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Benign and malignant thyroid neoplasms after childhood irradiation for tinea capitis.

The incidence of all thyroid surgery was studied among 10,842 persons whose thyroid glands had been exposed in childhood to an average dose of 9 rads of X-radiation during treatment for tinea capitis and among 2 matched control groups. A statistically significant increased risk for both benign and malignant neoplasms was found in the exposed group. The excess risk was 8.3 cases/year/rad/million population. There were no differences in other surgical conditions between the irradiated and nonirradiated groups. Persons irradiated under age 6 years had the highest excess risk for developing carcinomas. The incidence of thyroid neoplasms was approximately threefold higher in women than in men among the irradiated persons and among the controls, but the relative risk for the irradiated group of women was greater than the addition of the relative risks of the other groups. Low-dose radiation is instrumental in the development of both benign and malignant thyroid neoplasms.

Adenoma↗

Follow-up study of patients treated by X-ray epilation for Tinea capitis; resurvey of post-treatment illness and mortality experience.

This is the second follow-up study of 2,215 persons who during childhood between 1940 and 1959 had been given x-ray therapy for tinea capitis and of 1,395 persons well matched for age, sex, and race who were treated for the same disease during the same period without the use of x-ray therapy. The major finding of the study was an excess incidence in the irradiated cases of tumors of the head and neck including the skin, brain, thyroid, and parotid. However, between the groups there was no difference in death due to malignant neoplasms or any other cause. Among white patients, a 40% excess of treated psychiatric disorders was observed in the irradiated group, but there was no difference among blacks.

Adolescent↗

Evaluation of the adult carrier state in juvenile tinea capitis caused by Trichophyton tonsurans.

The anthropophilic dermatophyte Trichophyton tonsurans is an occasional cause of scalp ringworm in adults. An asymptomatic adult carrier state also has been described. In this study the parents and/or grandparents of 50 children with proved T. tonsurans tinea capitis were evaluated. Cultures were obtained from the scalps of 46 asymptomatic adults; 14 of the cultures grew T. tonsurans. This population may provide a source for continued reinfection in children.

Adult↗

Temporal triangular alopecia: report of an African-American child with TTA misdiagnosed as refractory tinea capitis.

Temporal triangular alopecia is an underrecognized form of nonscarring alopecia that appears in children between the ages of 3 and 6 years and is often misdiagnosed. Increased awareness of this entity is needed to prevent ineffective and harmful treatments. We present a case misdiagnosed as tinea capitis in an African-American girl, review the literature, and elucidate the major differential diagnoses.

Alopecia↗

Griseofulvin in the mass treatment of tinea capitis.

The prevalence of ringworm of the scalp in many countries, and the fact that many of the current measures to control it are inconvenient for mass use, lend particular interest to the account given in this paper of mass treatment of tinea capitis in an Arab village in Israel. A total of 446 cases were treated, on an ambulatory basis, with a single daily dose (25-30 mg/kg) of griseofulvin, and it was found that clinical cure, confirmed by microscopy, was achieved in 3-6 weeks in the majority. All cases were cured after 10 weeks' treatment.A preliminary study on 25 hospitalized children had previously shown the drug to be effective and apparently safe, the only side-effects encountered in these children and in the Arab village being nausea, furunculosis and drug eruption. No relapses were seen in the 25 children, who were followed up for from two to six months.

Disease↗

[Tinea capitis presenting as staphylococcal pyodermatitis of the scalp].

Two severe cases of pyoderma (staphylococcus aureus) of the scalp, resistant to appropriate antibiotic treatment, proved to be due to exotic dermatophytes (Trichophyton soudanense and Trichophyton violaceum) in two North African children living in France. Both cases exemplify the growing number of Tinea capitis due to anthropophilic species imported from Africa by immigrated populations, their sometimes atypical clinical presentation and their familial epidemiology. Fungal cultures and identification procedures are essential for the diagnosis and epidemiological investigation of such cases.

Child, Preschool↗

Meningiomas after radiotherapy for tinea capitis--still no history.

