Treatment of Recalcitrant Dermatophytosis Using Combined Oral Acyclovir and Oral Antifungal: A Case Series
Main Article Content
Keywords
Dermatophytosis, Recalcitrant dermatophytosis, Acyclovir, Antifungal Therapy, Combination Treatment, Viral co-infections, immune compromise
Abstract
Objective: The purpose of this study was to evaluate the efficacy of combination therapy with oral acyclovir and antifungal drugs in addressing persistent dermatophytosis, particularly in patients with viral co-infections and impaired immune systems. Methods: A prospective study was performed on eight patients with persistent fungal infections who were all treated with a combination of antifungal drugs, oral acyclovir, topical steroids, antihistamines, and supportive care. Patient outcomes were monitored over six months. Recovery time and the efficacy of preventive courses were assessed. Results: All patients were fully recovered within six months. Symptoms subsided within 2-4 weeks, and full recovery occurred in 6-8 weeks. Preventive courses helped to avoid relapses. Combining antiviral and antifungal drugs proved valuable, especially in cases of treatment resistance or recurring infections. Conclusion: The study focuses on the potential benefits of combining oral acyclovir with antifungal medications for treating recalcitrant dermatophytosis. This method is a promising strategy for improving outcomes in difficult cases, particularly for patients with viral co-infections. Further research with controlled studies is necessary to confirm these findings.
References
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31. Shenoy M, Poojari S, Rengasamy M, Vedmurthy M, Barua S, Dhoot D, et al. Management of dermatophytosis: Real-world Indian perspective. Indian Dermatol Online J [Internet]. 2023 May 1 [cited 2024 Oct 5];14(3):347–56. Available from: https://journals.lww.com/idoj/fulltext/2023/14030/management_of_dermatophytosis__real_world_indian.5.aspx
32. Brescini L, Fioriti S, Morroni G, Barchiesi F. Antifungal Combinations in Dermatophytes. Journal of Fungi 2021, Vol 7, Page 727 [Internet]. 2021 Sep 5 [cited 2024 Oct 5];7(9):727. Available from: https://www.mdpi.com/2309-608X/7/9/727/htm
33. Capoci IRG, Faria DR, Sakita KM, Rodrigues-Vendramini FAV, Bonfim-Mendonça P de S, Becker TCA, et al. Repurposing approach identifies new treatment options for invasive fungal disease. Bioorg Chem. 2019 Mar 1;84:87–97.
34. Peyclit L, Yousfi H, Rolain JM, Bittar F. Drug Repurposing in Medical Mycology: Identification of Compounds as Potential Antifungals to Overcome the Emergence of Multidrug-Resistant Fungi. Pharmaceuticals [Internet]. 2021 May 1 [cited 2024 Oct 5];14(5). Available from: /pmc/articles/PMC8161392/
35. Mochizuki T, Tsuboi R, Iozumi K, Ishizaki S, Ushigami T, Ogawa Y, et al. Guidelines for the management of dermatomycosis (2019). J Dermatol [Internet]. 2020 Dec 1 [cited 2024 Oct 5];47(12):1343–73. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/1346-8138.15618
36. Malcolm TR, Chin-Hong P V. Endemic Mycoses in Immunocompromised Hosts. Curr Infect Dis Rep [Internet]. 2013 Dec [cited 2024 Oct 5];15(6):536. Available from: /pmc/articles/PMC4939090/
37. Kumar S, Kaur A, Kaur S. Autoimplantation Therapy in Extensive and Recalcitrant Dermatophytosis: A Case Series. J Clin Aesthet Dermatol [Internet]. 2021 Jan 1 [cited 2024 Oct 5];14(1):34. Available from: /pmc/articles/PMC7869813/
38. Azim A, Ahmed A. Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review. Front Cell Infect Microbiol. 2024 Mar 5;14:1256158.
39. Shenoy MM, Rengasamy M, Dogra S, Kaur T, Asokan N, Sarveswari KN, et al. A multicentric clinical and epidemiological study of chronic and recurrent dermatophytosis in India. Mycoses. 2022 Jan 1;65(1):13–23.
40. Kavya C, Sara Thampi A, S MB, Thejaswi SR, Hosthota D, Hosthota A. CLINICO-MYCOLOGICAL STUDY OF DERMATOPHYTOSIS IN A TERTIARY CARE CENTRE. [cited 2024 Oct 5]; Available from: https://doi.org/10.48047/AFJBS.6.7.2024.4047-4053
41. Singh BhabaniSTP, Tripathy T, Kar B, Ray A. Clinicomycological study of dermatophytosis in a tertiary care hospital in eastern India: A cross-sectional study. Indian Dermatol Online J [Internet]. 2020 [cited 2024 Oct 5];11(1):46. Available from: https://journals.lww.com/idoj/fulltext/2020/110
2. Ng’ang’a Z, Wambura M, Ogutu M, Namasaka M. Superficial mycoses among psychiatric patients in Mathari hospital, Nairobi, Kenya. East Afr Med J [Internet]. 2010 [cited 2024 Sep 18];87(9).
