Assessment of Quality of Life in Patients with Superficial Dermatophytosis: A Cross-sectional Study

Devanshi Nimbark^1* , Bhavesh Astik², Hita Mehta³, Vivek Nimbark¹, Manal Dave⁴

¹Consultant Dermatologist at Umang Skin clinic, Bhavnagar, India

²Professor and Head of Department, GMERS Himatnagar, Gujarat, India

³Professor and Head of Department, Sir Takhtasinhji and Government Medical College, Bhavnagar, India

⁴Consultant Dermatologist at Sterling Hospital, Ahmedabad, India

*Correspondence author: Devanshi Nimbark, Consultant Dermatologist at Umang Skin clinic, Bhavnagar, India; Email: [email protected]

Citation: Nimbark D, et al. Assessment of Quality of Life in Patients with Superficial Dermatophytosis: A Cross-sectional Study. J Dermatol Res. 2026;7(1):1-14.

Copyright: © 2026 The Authors. Published by Athenaeum Scientific Publishers.

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL: https://creativecommons.org/licenses/by/4.0/

Objective: Evaluate the quality of life of individuals with chronic (>3 months) dermatophyte infection.

Materials and Methods: The study received approval from the Institute’s Ethics Committee. After obtaining written informed consent, consecutive individuals with superficial cutaneous dermatophytosis infection older than 18 years were invited to participate. 306 cases of tinea infection were enrolled. Based on the patient’s medical history and a physical examination of lesions, a diagnosis was made. In cases of dispute, a potassium hydroxide mount of lesion scrapings was used for microscopic evaluation.

The following clinical parameters were recorded: disease duration (3 months, 3-6 months or >6 months), symptoms, family history, treatment history, clinical type and total Body Surface Area (BSA) involvement along with occupation and marital history. Dermatology Life Quality Index (DLQI) questionnaires were given to all the patients and the total score was calculated.

Results: Among 306 patients, 149 were male and 157 females with the maximum number of patients having a combination of tinea corporis and cruris. Patients with increased BSA, increased duration of infection, family history of infection and past history of treatment significantly impaired quality of life. The mean DLQI + Standard Deviation (SD) of our study was 16.539 + 6.69377. The most impaired aspect of the DLQI questionnaire was due to skin symptoms and the other was embarrassment due to itching and cosmetic disfigurement. Gender and age had no correlation with the DLQI score.

Conclusion: We found a very large effect on the Quality of Life of the patients and a greater impact with a longer duration of disease, multifocal distribution of the lesion leading to increased body surface area involvement and family history of tinea infection. However, there was no gender as well as age correlation with DLQI scoring. In conclusion, persistent and recurrent dermatomycosis causes patients tremendous social, emotional and financial distress. Thus, the study emphasizes the necessity of counseling in conjunction with effective dermatophytosis treatment.

Keywords: Superficial Dermatophytosis; Body Surface Area; Quality of Life

Introduction

Dermatophyte infections of the skin, hair and nails are among the most common infectious dermatoses worldwide, affecting approximately 20-25% of the global population [1]. Dermatophytosis is a superficial fungal infection caused by species of the genera Microsporum, Trichophyton and Epidermophyton [2]. Over the past few decades, the prevalence of superficial mycotic infections has increased globally. However, their distribution and clinical patterns vary according to geographic location, socioeconomic status and cultural practices [1,3].

In tropical countries such as India, fungal infections are highly prevalent due to climatic conditions, including heat and humidity, along with socioeconomic factors such as overcrowding and inadequate hygiene [4-7]. In recent years, India has witnessed a marked increase in chronic, recurrent and treatment-resistant dermatophytosis. This has been largely attributed to the misuse of topical corticosteroid-containing fixed-dose combinations and inappropriate antifungal therapy, leading to altered clinical presentations and prolonged disease courses [8,9].

Beyond physical symptoms such as pruritus, scaling and discomfort, dermatophytosis has substantial psychosocial consequences. Chronicity, frequent relapses and visible lesions particularly on exposed body parts can lead to embarrassment, social withdrawal, reduced self-esteem, impaired sexual relationships and decreased work productivity [10,11]. Since most affected individuals belong to the economically productive and socially active age group, these impairments may result in significant personal, social and financial burden.

The World Health Organization defines Quality of Life (QoL) as an individual’s perception of their position in life in relation to their goals, expectations and cultural context [12]. In dermatological diseases, quality of life assessment has emerged as an important clinical outcome, as it reflects the overall disease burden from the patient’s perspective. Evaluation of QoL helps clinicians understand the psychological and social impact of skin diseases, assess treatment effectiveness, guide therapeutic decision-making and identify patients who may benefit from additional counseling and psychosocial support [13].

