Irrational and Erroneous Use of Harmful Topical and Systemic Agents in the Treatment of 'Superficial Fungal Infection' in Bangladesh: A Cross-Sectional Study

Background: Superficial fungal infections (SFI) are the most common dermatological diseases worldwide, with a prevalence rate of 20%–25%. Topical antifungals are effective in circumscribed areas of the skin surface. Some topical antifungals exhibit anti-inflammatory and antibacterial effects as well as antifungal activity, and are indicated for infections with inflammation and potential bacterial infection. Topical corticosteroid should be avoided as it may lead to suppression of signs of infection.

Objective: To find out the medication used by the patients with SFI before consulting a dermatologist.

Materials and method: This study was conducted in the department of Dermatology of Noakhali Medical College, Bangladesh. During the period of August’22 to September’22. The study was approved by ethical committee of the same institute. Patients’ permission was taken. Patients’ particulars and drug history were noted in a data collection sheet. 29 patients were purposively selected from a private chamber of a dermatologist in a rural setting.

Result: The mean ±SD age of the patients was 34.34±13.17 years (1 to 55 years). Males were 12(41.38%). Among the participants 27 (93.1%) patients took both oral and topical medication and only 2(6.9%) patients took only oral medication. Three (10.34%) patients took systemic steroid: betamethasone 0.5mg by 1(3.45%) patient, deflazacort 6mg by 1(3.45%) patient and dexamethasone 0.5mg by 1(3.45%) patient. Fluconazole, itraconazole, terbinafine and voriconazole were taken by 5(17.24%), 8(27.58%), 8(27.58%), and 3(10.34%) patients respectively. Regarding topical agents, 16(55.17%) patients used antifungal + steroid, 3(10.34%) antifungal+ antibiotic + steroid, 3(10.34%) steroid + antibiotic, 16(55.17%) used only antifungal, 3(10.34%) used only antibiotic, 7(25.92%) used miscellaneous agents having no antifungal activity.

Conclusion: Patients with SFI use different systemic and topical medications before attending a dermatologist. Some of those medicine have no indication for SFI, some cause acute irritant contact dermatitis and use of topical steroids suppresses the disease temporarily which makes diagnosis delay.