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Cross‑sectional study on assessing
quality of life of patients diagnosed
with superficial dermatophytosis in
South‑West India
Website:
www.ijournalhs.org Bhavana Doshi, Vijaya Sajjan, B. S. Manjunathswamy, Anisha P. Bindagi
DOI:
10.4103/kleuhsj.
kleuhsj_265_19 Abstract:
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.
Department of Keywords:
Dermatology, Venereology
and Leprosy, KLE Dermatologists, dermatophytosis, Dermatology Life Quality Index, steroids, tinea
Academy of Higher
Education and Research’s
JN Medical College
and Dr. Prabhakar Kore
Introduction Although its incidence is advancing, no
Hospital, Belagavi, measures have been taken in India for the
Karnataka, India

Address for
D ermatophyte infections are common,
with the most infective cases observed
in the dermatology outpatient clinics.[1,2]
control of dermatophyte infections.[2] The
study chose to cover the region of North
correspondence:
Karnataka as it falls in the tropics, with
Dr. Vijaya Sajjan, The causative organisms include species epidemic proportions in areas having high
Department of of Trichophyton, Microsporum, and rates of humidity with excessive sweating,
Dermatology, Venereology Epidermophyton.[3] The frequency of chronic making people prone to skin infections.
and Leprosy, KLE and recurrent dermatophytosis over the
Academy of Higher
Education and Research’s recent years has increased alarmingly. Superficial mycosis is a disease of the skin
JN Medical College The prevalence rate of superficial mycotic and its appendages, caused by fungi, and
and Dr. Prabhakar Kore infection around the world is 20%–25%, includes dermatophytosis, candidiasis, and
Hospital, Belagavi, and in India, it ranges from 36.6% to 78.4%.
Karnataka, India. pityriasis versicolor.[4] Transmission of this
E‑mail: drsajjanvijaya@ infection is through the infecting fungus;
gmail.com This is an open access journal, and articles are
distributed under the terms of the Creative Commons
Received: 22 October Attribution‑NonCommercial‑ShareAlike 4.0 License, which How to cite this article: Doshi B, Sajjan V,
2019, allows others to remix, tweak, and build upon the work Manjunathswamy BS, Bindagi AP. Cross‑sectional
Revised: 23 November non‑commercially, as long as appropriate credit is given and study on assessing quality of life of patients diagnosed
2019, the new creations are licensed under the identical terms. with superficial dermatophytosis in South‑West India.
Accepted: 16 April 2020, Indian J Health Sci Biomed Res 2020;13:160-4.
Published: 23 June 2020 Forreprintscontact:WKHLRPMedknow_reprints@wolterskluwer.com

160 © 2020 Indian Journal of Health Sciences and Biomedical Research KLEU | Published by Wolters Kluwer - Medknow
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Doshi, et al.: QoL of dermatophytosis patients
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.[5] Chronic and recurrent dermatophytic
infections cause significant distress to the patients
socially, emotionally, and financially.[6] 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.[4,5,7]
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.[7] 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.
Study design
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
Indian Journal of Health Sciences and Biomedical Research KLEU - Volume 13, Issue 2, May-August 2020 161
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.[8]
Statistical analysis
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.
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
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Doshi, et al.: QoL of dermatophytosis patients