AIMS AND BACKGROUND: To review the clinical, radiological and histological findings of 19 patients with radiation-induced intracranial meningiomas treated at our neurosurgical department between 1981 and 1996. METHOD: The records of 18 patients with intracranial meningiomas who underwent low-dose radiation for tinea capitis in childhood, and of one patient irradiated for pituitary adenoma, were analyzed in respect of the previously reported features of postradiation meningiomas. RESULTS: The mean age of the patients with low-dose radiation-induced meningiomas was 58 years and the mean shortest onset latency was 48 years. The male to female ratio was 1.1:1. Forty-seven percent of patients presented with mental changes and/or focal neurological signs, 21% with signs of increased intracranial pressure and 26% with seizures. Calvarial location of the meningiomas was found in 54% of patients and in one patient the tumor arose from the skull base. Multiple tumors were present in 15% of patients and 29% of the meningiomas displayed malignant features on histological examination. A significantly lower meningioma recurrence rate was found in our series compared to the recurrence rate in the reported series of postradiation meningiomas. Five patients had a history of a second neoplasm other than meningioma. CONCLUSION: Our series of low-dose radiation-induced meningiomas represents one of the largest of its kind in the English literature. The patients did not differ substantially in sex ratio, tumor localization, multiplicity and histological features from the previously reported postradiation meningioma patients, except for the significantly lower tumor recurrence rate. It would seem that over the next years we will be further witnessing the deleterious effects of low-dose radiation administered in childhood.

Adult↗

Tinea capitis.

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Humans↗

[Identification of geophilic and zoophilic dermatophytes in siblings with tinea capitis. A pathogenic factor or contamination?].

Two siblings of African origin presented with multiple scaling patches and alopecia on the scalp four weeks after returning from a vacation in Eritrea. Direct KOH examination revealed fungal elements; Trichophyton mentagrophytes and Trichophyton terrestre were identified in the fungal culture. We discuss the putative pathogenic role of both microorganisms in causing disease. Although infection with Microsporum canis currently accounts for almost fifty percent of all cases of tinea capitis in Germany, other fungi have gained importance due to tourism and increasing migration.

Alopecia↗

Multiple basal cell carcinomas developed after radiation therapy for tinea capitis: a case report.

Development of skin neoplasms is the most important complication of radiation therapy. There are contradictive reports about the type of these neoplasms. Squamous cell carcinomas are considered the most frequent tumors arising on chronic radiodermatitis areas, but recent studies have demonstrated that the type of neoplasm occurring in response to ionizing radiation exposure depends on several factors. Herein we report a patient who had received low-dose radiation for the treatment of tinea capitis and developed multiple basal cell carcinomas in the radiated areas after a long latent period of 53 years.

Basal Cell Carcinoma↗

Long-term follow-up for brain tumor development after childhood exposure to ionizing radiation for tinea capitis.

Ionizing radiation is an established risk factor for brain tumors, yet quantitative information on the long-term risk of different types of brain tumors is sparse. Our aims were to assess the risk of radiation-induced malignant brain tumors and benign meningiomas after childhood exposure and to investigate the role of potential modifiers of that risk. The study population included 10,834 individuals who were treated for tinea capitis with X rays in the 1950s and two matched nonirradiated groups, comprising population and sibling comparison groups. The mean estimated radiation dose to the brain was 1.5 Gy. Survival analysis using Poisson regression was performed to estimate the excess relative and absolute risks (ERR, EAR) for brain tumors. After a median follow-up of 40 years, an ERR/Gy of 4.63 and 1.98 (95% CI = 2.43-9.12 and 0.73-4.69) and an EAR/Gy per 10(4) PY of 0.48 and 0.31 (95% CI = 0.28-0.73 and 0.12-0.53) were observed for benign meningiomas and malignant brain tumors, respectively. The risk of both types of tumors was positively associated with dose. The estimated ERR/Gy for malignant brain tumors decreased with increasing age at irradiation from 3.56 to 0.47 (P = 0.037), while no trend with age was seen for benign meningiomas. The ERR for both types of tumor remains elevated at 30-plus years after exposure.

Adolescent↗

Trichophytin reactions in children with tinea capitis.

Of 52 patients with proved Trichophyton tonsurans infection of the scalp, 16 had an inflammatory reaction to this infection (kerion), while the rest had only slight scaling and broken hairs (black dot ring-worm). Each patient was tested with trichophytin antigen to determine whether cell-mediated immunity (CMI) was responsible for the differences in these different clinical presentations. Fifteen of 16 with kerion had a 48-hour reaction greater than 10 mm, while none of the 36 with noninflammatory (black dot) tinea capitis had a similar response. This suggests that the patient's immune response (CMI) may be responsible for kerion infections of the scalp and that therapy could be directed initially toward suppressing this reaction.

