Deficult to treat recalcitrant tinea

Dermatophytosis is a superficial fungal infection of keratinized tissue of the skin. Dermatophytes, which are keratophilic organisms that have the ability to invade hair, nails, and the skin, total 39 species that are closely related to one another across the following three genera: Microsporum, Trichophyton, and Epidermophyton.1 These organisms metabolize keratin and trigger a range of pathologic clinical presentations, including tinea corporis, tinea cruris, and tinea faciale.2 The lesions may become widespread and may have significant negative social, economic, psychological, and occupational health effects and can affect the quality of life significantly.3 High humidity, overcrowding, and poor hygienic conditions are predisposing factors for dermatophytosis, making it a major public health concern in many countries.4

Dermatophytosis is one of the most common skin diseases worldwide, especially in developing countries like India.5 Recently reported prevalence rates of dermatophytosis in India range from 36.6% to 78.4%.6 Various antifungal agents (e.g., itraconazole, terbinafine, and fluconazole) used in conventional regimens appear to have lost their relevance in the current clinical scenario.7 There is a rising trend of patients experiencing relapse following the cessation of antifungal therapy, which has not been conclusively proven to be consequent to drug resistance.5 Possibly, there may be other factors that play a role, including the host immune response and impaired barrier functioning of the epidermis. The use of corticosteroids in fixed-dose combinations (FDCs) with antifungals and their misuse may also account for such relapses.

Healthy individuals have adequate immunity against fungal infections, but such infections are increasing very rapidly8,9 and cell-mediated immunity appears to be of particular importance in this context.

Homologous autoimplantation is a simple technique that works by inducing cell-mediated immune response against the antigens essential for the clearance of dermatophytes. It has already provoked a good clinical response in patients with verruca vulgaris in various clinical studies.12,13 Here, we present a case series of three patients with difficult-to-treat and recalcitrant dermatophytosis who were treated with homologous autoimplantation.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869813/