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PubMedDate not supplied

Oral griseofulvin remains the treatment of choice for tinea capitis in children.

Tinea capitis is one of the most common infections of children. The standard treatment is griseofulvin. Itraconazole and terbinafine have in large part replaced griseofulvin in the treatment of onychomycosis and, in addition to fluconazole and ketoconazole, are evolving treatments for tinea capitis. The purpose of this review is to compare the efficacy, safety, and cost of oral antifungal agents for tinea capitis. Small, open-label studies of itraconazole, terbinafine, and fluconazole have reported encouraging results, suggesting that these drugs may be effective alternatives to griseofulvin; however, in large controlled studies griseofulvin continues to exhibit greater or equal efficacy. Ketoconazole appears to be the least efficacious. All five drugs appear relatively safe, however, only griseofulvin has a long track record of safety, is Food and Drug Administration (FDA) approved for the treatment of tinea capitis in children, and has the least known drug interactions. Fluconazole is FDA approved for use in children more than 6 months of age, yet not for the treatment of tinea capitis. Oral griseofulvin and terbinafine tablets are the least expensive of the antifungal agents; griseofulvin suspension is, however, more expensive than fluconazole suspension. For the combined reasons of efficacy, safety, and cost, and a long track record of use, we feel oral griseofulvin is still the present treatment of choice for tinea capitis. Newer antifungals are currently under investigation, and their role in treating tinea capitis in children is still being defined.

Administration, Oral↗
PubMed2005

Current topics of tinea capitis in China.

Tinea capitis is one type of superficial fungal infection which is found all over the world. The major etiologic agent of tinea capitis varies in different areas. Tinea capitis in China has unique characteristics. The epidemiology, transmission and therapy of child and adult tinea capitis in China are reviewed in this paper.

Adult↗
PubMedDate not supplied

Tinea capitis in adults.

Tinea capitis is regarded as rare in healthy adults. A study of 46 adults presenting with scalp problems with no other identifiable cause and 26 asymptomatic adult contacts of children with tinea capitis was undertaken. The confirmation of tinea capitis in 9 of 46 patients and 5 carriers among 26 adult contacts suggests that tinea capitis may affect healthy adults more often than was supposed. Further epidemiologic studies may be of interest.

Adult↗
PubMedDate not supplied

Oral terbinafine in tinea capitis in children.

Tinea capitis is a disease that frequently affects children. In most cases systemic antimycotic treatment is necessary Griseofulvin is still the drug of choice, but requires prolonged periods of treatment (several months). To estimate the efficiency and tolerability of terbinafine for treatment of tinea capitis in children, four patients (aged 3-9 years) with tinea capitis proven by culture were treated with terbinafine at a dose of 125 mg a day for different periods (4-10 weeks). Isolates were subjected to minimal inhibitory concentration testing against terbinafine and griseofulvin. In all four cases terbinafine treatment resulted in complete remission. The clinical response was accompanied by negative culture results on follow-up. Terbinafine was well tolerated in each case. Determination of the minimal inhibitory concentration confirmed the excellent in vitro activity of terbinafine against dermatophytes. Controlled studies involving a larger number of children are necessary to answer questions concerning dose and duration of terbinafine treatment as well as the frequency and severity of drug-related side-effects.

Administration, Oral↗
PubMed2004

Molecular typing study of the Microsporum canis strains isolated from an outbreak of tinea capitis in a school.

Tinea capitis is a dermatophyte infection of the scalp that occurs most often in prepubescent children. Tinea capitis may be transmitted by shared use of contaminated hairbrush, by contact with fomites or by direct physical contact with an infected person. Occasionally, outbreak of tinea capitis would happen under some special conditions. Last year, we found an outbreak of tinea capitis in a school due to Microsporum canis. In epidemiological study, we performed the prevalence survey to all of the exposed persons by physical examinations and mycological laboratory tests, including KOH preparation and fungal cultures. We also investigated the environment in the school. In molecular typing study of the M. canis isolated from patients and the environment, random primer amplification polymorphic DNA (RAPD) method, the specific amplification of subrepeat element in the ribosomal DNA nontranscribed spacer (NTS), and the analysis of DNA sequence in the intertranscribed spacer (ITS) of rDNA were performed. The total number of exposed children was seventy-one, among them forty-two were attacked by tinea capitis. The ratio between boy and girl was 13:1. The ages of the patients was ranged from 3.5 years old to 10 years old. Four patients bred cat or dog as pet. Most patients appeared noninflammatory type of tinea capitis and several patients were inflammatory type. Under microscopic examination the invaded hair were all ectothrix. The pathogens isolated from these patients were M. canis. And we also isolated M. canis from the carpet and the pillowcase in the school. The patterns of total strains of M. canis in the RAPD method and PCR amplification of the rDNA NTS region study were identical, and the isolates from patients and the environment contained the same DNA sequences in the ITS region. The outbreak of tinea capitis was caused by M. canis. The M. canis isolated from patients and from the environment were probably the same origin.

Child↗
PubMed2001

[Epidemiology of tinea capitis].