Table 1: Sociodemographic data and clinical DLQI is one of the most widely used dermatology‑specific
characteristics of the patients QoL instruments, by both clinicians and the researchers as
Parameters Percentage (%) Mean DLQI±SD P it is short, simple, and easy for the patients to understand,
Age (years) without requiring any external assistance. There are other
≤15 5 7.6±4.67 0.474 well‑validated methods to measure the impact of QoL of
16-30 59 7.9±4.57 the dermatology patients which include health‑related
31-60 35 9.14±5.55
QoL (HRQoL) inventories such as Skindex, DLQI scales,
>60 1 -
and the latest Impact of Chronic Skin Disease on Daily
Gender
Life.[3,10,11] However, DLQI was chosen as a reliable HRQoL
Male 52 8.44±4.52 0.81
for this study as it provides assessment of new therapies
Female 48 8.21±5.34
of patient‑orientated and outcome‑relevant measures. The
Occupation
Student 35 8.2±4.72 0.88
method compares the impact of different skin diseases and
Employee 34 8.38±4.57
diseases affecting other organs; however, in the present
Homemaker 24 7.71±5.86 study, it only focused on dermatophytosis. In addition,
Duration (months) a published survey related to the widely preferred DLQI
<6 55 7.22±4.08 0.006 states that the information generated from the survey
6-12 38 10.29±5.66 can be beneficial for the current users, with opinion on
>12 7 6.43±3.15 whether or not the DLQI should be used.[12]
Topical steroid
application In this study, dermatophytosis was found to be more
Yes 77 9.19±4.98 0.0002 common in men. Similar findings were reported in a
No 22 5.41±3.45 study by   Sentamilselvi, where males were affected at
Number of family least three times more frequently than females.[13] In
members affected
contrast, another study reported a higher prevalence in
0 -9 0.96
women than in men.[14] With regard to age, the maximum
1 32 7.67±7.09
number of cases were encountered in the age group
2 32 8.53±4.68
between 31 and 60 years, with a mean age of 29.09 years.
3 21 8.06±3.39
4 5 8.33±5.85
It is to be noted that the average age of patients with a
6 1 9.6±7.83
diagnosis of dermatophytosis varies widely with the
BSA (%) study and region. A study by Araújo Gde et al. observed
<3 22 7.18±5.03 0.41 that patients aged 0–20 years accounted for nearly half
3-10 49 8.88±5.46 of all cases of dermatophytosis in Paraíba, Brazil. In
>10 29 8.28±3.66 the case of the population considered, students were
DLQI: Dermatology Life Quality Index, SD: Standard deviation, BSA: Body the most common group of age group (16–30 years)
surface area affected than the employees and the homemakers.[15] In
a study conducted by Myfanwy et al., students were the
Table 2: Dermatology Life Quality Index scores ones who were most commonly affected.[16] In a study
DLQI score No. of Patients conducted by Patro et al., the mean DLQI score of the
No effect (0-1) 3 BSA of the patients was found to be 10.06 ± 5.34 (≤10%
Mild (2-5) 32 patients) and 12.60 ± 5.01 (>10% patients).[17] The usage
Moderate (6-10) 42
of topical steroid application was comparatively high,
Very large effect (11-20) 19
where a moderate correlation was found between
Extreme large effect (>20) 4
DLQI scores and use of topical steroids in our study;
DLQI: Dermatology Life Quality Index
similarly predicted in a study done by Dabas et al., an
alarming majority (77%) of cases also revealed using
on the DLQI scores, showing no correlation between the
topical corticosteroid combination creams for the same.
DLQI score and the age [Table 3]. [1]
In a study conducted by Dogra  et al., infection from
the contacts having multiple, affected family members
Discussion significantly impaired the QoL.[6] In the present study,
the data of how total number of family members of the
Dermatophytoses are superficial fungal infections, patient as well as those affected were collected, however
which are caused by keratinophilic dermatophytes.[9] we did not come across a significant correlation between
The current study highlights the effect of the disease in DLQI and the number of family members affected.
certain parts of North Karnataka, using DLQI method,
and measures the QoL of the patients suspected of having The present study focuses on the impact of QoL of patients
dermatophytic infections. suffering from superficial dermatophytosis, also covering
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Doshi, et al.: QoL of dermatophytosis patients

Table 3: Correlation of age, duration of dermatophytosis, topical steroids’ application, and body surface area
with Dermatology Life Quality Index scores
Variables Values No effect Mild Moderate Very large Extreme effect Correlation coefficient
Age ≤15 2 0.06
16-30 0 2 20 1 0
31-60 2 22 19 14 1
>60 1 8 1 4 3
Gender Male 2 16 19 14 1 NA
Female 1 16 23 5 3
Duration <6 3 20 21 11 0 0.18
6-12 0 9 17 8 4
>12 0 3 4 0 0
Use of steroids Yes 0 22 34 17 4 0.32
No 3 10 7 2 0
BSA (%) <3 3 6 10 2 1 0.04
3-10 0 19 15 12 3
>10 0 7 17 5 0
NA: Not applicable, BSA: Body surface area

the prevalence of this disease in the region of North Financial support and sponsorship
Karnataka. Nil.

Limitations Conflicts of interest

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.
Acknowledgment
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.
There are no conflicts of interest.
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