In dermatophytosis, routine clinical evaluation primarily focuses on lesion morphology, body surface area involvement and mycological cure. However, these parameters do not adequately capture the subjective suffering experienced by patients. Patients with similar clinical severity may experience markedly different levels of distress and functional impairment. Therefore, incorporating quality of life assessment into routine management is clinically important to ensure comprehensive, patient-centered care.

Although several studies have investigated the epidemiology, clinical patterns and therapeutic aspects of dermatophytosis, relatively few studies have systematically evaluated its impact on quality of life using validated instruments, particularly in patients with chronic and recurrent infections [14,15]. Moreover, existing studies are limited by smaller sample sizes, regional variations and inconsistent assessment of associated demographic and clinical factors. Data from Western India, where dermatophytosis has reached epidemic proportions, remain scarce. There is also limited evidence regarding the relationship between quality-of-life impairment and key disease-related variables such as duration of infection, body surface area involvement, type of tinea, prior treatment history and family history of infection. Understanding these associations is essential for identifying high-risk groups and tailoring management strategies accordingly. In view of these gaps, the present study was undertaken to assess the quality of life in patients with dermatophytosis attending a tertiary care center using the Dermatology Life Quality Index (DLQI) and to analyze its association with various demographic and clinical parameters. By providing region-specific data on the psychosocial burden of dermatophytosis, this study aims to emphasize the importance of holistic management and support the integration of quality-of-life assessment into routine clinical practice.

Materials and Methods

Study Design

Cross-Sectional study

Study Area

Out Patient Department of Dermatology, Government Medical College and Sir T Hospital, Bhavnagar.

Duration of Study

6 months from June 2022 to November 2022.

Study Population

Clinically diagnosed patients of tinea attending the Out-Patient Department of Dermatology, Sir T Hospital, Bhavnagar. When in doubt, a microscopic examination of the KOH mount of the scrapings from the lesion was performed.

Sample Size

We enrolled a total of 306 cases. We used the Consecutive sampling method for the selection of study subjects during the study duration. Thus, a total of 306 cases after giving informed consent and fulfilling eligibility criteria were taken for the study.

Inclusion Criteria

• Dermatophytosis infection for >3 months
• Age 18-65 years

Exclusion Criteria

• Based on a semi-structured interview, patients with concomitant illnesses such as cardiovascular illness, hepatic, renal and CNS diseases, previously diagnosed psychiatric illnesses and other dermatological conditions, which could influence their QoL, were excluded, as were patients who had suffered a recent serious life event
• Pregnant/Lactating females and patients with disease duration of <3 months
• Patients on any long-term (3 months) medication

The study received approval from the Ethics Committee of the Government Medical College, Bhavnagar, with the approval no. 1147/2022. After obtaining written informed consent, consecutive individuals were invited to participate. Based on the patient’s medical history and a physical examination of lesions, a diagnosis was made. In cases of dispute, a potassium hydroxide mount of lesion scrapings was used for microscopic evaluation. The following clinical parameters were recorded: disease duration (90-120 days, 120-180 days or >180 days), symptoms, family history, treatment history, clinical type and total Body Surface Area (BSA) involvement, along with occupation and marital history. Body Surface Area was calculated using the “Rule of Palm.” Together, the patient’s palm and five digits accounted for 1% of the total palmar surface area. Body Surface Area (in%) involvement was evaluated in the following groups: <5%, 6 to 10% and >10%. To minimise inter-observer variability, a single trained Dermatologist performed all BSA measurements using a standardised measurement protocol. The variables included in the study were age, gender, disease duration, site of involvement/regional diagnosis, BSA, occupation and DLQI.

The validated Hindi version of the original DLQI questionnaire which Finlay and Khan introduced in 1994 was collected for this study [16,17]. Questions were explained to the patient and they were told to fill out the form by themselves. Patients who could not read in either of the 2 languages (English or Hindi) were helped by an attendant to fill out the questionnaires.

Table 1: DLQI bandwidth.

The DLQI consists of 10 multiple-choice questions, with points ranging from “0” to “3” for each question. Each answer is scored as “not at all” for score 0, “a little” for score 1, “a lot” for score 2 and “very much” for score 3. The final score was determined by adding together all the points earned. The minimum score is 0; the maximum score is 30. The higher the score, the greater the reduction in quality of life. The questionnaire has been divided into 6 contexts: symptoms and feelings (questions 1 and 2), everyday tasks (questions 3 and 4), leisure (questions 5 and 6), workplace and education (question 7), personal relationships (questions 8 and 9) and treatment (question 10).