Female↗

Risk of thyroid cancer after childhood exposure to ionizing radiation for tinea capitis.

BACKGROUND: The thyroid gland is known to be sensitive to the carcinogenic effect of ionizing radiation, especially in children. The role of potential modifiers of the risk and latency period effects needs further investigation. We examined the effect of low doses of ionizing radiation (4.5-49.5 cGy) on the risk of developing thyroid cancer after long latent periods of up to 54 yr after childhood exposure. METHODS: The study population included 10,834 individuals irradiated against tinea capitis in the 1950s and two matched nonirradiated groups (general population and siblings) for comparison. Cancer statistics and vital status data were obtained from national registries, updated to December 2002. Excess relative and absolute risks [excess relative risk per gray (ERR/Gy), excess absolute risk (EAR)] were estimated using Poisson regression for survival analysis. RESULTS: Within the study period, 159 cases of thyroid cancer were diagnosed. Total ERR/Gy and excess absolute risk per gray per 10(4) person-years for developing thyroid cancer reached 20.2 (95% confidence interval 11.8-32.3) and 9.9 (95% confidence interval 5.7-14.7), respectively. The risk was positively associated with dose and negatively associated with age at exposure. ERR/Gy was significantly elevated 10-19 yr after exposure, peaking at 20-30 yr, and decreasing dramatically (although still significantly elevated) 40 yr after exposure. CONCLUSIONS: Our findings agree with patterns of risk modification seen in most studies of radiation-induced thyroid cancer, although risk per unit dose seems higher. Our data show that 40 yr after irradiation, ERR decreases dramatically, although remaining significantly elevated. The hypothesis of different genetic susceptibility of the Jewish population deserves further exploration.

Adolescent↗

Inflammatory tinea capitis caused by Microsporum gypseum in a five-year-old girl.

An otherwise healthy five-year-old girl presented for evaluation of a large patch of erythematous scaling alopecia on the vertex of her scalp. Previous attempts to treat this with various topical agents resulted in no improvement. Our evaluation included examination of fungal cultures, which grew out a colony with characteristic morphology of Microsporum gypseum, supported by lactolphenol blue tease mounts, demonstrating the characteristic conidia for this fungus. Treatment was begun with oral griseofulvin, and evidence of inflammation resolved along with conversion to negative cultures for M. gypseum, although an area of scarring alopecia from the kerion remains. The epidemiologic basis, clinical presentation, differential diagnosis, evaluation, and treatment principles for this important geophilic organism are reviewed. Physicians need to be aware of this agent of tinea capitis, since it is destructive and only responsive to oral therapy.

Child, Preschool↗

Prevalence of tinea capitis in Ethiopian schoolchildren.

The prevalence of dermatophytosis and the spectrum of dermatophyte species were determined in children attending two schools in Addis Ababa, Ethiopia. Demographic and clinico-dermatological data were collected. Specimens were taken for microscopy and culture from all suspected lesions. Dermatophyte species were identified by morphology and biochemical tests, supplemented by sequencing of the rDNA ITS 2 region in selected isolates. From the Biruh Tesfa Elementary School (BTES) 824 students, and from Mount Olive Academy (MOA) all 124 students, were included. In BTES 513 (62.3%) students were clinically diagnosed with dermatophytosis, 463 (90.3 %) of them with tinea capitis. In 200 consecutive samples from BTES, and in 66 from MOA, 75 and 62%, respectively, contained fungal elements at microscopy. From BTES, 163/496 (33%) samples were culture-positive, of which 149 (91.4%) grew with dark purple colonies identified as Trichophyton violaceum, while 244 (49.4%) samples were contaminated. A few strains grew slowly developing white to cream colonies, two were identified as T. verrucosum, and 12 as white T. violaceum. From MOA 44 (66.7%) of samples were culture-positive, 38 (87%) were identified as T. violaceum, and one (2.3%) as T. verrucosum, while 33% showed no growth. Four white isolates of T.violaceum were confirmed by DNA-sequencing. Dermatophytosis was thus diagnosed in 55-62% of children screened at two schools of different socioeconomic standards in the Ethiopian capital. Trichophyton violaceum constituted 87-90% of all isolates. White variants of T. violaceum were diagnosed in 16 cases.

Adolescent↗