3. Del Boz-González J. Tinea Capitis: Trends in Spain. Actas Dermo-Sifiliográficas (English Edition). 2012 May 1;103(4):288–93.
4. Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol. 2010 Mar 1;28(2):197–201.
5. Sahin I, Oksuz S, Kaya D, Sencan I, Çetinkaya R. Dermatophytes in the rural area of Duzce, Turkey. Mycoses [Internet]. 2004 Dec 1 [cited 2024 Sep 19];47(11–12):470–4.
6. Klevan J. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 17th Edition. American Journal of Health-System Pharmacy [Internet]. 2012 May 1 [cited 2024 Sep 19];69(9):806–806. Available from: https://dx.doi.org/10.1093/ajhp/69.9.806
7. Goldstein AO, Smith KM, Ives TJ, Goldstein B. Mycotic infections. Effective management of conditions involving the skin, hair, and nails. Geriatrics. 2000 May;55(5):40–2, 45–7, 51–2.
8. Robinson J. Fungal skin infections in children. Nursing Standard. 2012 Nov 14;27(11):52–8.
9. Hainer BL. Dermatophyte infections. Am Fam Physician. 2003 Jan 1;67(1):101–8.
10. Jagdish Chander. Dermatophytoses. In: Textbook of Medical Mycology. 3rd ed. New Delhi: Mehta publishers; 2009.
11. Fungal Infections Diagnosis and Treatment: 1/e 2017 - Kabir Sardana - بتك Google [Internet]. [cited 2024 Sep 19].
12. Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive? Indian Dermatol Online J [Internet]. 2016 [cited 2024 Sep 19];7(2):73. Available from: https://pubmed.ncbi.nlm.nih.gov/27057485/
13. Ebert A, Monod M, Salamin K, Burmester A, Uhrlaß S, Wiegand C, et al. Alarming India-wide phenomenon of antifungal resistance in dermatophytes: A multicentre study. Mycoses [Internet]. 2020 Jul 1 [cited 2024 Sep 19];63(7):717–28. Available from: https://pubmed.ncbi.nlm.nih.gov/32301159/
14. Jain A, Dhamale S, Sardesai V. Factors responsible for difficult to treat superficial fungal infections: A study from a tertiary healthcare centre in India. Mycoses [Internet]. 2021 Nov 1 [cited 2024 Sep 19];64(11):1442–7. Available from: https://pubmed.ncbi.nlm.nih.gov/33966290/
15. Wang Y, Pawar S, Dutta O, Wang K, Rivera A, Xue C. Macrophage Mediated Immunomodulation During Cryptococcus Pulmonary Infection. Front Cell Infect Microbiol [Internet]. 2022 Mar 24 [cited 2025 Jan 17].
21. Johnson KE, Chikoti L, Chandran B. Herpes Simplex Virus 1 Infection Induces Activation and Subsequent Inhibition of the IFI16 and NLRP3 Inflammasomes. J Virol [Internet]. 2013 May [cited 2025 Jan 17];87(9):5005. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3624293/
22. Miettinen JJ, Matikainen S, Nyman TA. Global Secretome Characterization of Herpes Simplex Virus 1-Infected Human Primary Macrophages. J Virol [Internet]. 2012 Dec [cited 2025 Jan 17];86(23):12770. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3497699/
23. Verma S, Madhu R. The Great Indian Epidemic of Superficial Dermatophytosis: An Appraisal. Indian J Dermatol [Internet]. 2017 May 1 [cited 2024 Oct 5];62(3):227. Available from: /pmc/articles/PMC5448256/
24. Rengasamy M, Chellam J, Ganapati S. Systemic therapy of dermatophytosis: Practical and systematic approach. Clinical Dermatology Review [Internet]. 2017 [cited 2024 Oct 5];1(3):19. Available from: https://journals.lww.com/cddr/fulltext/2017/01001/systemic_therapy_of_dermatophytosis__practical_and.4.aspx
25. Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J [Internet]. 2016 [cited 2024 Oct 5];7(2):77. Available from: /pmc/articles/PMC4804599/
26. Martinez-Rossi NM, Peres NTA, Bitencourt TA, Martins MP, Rossi A. State-of-the-Art Dermatophyte Infections: Epidemiology Aspects, Pathophysiology, and Resistance Mechanisms. Journal of Fungi [Internet]. 2021 Aug 1 [cited 2024 Oct 5];7(8). Available from: /pmc/articles/PMC8401872/
27. Ebert A, Monod M, Salamin K, Burmester A, Uhrlaß S, Wiegand C, et al. Alarming India-wide phenomenon of antifungal resistance in dermatophytes: A multicentre study. Mycoses [Internet]. 2020 Jul 1 [cited 2024 Oct 5];63(7):717–28. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/myc.13091
