Chronic Dermatophyte Infection Recalcitrant to Various Antifungal Agents Therapy

Abstract

Chronic dermatophyte infection rarely fails to respond to topical or systemic antifungal

therapy. Such refractory condition relates to many factors and one of them is the

decreased response of delayed type hypersensitivity. A plausible mechanism by which

the delayed hypersensitivity response may cause dermatophyte inhibition has been

proposed already. Our patient had skin rashes for 6 years. It was diagnosed as tinea

corporis and treated with various systemic antifungal agents, such as griseofulvin,

itraconazole, fluconazole, terbinafine and topical forms of econazole and terbinafine. But

the skin lesions did not resolve completely and reaggravated frequently. Numerous

verrucae planar were found on face, neck and both extremities. Trichophyton rubrum

was identified by fungus culture study. Laboratory examination showed no response

against multi-CMI test, DPCP sensitization and prick test for trichophytons. We

challenged the therapy with the combined antifungal agents and immune stimulatory

drugs. This case is thought to be a chronic dermatophyte infection due to the defects in

the both cell mediated immunity and immediate type hypersensitivity which is crucial for

the host defence mechanisms against fungal infection.