement of tinea corporis and cruris and advantage of using combination treatment of fluconazole and giseofulvin for treatment of tinea cruris/corporis. Treatment to all groups was given for a period of 4 weeks. The patients in all the groups were given topical clotrimazole 2% and oral antihistaminics during the treatment period.

MATERIALS AND METHOD
All patients were followed every week during the treatment period and four weeks after the completion of treatment to observe any relapse (i.e.till the end of 8 th week).
Patient would visit the hospital six times during the study period, first baseline visit then four visit at the end of each week for the total treatment period of four weeks and a follow up visit at 8 th week 3. History of hypersensitivity to study drugs.
5. Pregnant or lactating women. 6. Patient with history of any liver disease.

DATA ANALYSIS
1. Master chart was prepared from the details recorded on the proforma.
2. Epidemiological and clinico morphological data was obtained from master chart for making respective tables.
3. Statistical analysis was assessed by chi square test and p value less than 0.05 was considered significant.

OBSERVATIONS
Present study was conducted on 600 patients of Tinea cruris and corporis. The cases were diagnosed clinically and confirmed by 10%KOH mount and /or culture. The patients were divided into three groups randomly by simple randomization method. Group A received combination of Fluconazole and Griseofulvin, Group B received Fluconazole and Group C received Griseofulvin for a period of 4 weeks. Thirty patients in Group A, while 27 patients each in Group B and C were lost to follow up. There was no statistically significant difference in all the three groups (p>0.05).  Table 2, demonstrates the condition of patients at 2 weeks of treatment. Complete clinical cure was seen in 3 (1.76%) patients in group A, 1(0.58%) patient in group B and 3(1.73%) patients in group C. Partial cure was seen in 167(98.24%), 172(99.42%) and 170(98.27%) patients in group A, group B and group C respectively. There was no statistically significant difference in all the three groups (p>0.05).   Table 4 shows the condition of patients at the end of 4 weeks (end of treatment). Complete clinical cure was seen in 148(87.05%) patients in group A, 125(72.25%) patients in group B and 119(68.78%) patients in group C. Partial cure was seen in 22(12.95%), 48(27.75%) and 54(31.22%) patients in group A, group B and group C respectively. There was statistically significant difference in all the three groups (p<0.05).  Table 5 shows the condition of patients at the end of 4 weeks (end of treatment). Complete mycological cure was seen in 137(80.58%) patients in group A, 105(60.69%) patients in group B and 93(53.76%) patients in group C among the totally clinically cured patients. There was statistically significant difference in all the three groups (p<0.05) In our study we compared efficacy and safety of three different drug regimen with one regimen containing two drugs. It is one of the study being conducted for first time, as per scanning of the literature

CONCLUSSION
This study proves that combination of Fluconazole and Griseofulvin is a bettar treatment option to treat tinea cruris and corporis as compared to mono therapy with Fluconazole or Griseofulvin. It is needed to combine two antifungals to get bettar clinical and mycological cure rates. Patients should be advised to avoid steroid containing combination creams, adopt proper cleaning and ironing of clothes and treatment of all family members who are suffering from same ailment simultaneosly.