Assessing the Impact of Dermatophytosis on Quality of Life Using the Dermatology Life Quality Index: A Real-World Cross-Sectional Study From India

Background and objective: Dermatophytosis has emerged as a chronic, recurrent, and high-burden dermatosis in India, with increasing reports of extensive involvement and treatment difficulty. Although clinical assessment is routinely performed, patient-reported quality of life (QoL) evaluation is inconsistently integrated into practice. This multicentric real-world study aimed to assess the QoL burden associated with dermatophytosis using the Dermatology Life Quality Index (DLQI). Methods: A cross-sectional study was conducted between April and October 2025 involving clinically diagnosed dermatophytosis patients attending the outpatient department from 325 centres across India with Independent Ethics Committee approval. The primary endpoint of the study was to assess DLQI in these patients, whereas secondary endpoints included evaluation of the association between DLQI scores and demographic, clinical, occupational, comorbidity-related, and treatment-related variables. Results: We analysed the data of 2776 patients who met the inclusion criteria, highlighting the predominance of males (57%). The median DLQI was 12 (interquartile range (IQR) 8-17), indicating a very large impact of dermatophytosis on daily life. The QoL impairment increased progressively with disease extent, demonstrating a clear severity impact correlation relationship between lesion burden and DLQI (p<0.001). The DLQI differed significantly across age groups (p<0.001) and was markedly higher in patients with facial (p<0.001) and trunk/back involvement (p<0.001). Occupations associated with high sweat and friction exposure showed the greatest impairment (p=0.003). Systemic comorbidities, including obesity, diabetes, hepatic, cardiac, and renal disorders, were consistently associated with worse DLQI (all p<0.001). Treatment regimens significantly influenced patient-reported outcomes (p<0.001), with super-bioavailable(SBA) itraconazole combined with topical therapy demonstrating the most favorable QoL profile. Conclusion: The QoL impairment in these patients is most pronounced with facial involvement, higher lesion counts, high sweat/friction occupations, and systemic comorbidities. Notably, treatment with SBA itraconazole in combination with topical antifungal therapy was associated with lower DLQI. These findings emphasize the importance of individualized management, prioritizing patients with visible/extensive disease and medical comorbidities for more intensive treatment and supportive counseling.