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

Sami Fatehi Abdalla *

Clinical Department, College of Medicine, Almaarefa University, Riyadh, Saudi Arabia.

*Author to whom correspondence should be addressed.


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.

Keywords: Recalcitrant dermatophyte infection, HSV-I antibodies, acyclovir antifungal combination therapy, dermatophytosis

How to Cite

Abdalla, S. F. (2023). Successful Elimination of a Recalcitrant Dermatopytosis Using Acyclovir and Antifungal Treatment in a Patient with High HSV IgG Antibodies. Asian Journal of Research in Dermatological Science, 6(1), 90–94. Retrieved from


Gupta CM, Tripathi K, Tiwari S, Rathore Y, Nema S, Dhanvijay AG. Current trends of clinicomycological profile of dermatophytosis in Central India IOSR J Dent Med Sci. 2014;13:23–6.

Rajagopalan M, Inamadar A, Mittal A, Miskeen AK, Srinivas CR, Sardana K, et al Expert consensus on the management of dermatophytosis in India (ECTODERM India) BMC Dermatol. 2018;18:6.

Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive? Indian Dermatol Online J. 2016;7:73–6.

Sentamilselvi G, Kamalam A, Ajithadas K, Janaki C, Thambiah AS. Scenario of chronicdermatophytosis: An Indian study Mycopathologia. 1997;1998(140):129–35.

Pathania S, Rudramurthy SM, Narang T, Saikia UN, Dogra S. A prospective study of the epidemiological andclinical patterns of recurrent dermatophytosis at a tertiary care hospital in India Indian J Dermatol Venereol Leprol. 2018;84:678–84.

Shenoy M, Poojari S, Rengasamy M, Vedmurthy M, Barua S, Dhoot D, Barkate H. Management of Dermatophytosis: Real-World Indian Perspective. Indian Dermatol Online J. 2023 Apr 27;14(3):347-356.

DOI: 10.4103/idoj.idoj_643_22

PMID: 37266073; PMCID: PMC10231727.

Rengasamy M, Shenoy MM, Dogra S, Asokan N, Khurana A, Poojary S, et al. Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) Task Force against Recalcitrant Tinea (ITART) Consensus on the Management of Glabrous Tinea (INTACT) Indian Dermatol Online J. 2020;11:502–19.

Cermelli C, Orsi CF, Ardizzoni A, Lugli E, Cenacchi V, Cossarizza A, Blasi E. Herpes simplex virus type 1 dysregulates anti-fungal defenses preventing monocyte activation and downregulating toll-like receptor-2. Microbiol Immunol. 2008 Dec; 52(12):575-84. DOI: 10.1111/j.1348-0421.2008.00074.x

PMID: 19120971.

David W Kimberlin, Richard J Whitley. Antiviral therapy of HSV-1 and -2 Human Herpesviruses: Biology, Therapy, and Immunoprophylaxis. Arvin A, Campadelli-Fiume G, Mocarski E, et al., editors. Cambridge: Cambridge University Press.

Singh SK, Subba N, Tilak R. Efficacy of terbinafine and itraconazole in different doses and in combination in the treatment of tinea infection:A randomized controlled parallel group open labeled trial with clinico-mycological correlation. Indian J Dermatol. 2020;65:284–9.