Interpretation of the questionnaire was done as follows: DLQI Scoring- The bands of DLQI is according to Hongbo, et al., [18].

Data thus collected were entered in Microsoft Excel 2019 Worksheet in the form of a master chart. These data were classified and analyzed as per the aim and objectives. Means and Standard Deviations (SD) for continuous variables and frequency and percentage for categorical variables were used to describe data. Qualitative data were expressed in the form of percentages and the association with DLQI was measured by Linear regression using one way ANOVA table in GraphPad. The association was checked between gender, body surface area, duration of infection, type of tinea and DLQI score. Mendeley’s desktop application was used for reference management in this study. For the graphical representation of data, MS Excel and MS word were used to obtain various types of graphs such as bar diagrams and pie charts. All two‐tailed tests were considered statistically significant at P value <0.05.

Results

A total of 306 patients were taken among which 157 were female and 149 were male. Age ranged from 18 to 65 years divided into 3 groups 18-30, 31-50 and 51-65. In our study females outnumbered males and the maximum number of patients were in the age group 31-50. Demographic features along with occupation and marital details are detailed below Table 2, Fig. 1.

Table 2: Demographic details.

Figure 1: Bar diagram showing demographic details.  

3 types of tineas were considered in our study, tinea corporis, tinea facei and tinea cruris and total duration was divided into 3 groups from <3 months, 3-6 months and >6 months. The combination of tinea cruris and corporis outnumbered all the other categories Table 3, Fig. 2,3.

Figure 2: Pie chart showing types of tineas.

Table 3: Duration of infection according to the proportion of cases.

Figure 3: Bar diagram showing the occupation of the patients.

As females outnumbered males in our study, the maximum number of females were housewives as shown in the below chart. Information regarding the prior topical application on the lesion as well as similar complaints of tinea infection in the family was also asked from the participants Table 4.

Table 4: Proportion of cases with a family history of infection and past history of treatment.

Body surface area was calculated by the ‘Rule of Palm’ considering the whole palm including the finger as 1%. The maximum number of patients had 6-10% involvement as shown below Table 5.

Table 5: Proportion of cases according to the body surface area involvement.

The DLQI score ranges from a minimum of 0 to a maximum of 30 and it is divided into different bands according to the effect on the quality of life, the highest 153(50%) participants were in the range of 11-20, showing a large effect on their quality of life, 90(29.4%) participants showing an extremely large effect and moderate to small effect in 40(13.07%) and 21(6.86%) respectively and only 2(0.65%) participants had no effect on their quality of life Table 6,7.

Table 6: Distribution of cases according to DLQI Bandwidth.

Table 7: Mean DLQI according to gender and age.

Table 8 shows that Age has no statistically significant correlation with DLQI Score. The Mean DLQI Score is higher in case of females compared to males; however, it is also seen that there is no statistically significant correlation between Gender and DLQI score (Table 9).

Table 8: Association of demographic features with DLQI score.

Table 9: Association of BSA and Duration with DLQI score.

The below scatter diagram and Linear regression show that there is an increase in DLQI score with the increase in Body surface area Fig. 3.

Figure 4: Scatter diagram and regression line between BSA and DLQI score.

The below scatter diagram and Linear regression between duration and DLQI score show that there is an increase in DLQI score with the increase in the duration of infection Fig. 4.

Figure 5: Scatter diagram and regression line between duration and DLQI score.

The mean DLQI score was highest in patients having all the 3 types of tineas affecting the QOL severely (Table 10).

Table 10: Mean DLQI among different type of tineas.

Individual questions were analysed to see which question had the maximum effect on the score along with their mean DLQI (Fig. 6).

Figure 6: Line diagram between question and Mean DLQI.

DLQI correlation with occupation was also statistically significant. Labourers had comparatively lower DLQI scores, indicating lesser impairment of QOL, whereas Office workers and housewives had a significant effect (Table 11, Fig. 7).

Figure 7: Clustered column chart according to individual question.

Table 11: Association between occupation and DLQI score.

According to the history elicited from all the patients, prior treatment taken in the form of topical triple combinations or any antifungals in past had a significant effect on the patient’s quality of life compared to those who were treatment naïve patients (Table 12, Fig. 8).

Figure 8: Bar chart showing association between prior history of treatment and Mean DLQI score.

Table 12: Association between Prior history of treatment and DLQI score.

The association between prior history of treatment compared to treatment naïve patients showed a statistically significant positive correlation with DLQI score (Table 13, Fig. 9).

Table 13: Association between Family history of infection and DLQI score.

