Successful Elimination of a Recalcitrant Dermatopytosis Using Acyclovir and Antifungal Treatment in a Patient with High HSV IgG Antibodies

Abstract

The prevalence of recalcitrant or widespread dermatophytosis is increasing, posing a significant challenge for dermatologists globally. The efficacy of antifungal regimens in treatment has historically been high, attributed to their broad-spectrum antifungal properties. However, there has been a noticeable increase in treatment failures in recent times. The infection caused by Herpes Simplex Virus type 1 (HSV-1) has a moderating effect on the ability of monocytes to effectively eliminate fungi that have been engulfed during phagocytosis. In the reported patient, the HSV I antibody titre was high, so the systemic antiviral (acyclovir) was added in remission dose to the existing antifungal regimen. The eradication of dermatophytes was nearly achieved within a fortnight following the administration of therapy. Therefore, it is advisable to consider obtaining HSV type I IgGs for every patient who presents with a widespread or recalcitrant superficial fungal infection, and to begin a combined antiviral and antifungal treatment approach.