28. Verma SB, Panda S, Nenoff P, Singal A, Rudramurthy SM, Uhrlass S, et al. The unprecedented epidemic-like scenario of dermatophytosis in India: III. Antifungal resistance and treatment options. Indian J Dermatol Venereol Leprol [Internet]. 2021 Jun 30 [cited 2024 Oct 5];87(4):468–82. Available from: https://www.ijdvl.com/the-unprecedented-epidemic-like-scenario-ofdermatophytosis-in-india-iii-antifungal-resistance-and-treatment-options/
29. Gu D, Hatch M, Ghannoum M, Elewski BE. Treatment-resistant dermatophytosis: A representative case highlighting an emerging public health threat. JAAD Case Rep [Internet]. 2020 Nov 1 [cited 2024 Oct 5];6(11):1153. Available from: /pmc/articles/PMC7591325/
30. Jartarkar SR, Patil A, Goldust Y, Cockerell CJ, Schwartz RA, Grabbe S, et al. Pathogenesis, Immunology and Management of Dermatophytosis. Journal of Fungi [Internet]. 2022 Jan 1 [cited 2024 Oct 5];8(1). Available from: /pmc/articles/PMC8781719/
31. Shenoy M, Poojari S, Rengasamy M, Vedmurthy M, Barua S, Dhoot D, et al. Management of dermatophytosis: Real-world Indian perspective. Indian Dermatol Online J [Internet]. 2023 May 1 [cited 2024 Oct 5];14(3):347–56. Available from: https://journals.lww.com/idoj/fulltext/2023/14030/management_of_dermatophytosis__real_world_indian.5.aspx
32. Brescini L, Fioriti S, Morroni G, Barchiesi F. Antifungal Combinations in Dermatophytes. Journal of Fungi 2021, Vol 7, Page 727 [Internet]. 2021 Sep 5 [cited 2024 Oct 5];7(9):727. Available from: https://www.mdpi.com/2309-608X/7/9/727/htm
33. Capoci IRG, Faria DR, Sakita KM, Rodrigues-Vendramini FAV, Bonfim-Mendonça P de S, Becker TCA, et al. Repurposing approach identifies new treatment options for invasive fungal disease. Bioorg Chem. 2019 Mar 1;84:87–97.
34. Peyclit L, Yousfi H, Rolain JM, Bittar F. Drug Repurposing in Medical Mycology: Identification of Compounds as Potential Antifungals to Overcome the Emergence of Multidrug-Resistant Fungi. Pharmaceuticals [Internet]. 2021 May 1 [cited 2024 Oct 5];14(5). Available from: /pmc/articles/PMC8161392/
35. Mochizuki T, Tsuboi R, Iozumi K, Ishizaki S, Ushigami T, Ogawa Y, et al. Guidelines for the management of dermatomycosis (2019). J Dermatol [Internet]. 2020 Dec 1 [cited 2024 Oct 5];47(12):1343–73. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/1346-8138.15618
36. Malcolm TR, Chin-Hong P V. Endemic Mycoses in Immunocompromised Hosts. Curr Infect Dis Rep [Internet]. 2013 Dec [cited 2024 Oct 5];15(6):536. Available from: /pmc/articles/PMC4939090/
37. Kumar S, Kaur A, Kaur S. Autoimplantation Therapy in Extensive and Recalcitrant Dermatophytosis: A Case Series. J Clin Aesthet Dermatol [Internet]. 2021 Jan 1 [cited 2024 Oct 5];14(1):34. Available from: /pmc/articles/PMC7869813/
38. Azim A, Ahmed A. Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review. Front Cell Infect Microbiol. 2024 Mar 5;14:1256158.
39. Shenoy MM, Rengasamy M, Dogra S, Kaur T, Asokan N, Sarveswari KN, et al. A multicentric clinical and epidemiological study of chronic and recurrent dermatophytosis in India. Mycoses. 2022 Jan 1;65(1):13–23.
40. Kavya C, Sara Thampi A, S MB, Thejaswi SR, Hosthota D, Hosthota A. CLINICO-MYCOLOGICAL STUDY OF DERMATOPHYTOSIS IN A TERTIARY CARE CENTRE. [cited 2024 Oct 5]; Available from: https://doi.org/10.48047/AFJBS.6.7.2024.4047-4053
41. Singh BhabaniSTP, Tripathy T, Kar B, Ray A. Clinicomycological study of dermatophytosis in a tertiary care hospital in eastern India: A cross-sectional study. Indian Dermatol Online J [Internet]. 2020 [cited 2024 Oct 5];11(1):46. Available from: https://journals.lww.com/idoj/fulltext/2020/110
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Mar 12, 2026
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Treatment of Recalcitrant Dermatophytosis Using Combined Oral Acyclovir and Oral Antifungal: A Case Series. Pharm Pract (Granada) [Internet]. 2026 Mar. 12 [cited 2026 Mar. 26];24(1):1-11. Available from: https://pharmacypractice.org/index.php/pp/article/view/3252
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How to Cite
1.
Treatment of Recalcitrant Dermatophytosis Using Combined Oral Acyclovir and Oral Antifungal: A Case Series. Pharm Pract (Granada) [Internet]. 2026 Mar. 12 [cited 2026 Mar. 26];24(1):1-11. Available from: https://pharmacypractice.org/index.php/pp/article/view/3252