To the Editor.—
In their excellent recent discussion of griseofulvin-resistant dermatophytosis (the Archives 1981;117:16-19), Artis et al listed the following seven reasons for treatment failures: (1) inadequate dosage, (2) poor patient compliance, (3) inadequate absorption of the drug from the gastrointestinal tract, (4) microsomal enzyme inactivation and drug interaction, (5) failure of griseofulvin to enter the site of infection despite adequate blood levels, (6) diminished activity within infected skin, and (7) infection with a dermatophyte that is not sensitive to griseofulvin. The authors chose not to discuss an eighth reason—inadequate host response to the infecting dermatophyte. Many studies have shown a relatively specific defect in delayed hypersensitivity to trichophytin in patients with therapy-resistant dermatophytosis as assessed by intradermal testing with a panel of antigens. Recent investigations, however, question the reliability of intradermal skin testing alone in assessing cell-mediated immunity in some patients with chronic dermatophytosis.1Chronic dermatophytosis is well
Jorizzo JI, Smith EB, Henry JC. Griseofulvin-Resistant Dermatophytosis. Arch Dermatol. 1982;118(1):2–3. doi:10.1001/archderm.1982.01650130006004
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