Safety and efficacy of oral itraconazole versus oral itraconazole with isotretinoin in chronic and recurrent superficial dermatophytosis A randomized trial

Dermatophytosis is a superficial cutaneous fungal infection of the keratinized tissues of skin, hair and nails. These infections are very common in India where hot and humid climate in association with poor hygienic conditions play an important role in the growth of these fungi. In the past few years, the chronicity, severity, clinical presentation, relapse rates and resistance to treatment patterns have significantly altered in India.  Various factors such as host, agent, pharmacologic or environmental may be responsible for these alterations. Chronic dermatophytosis is defined as illness that lasts for more than 6 months to 1 year, with or without recurrence, irrespective of the treatment. Recurrent dermatophytosis applies to the re-occurrence of the fungal infection within a few weeks of completion of treatment.  Antifungal drugs like itraconazole, griseofulvin, terbinafine are no longer giving satisfactory results. Such infections are a cause of significant distress to patients socially, financially, and emotionally. In few studies combination of itraconazole and isotretinoin was successfully treated chronic dermatophytosis. It was proposed that retinoids cause desquamation and decrease the fungal colonies from stratum corneum. However there is paucity of literature comparing efficacy of itraconazole versus isotretinoin with itraconazole. In this study, we will evaluate comparative efficacy and safety of oral itraconazole versus oral itraconazole with isotretinoin in chronic and recurrent dermatophytosis.