Role of increasing protein intake and correction of micronutrients imbalance to promote desired autophagy in treating resistant dermatophyte infection: A cohort of 62 patients

Background: Chronic and recurrent dermatophytosis is being increasingly reported worldwide, posing significant therapeutic challenges. Emerging evidence suggests a potential role of host factors, including nutritional status and autophagy, in disease persistence. Objective: To evaluate the clinical, nutritional, and biochemical profiles of patients with recalcitrant dermatophytosis and assess treatment outcomes following systemic antifungal therapy combined with protein and micronutrient supplementation. Methods: A retrospective chart review of 62 patients with recalcitrant dermatophytosis was conducted. A subgroup (n=17) underwent detailed nutritional and biochemical assessment. All patients received oral itraconazole, and those with deficiencies were provided dietary counselling, protein and micronutrient supplementation. Results: Protein deficiency was observed in all patients assessed, with 58.8% consuming <50% of daily protein requirements. Vitamin D3 deficiency (82.3%) and low serum ferritin (76.5%) were prevalent. Comorbidities like diabetes and dyslipidemia were also noted. Clinical cure was achieved in 83.87% of patients, with recurrences in only 6.5% patients over period of one year linked to poor compliance or use of alternative therapies. Conclusion: Host nutritional deficiencies, particularly in protein and iron, may contribute to deregulated autophagy and persistent dermatophytosis. Addressing these deficits alongside antifungal therapy improves treatment outcomes and reduces relapse risk. Evaluation for protein and micronutrient deficiencies and corrective measures should be integrated into the management protocols for recalcitrant dermatophytosis.