The scatter diagram shows a statistically significant positive correlation between a family history of tinea infection and DLQI.

Figure 9: Scatter diagram and regression line between family history of treatment and DLQI score.

Discussion

Dermatophytes are divided into three genera, namely Trichophyton, Microsporum and Epidermophyton, according to the shape of micro and macroconidia produced during asexual reproduction. They obtain their sustenance by infecting keratin-rich host surfaces, such as skin, hair and nails. The prevalence of dermatophytosis in a community is influenced by climate and way of life. Tropical locations’ hot and humid climates and overpopulation increase the risk of dermatophyte diseases. Increased urbanization, tight synthetic clothing, the sharing of fomites, the usage of occlusive footwear, community baths and sports have also been connected to the rising incidence [18,20]. Recently, it has become increasingly difficult for dermatologists to address the daily increase in chronic and recurrent cases. Chronic dermatophytosis is defined as a disease duration of >6 months to 1 year, with or without recurrence in spite of treatment [19]. Recurrent dermatophytosis was formerly referred to arbitrarily as the recurrence of the infection within a few weeks following treatment but is now defined as the recurrence of the infection within six weeks of stopping appropriate antifungal therapy, with at least two episodes within six months [21]. In addition to the atypical and emerging types of dermatophytosis, recurring infections, often known as tinea recidivans, are highly common throughout India. Instead of resistant organisms, robust organisms are responsible for manifestations. Resistance is characterized by a lack of therapeutic response, whereas recidivans or recurring forms are characterized by an initial treatment response followed by relapse within a week of quitting medication or while on treatment. It is characterized by the appearance of lesions along the edges of the healing patches [22]. Chronic and recurring dermatophytosis is not only a cause for concern for the patient and their family but also a difficulty for the treating physician.

There is numerous literature available on the effect of chronic dermatological disorders like psoriasis, vitiligo and alopecia on the quality of life but very minimal on acute conditions like dermatophyte infection which eventually is also coming under chronic infective disorder and detrimentally impacts the quality of life secondary to the uncontrollable pruritus causing hindrance in the work-life as well as the aesthetic humiliation brought on by the lesion’s prominent visibility.

Quality of Life (QoL) refers to a person’s overall wellness, which includes their physical, sexual, social, psychological, educational, occupational and financial well-being. A healthy body is the most crucial factor and even the slightest ailment can have an impact on all elements of quality of life [19].

The DLQI consists of 10 multiple-choice questions, with points for each question ranging from “0” to “3”; each question is scored as “not at all” for a score of 0, “a little” for a score of 1, “a lot” for a score of 2 and “very much” for a score of 3. The final score was determined by adding together all the points earned. Minimum score is 0; maximum score is 30. The higher the score, the greater the reduction in quality of life. Questionnaire was grouped into 6 domains: symptoms and feelings (question 1 and 2), everyday activities (question 3 and 4), leisure (question 5 and 6), job and school (question 7), personal connections (question 8 and 9) and treatment (question 10). DLQI Scoring0-1-No effects on the patient’s life, 2-5-Small effect on the patient’s life, 6-10-Moderate effect on the patient’s life, 11-20-Very large effect on the patient’s life, 21-30-Extremely huge effect on the patient’s life.

In our study male to female ratio was 1:1.5 and the total sample size was 306 among which 149 were male and 157 females showing female preponderance as observed in the study done by Patro, et al., [23]. The mean DLQI score of female patients was 18.089 + 6.69377 and that of the male was 15.926 + 6.73421. The mean DLQI score was higher in females compared to males; however, no statistically significant correlation was found with DLQI similar to the study conducted by Shivani, et al., [24]. The majority of the patients (n=131) were in the age group 31-50 as this age group is most susceptible to work outside, with a mean DLQI score of 17.503 + 6.69377, but the association of age with DLQI score was insignificant as observed in the study by Das NK, et al., [25].

Assessing the QoL of patients according to the DLQI questionnaire as evident in the results section, we found a very large effect (score 11-20) on QOL in 50% of our patients. The mean DLQI score of the study was 16.539 + 6.69377. There was no effect on DLQI in 2 patients (0.65%), a small effect in 21 patients (6.86%), a moderate effect in 40 (13.07%) patients, a very large effect in 153 (50%) patients and an extremely large in 90 (29.4%) on patients. With regard to individual aspects of the DLQI questionnaire, the skin symptoms (itchy, sore, painful, stinging) were the most frequently affected aspect with the mean DLQI of 2.43 + 0.685, followed by impact on embarrassment/self-consciousness then influence on clothing, impact on working/studying followed by impact on social/leisure activity as seen in the below Fig. 10.

