{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:18:30Z","timestamp":1788376710014,"version":"build-2803163510"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Steroid-modified tinea or tinea incognito has emerged as a significant challenge in India due to the widespread misuse of topical corticosteroids, leading to chronic, treatment-resistant dermatophytosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim and Objectives:<\/jats:title>\n                    <jats:p>This study was performed to compare the efficacy and safety of antifungal drugs: oral terbinafine, itraconazole, and griseofulvin in the treatment of steroid-modified tinea. In addition, patient awareness about steroid misuse and consequent impact on quality of life were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 90 potassium hydroxide (KOH)-positive patients ( \u226518 years) with tinea corporis, cruris, or faciei, having a history of prior topical steroid use, were randomly assigned to receive terbinafine (250 mg twice a day), itraconazole (100 mg twice a day), or griseofulvin (500 mg twice a day) for eight weeks (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 30 each). Clinical severity scores, cure rates, dermatology life quality index (DLQI) scores, steroid misuse patterns, and any adverse drug reactions reported were recorded for each patient.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The group treated with itraconazole showed highest cure rate (70%) at eight weeks, followed by terbinafine (36.7%) and griseofulvin (26.7%) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.529). Clinical severity scores reduced significantly in all three groups by the end of eight weeks (within-group comparison\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). DLQI scores improved most with itraconazole (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.003). Regarding a prior history of steroid use in the study population, the misuse of clobetasol propionate was seen in 46.7\u201376.7%, with 90\u2013100% of patients being unaware of steroid content or its side effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>Limited sample size may have limited statistical ability to detect significant cure rates. Despite intention-to-treat analysis, loss of follow-up may introduce bias. Baseline differences in gender and comorbidities among the study groups may have confounded the observed outcomes. Additionally, the lack of blinding may have influenced outcome assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Itraconazole appears to be the most effective for steroid-modified tinea, with superior clinical and quality-of-life outcomes. Steroid misuse, driven by pharmacist recommendations, underscores the need for public health interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/idoj.idoj_1126_25","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:00:20Z","timestamp":1787756420000},"page":"675-682","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Efficacy of Terbinafine, Itraconazole, and Griseofulvin in Treatment of Steroid-Modified Tinea"],"prefix":"10.4103","volume":"17","author":[{"given":"K.","family":"Sneha","sequence":"first","affiliation":[{"name":"Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7677-4190","authenticated-orcid":false,"given":"Seema","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepika","family":"Pandhi","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Sexually Transmitted Diseases, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shukla","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumita","family":"Halder","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"R1-20260902","doi-asserted-by":"crossref","first-page":"957","DOI":"10.3390\/pathogens11090957","article-title":"Current topics in dermatophyte classification and clinical diagnosis","volume":"11","author":"Moskaluk","year":"2022","journal-title":"Pathogens"},{"key":"R2-20260902","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1439-0507.2008.01606.x","article-title":"Epidemiological trends in skin mycoses worldwide","volume":"51","author":"Havlickova","year":"2008","journal-title":"Mycoses"},{"key":"R3-20260902","doi-asserted-by":"crossref","first-page":"154","DOI":"10.25259\/IJDVL_301_20","article-title":"The unprecedented epidemic-like scenario of dermatophytosis in India: I. 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