Skin Barrier Function Defect - A Marker of Recalcitrant Tinea Infections

CONTEXT: Recently, there has been an increase in the number of chronic, recurrent, and recalcitrant dermatophytosis. Many factors implicated are barrier defects, aberrant host immune response, application of steroids or other irrational combination creams, transmission within family, occlusive clothing, poor hygienic conditions, poor compliance, drug resistance and virulence of the infecting strain. Transepidermal water loss (TEWL) is an important index in accessing the barrier function of skin. AIM: To ascertain the role of TEWL from the lesional skin and its effect on the cure rate and relapse in patients of tinea cruris. MATERIALS AND METHOD: A hospital based prospective comparative study was conducted for 1 year. A total of 200 patients of tinea cruris diagnosed clinically and by KOH examination, were included in the study. TEWL was calculated using Tewameter TM300 open chamber probe of Courage and Khazaka, Cologne, Germany. Patients were classified according to the TEWL values into Group A (patients with abnormal TEWL) and Group B (normal TEWL). Both groups were given oral itraconazole and antihistamines for 4 weeks. The cure rates and recurrence rates of both the groups were analyzed and compared. RESULTS: In the Group A, i.e., patients of tinea cruris with abnormal TEWL, only 28% of the patients showed clinical improvement at the end of 1 month. Out of those cured, 78.57% of the cases showed recurrence after 2 months of completion of therapy. In Group B, i.e., patients of tinea cruris with normal TEWL, 69% (n = 69) of the patients showed clinical improvement at the end of 1 month. Out of those cured, only 21.74% of the cases (n = 15) showed recurrence. CONCLUSION: The cases of tinea cruris with abnormal TEWL show significant decrease in cure rates and significant relapse rates among those initially cured.