Male genital dermatophytosis – clinical features and the effects of the misuse of topical steroids and steroid combinations – an alarming problem in India

Abstract

Genital dermatophytosis has been considered rare by most Western authorities. However, to the contrary, Indian reports have shown a higher prevalence of genital dermatophytosis due to warm and humid climate, overcrowding and lack of hygiene. A review is presented for 24 cases of male genital dermatophytosis occurring in patients suffering from tinea cruris in India who have been randomly applying various broad-spectrum steroid antifungal and antibacterial creams containing one or more antifungal and antibiotic in addition to potent corticosteroids, mainly clobetasol propionate. This is such a common phenomenon that Indian dermatologists are witnessing an epidemic of sorts of steroid-modified dermatophytosis and we hereby share various clinical presentations of dermatophytosis of penis and/or scrotum in patients with tinea cruris who have been applying the above-mentioned creams. The review also discusses the bleak scenario that prevails in India regarding the drug regulatory affairs that allow such dangerous and irrational combinations that are sold over the counter because of misinterpretation of the law and lax implementation of existing laws.

Prevalence of low inflammatory tinea genitalis in southern China

“…It may be expected that the epidemiology of dermatophytosis varies among geographical areas, associated with human behaviour and predisposing factors, with the emergence of virulent genotypes as a new phenomenon. The recent reports of tinea genitalis due to T. interdigitale in Switzerland and India indicate a possibility of sexual transmission of the fungus, and emergence of resistence due to misuse of over‐the‐counter low‐dose antifungal mixtures . None of our patients had severe skin inflammation, and their partners denied to have similar problems.…”

“…In line with other reports, most of our patients with infections caused by anthropophilic T. rubrum and E. floccosum had concurrent tinea infections showing erythematous, slightly scaling lesions, different from those of N. gypsea . The above‐described cases also differ from the series of genital infections from India and Switzerland, where mostly clonal emergence of a single Trichophyton species was concerned, some with severe inflammation leaving scars after cure. It may be expected that the epidemiology of dermatophytosis varies among geographical areas, associated with human behaviour and predisposing factors, with the emergence of virulent genotypes as a new phenomenon.…”

The great Indian epidemic of superficial dermatophytosis: An appraisal

“…[2425262728] There has been a paucity of recent literature from India on genital dermatophytosis barring one written by the author and Vasani which describes the current increase in male genital tinea against the backdrop of steroid abuse. [15] Genital dermatophytosis is observed to be seen more commonly in males and occurs more commonly on the penis rather than the scrotum. It is almost always accompanied by tinea cruris or tinea cruris et corporis treated by irrational FDCs.…”

“…It is almost always accompanied by tinea cruris or tinea cruris et corporis treated by irrational FDCs. [15] When it occurs in women, it usually affects the mons pubis and labia majora. While annular lesions with classic active borders may be seen on the penile shaft, some variants like areas of ill-defined scaly lesions and powdery scaling are also seen [Figure 7a and b].…”

“…Topical corticosteroids used in combination with antifungal agents are very often potent molecules like clobetasol propionate, they are available over the counter and are grossly abused which includes buying over the counter and applying at will for weeks, months and sometimes years. [111141516171819] This leads to chronic, treatment resistant dermatophytosis which is causing a havoc in India.…”