Figure 10: Impact on social/leisure activity.

The least affected aspects of our study were sports and sexual difficulties with a mean DLQI of 1.09+1.04 and 1.25+1.14 respectively, similar to the study conducted by Patro, et al., [23].

 Out of 306 patients, 121(39.5%) presented with 6-10% BSA involvement and 120(39.2%) with <5% and only 65(21.2%) with >10% involvement. There was a statistically significant positive correlation between BSA and DLQI score (P value <0.0001%). The duration of infection was divided into 3 categories, > 3 months, 3-6 months and > 6 months; the maximum number of patients (45%) in 3 months category, 31% of patients in > 6 months and 24% patients in 3-6 months unlike the study conducted by Shivani,  et al., where higher number of patients were having a history of 1-month duration only [24]. There is a statistically significant positive correlation between the duration of disease and DLQI score as shown in Table 6 [9]. Patients with 3 months duration generally came after multiple treatments in past and those with >6 months were patients with recurrence after remission. The majority of patients were having infection for 3 months as treatment duration generally lasts for 3 months but when the body surface area involvement was more, duration also increased due to delay in remission. Another way of viewing this is patients usually take treatment on their own for 3 months and later on when the infection still persists, they come to a tertiary care center. However, when tinea facei was present due to cosmetic disfigurement patients generally came earlier compared to other tineas.

The clinical subtypes we enrolled in were Tinea cruris, corporis and facei. The highest number of patients 36.9% presented with a combination of tinea cruris and tinea corporis, 20.3% with only tinea cruris, 18.3% with only tinea corporis, 10.5% with a combination of tinea cruris + tinea corporis + tinea facei, 4.9% with a combination of tinea corporis and facei and only 4.6% with tinea cruris + facei and only facei. Similar findings were observed in other studies where tinea corporis and cruris were the highest in number [23,24]. There was a statistically significant correlation between the DLQI score and the type of tinea, with an increase in DLQI when the face was involved. 

In comparison among the different occupations, office workers and housewives had a severe effect on their QOL showing a positive correlation with DLQI score and minimal effects were observed in other occupations. Patients with a family history of tinea infection and a history of prior treatment taken were also having a significant effect on their QOL due to an increase in chronicity secondary to infection in the family and side effects and financial damage due to past treatments without any improvement in the condition.

In addition to physical examination, the QOL scores can also be utilized as an effective method for evaluating the efficacy of treatment. Expensive therapies or significant resources involved with managing certain cutaneous or extracutaneous problems are appropriate when it can be proved that the disease has a very big to extremely large influence on the Quality-of-Life scores [26-28].

Limitations

This study has certain limitations. Its cross-sectional design precludes causal inference between clinical variables and quality of life impairment. Being a single-center study, the findings may not be generalizable to other populations or healthcare settings. Information regarding disease duration and prior treatment was based on patient recall and may therefore be subject to recall bias. Diagnosis was primarily based on clinical evaluation, with mycological confirmation performed only in selected cases, which may have introduced misclassification bias. Although the DLQI is a validated and widely used instrument, it may not fully capture certain aspects such as stigma, cultural perceptions and sexual functioning. Furthermore, the absence of comprehensive multivariable analysis limits the ability to identify independent predictors of quality-of-life impairment. These limitations should be considered when interpreting the results (Table 14).

Table 14: Comparison with other studies.

Conclusion

As is known that dermatophyte infection is rapidly becoming a widespread health issue, we assessed its influence on social and psychological health. In this study, we found a very large effect on the QOL of the patients and a greater impact with a longer duration of disease, multifocal distribution of the lesion leading to increase body surface area involvement and family history of tinea infection. But there was no gender as well as age correlation with DLQI scoring. In conclusion, persistent and recurrent dermatomycosis causes patients tremendous social, emotional and financial distress. This study emphasizes the necessity of counseling in conjunction with effective dermatophytosis treatment, thereby minimizing disease-related psychosocial complications and boosting treatment success. These findings accentuate the necessity for proper patient care and provide pertinent information regarding the disease, its prognosis and preventative strategies. People in our region are less aware of the need of using an appropriate medication, resulting in a strain on the economy from months to years of inappropriate pharmaceutical use.

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding Statement

This research did not receive any specific grant from funding agencies in the public, commercial or non-profit sectors.

Acknowledgement

None.

Data Availability Statement

Not applicable.

Ethical Statement                                                

The study received approval from the Ethics Committee of the Government Medical College, Bhavnagar, with the approval no. 1147/2022. 

Informed Consent Statement

Informed consent was taken for this study.

Authors’ Contributions

All authors contributed equally to this paper.

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