Comparative evaluation of host immune response and cytokine signature pertaining to Th1 and Th2 immune arms in serum and tissue among patients of acute localised vs. chronic disseminated dermatophytosis

Background: India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross-sectional comparative study to determine the difference in Th1 (IFN-gamma) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. Methods: Patients (18-60 years) were divided in two groups-group A (n = 114, BSA <5%, single anatomic site, duration <6 months, n = 118) and group B (n = 107 BSA >10%, > one anatomic site, duration >12 months, n = 118). Clinical parameters along with serum levels of IgE, IL-4 and IFN-gamma and expression of IL4 and IFN-gamma in dermal infiltrate were compared between group. Results: Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A-539.2, B-2901.0, p < .001) whereas levels IL-4(median A-21.3, B-20.4, p < .001) and IFN-gamma(median A-9.6, B-5.1, p < .001) were significantly lower in chronic cases. Expression of IL-4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN-gamma was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p < .001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p = .001), down arrow IFN-gamma (OR:4.683, CI:1.634, 13.418; p = .004) correlated significantly and independently with chronic dermatophytosis. Conclusion: Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN-gamma. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN-gamma cannot be established in our study.

Automated summary

The study revealed that chronic and disseminated dermatophytosis cases differ immunologically in terms of higher IgE levels and lower IL4 and IFN-gamma levels. Expression of IL4 is present in the tissue of acute, localized, and chronic disseminated cases, while the expression of IFN-gamma could not be established in the study.