PREDOMINANT IN CHILDREN: Tinea capitis is the most frequent fungal infection in children under the age of puberty. It occurs only rarely in men but is observed in adult women. Human-to-human, animal-to-human and soil-to-human transmission can be involved. HISTORICAL BACKGROUND: The spectrum of fungal species known to cause tinea capitis has steadily grown for more than a century, varying with the local urban or rural environment. Since the beginning of the 20th century and up to the advent of griseofulvin in the sixties, M. audouinii, an anthropophilic species, caused major epidemics in France, England and the USA. In the sixties to eighties, M. canis was the cause of most cases observed throughout the world. Over the last 20 years, anthropophilic species have again become the leading cause of tinea capitis epidemics, particularly in large cities, in relationship with immigration: T. tonsuransi in the USA and England and T. soudanense and M. langeronii in France. HYGIENE AND EDUCATION: Despite the benign curable nature of the disease, interhuman transmission of tinea capitis is nevertheless a considerable public health problem due to the increasing number of children affected and the risk of contagion in schools. The considerations resulting from recent studies point out the fact that transmission occurs more often in the family than the school setting, particularly indirectly by common use of grooming instruments. This would explain the high percentage of tinea capitis in large immigrant families where hair combing habits favor transmission. In France, these observations should lead to a revision of the current regulations concerning expulsion from school of children affected by tinea capitis. Better education would be a more appropriate response to the problem.

Adolescent↗
PubMed1982

Tinea capitis in Brooklyn.

Tinea capitis, a disease of children, occurs throughout the United States. We studied 144 clinically diagnosed cases of tinea capitis within a 12-month period. Ninety-six of them had positive cultures; Trichophyton tonsurans grew in 89% and Microsporum organisms in 11%. Ninety-five (99%) of the patients with positive cultures were black, and one (1%) was hispanic. The peak incidence was in the 4-to-5-year age group. Boys and girls were equally affected. Sixty percent of the 96 culture-proved cases were noninflammatory, and 40% were inflammatory (kerions). In four patients, the initial clinical manifestations were severe diffuse seborrhealike scales and crusting of the scalp with minimal alopecia. Mycologic and clinical cure were obtained by a mean of 4.7 weeks of griseofulvin therapy. Neither systemic erythromycin, topical antifungal agents, nor systemic prednisone resulted in earlier eradication. However, prednisone caused the inflammation of the kerions to subside dramatically.

Black or African American↗
PubMed1983

The rise and fall of fluorescent tinea capitis.

The epidemiology of tinea capitis has had a remarkable change in the past 20 years. It is important for physicians to realize that most tinea capitis in the United States is caused by Trichophyton tonsurans and that these lesions cannot be diagnosed by the Wood's lamp. Trichophyton tonsurans tinea capitis is frequently misdiagnosed because the lesions mimic such common scalp conditions as dandruff and seborrhea. Further, this organism can cause chronic tinea capitis in women that may become a infectious reservoir for other family members. A negative potassium hydroxide preparation will not rule out infection with T tonsurans and cultures are necessary. Scalp lesions in children should be considered tinea capitis until culturally proved otherwise.

Adult↗
PubMed1985

Tinea capitis: current concepts.

Tinea capitis is still with us. The hair has been beaten into submission by irradiation in past years; the organisms have been beaten into submission with griseofulvin and other agents; yet the disease lives on. We thought it appropriate to have a symposium on the subject of the epidemiology of tinea capitis, its changing nature, its complications, the carrier state, differential diagnosis, culture techniques, and the current status of the management of its various causes. As one of our authors stated, it is a "vexatious" disease.

Adolescent↗
PubMed2004

New treatments for tinea capitis.

PURPOSE OF REVIEW: Tinea capitis, a dermatophyte infection involving the hair shaft on the scalp, is primarily a disease of preadolescent children. The predominant pathogen varies according to the geographical location. Trichophyton tonsurans and Microsporum canis account for the majority of infections in north America and certain parts of Europe. The current standard of care for the treatment of tinea capitis in the USA is oral griseofulvin, but evidence is accumulating that some of the newer antifungal agents may also be useful. RECENT FINDINGS: The newer oral antifungal agents such as terbinafine, itraconazole and fluconazole seem to be effective, safe, and have the advantage of a shorter treatment duration. Although a significant number of clinical studies and reports have documented experience with terbinafine and itraconazole for the treatment of tinea capitis, it should be noted that only a few trials have been conducted utilizing fluconazole. Both 2% ketoconazole and 1% selenium sulfide shampoos are often recommended as adjuvant topical therapy. SUMMARY: Currently, many experts consider griseofulvin to be the drug of choice for tinea capitis. Short-term terbinafine, itraconazole and fluconazole therapy have been shown to be comparable in efficacy and safety with griseofulvin. Regular epidemiological surveillance of causative fungal organisms in the community and their antifungal susceptibility is an essential component in the management of this condition.

Administration, Oral↗
PubMed2001

Aetiology of tinea capitis in school children.

BACKGROUND: Tinea capitis is a superficial fungal infection of the scalp and hair of the head which is common in children aged between two and eleven years. An endothrix infection is best treated using parenteral antifungal drugs while an ectothrix one may be treated by parenteral or topical antifungal drugs. The organism that commonly causes tinea capitis in the Western world is Trichophyton tonsurans while there is inadequate information on the actual causative agent in Kenya. OBJECTIVES: To determine the prevalence and the aetiology of tinea capitis and the fungal agents responsible for it and; to recommend the correct mode of treatment in school children attending a primary school near Eldoret. DESIGN: Prospective and descriptive study. SETTING: Private primary school near Eldoret town. SUBJECTS: Sixty eight primary school children aged between six and 14 years in classes 1 to 5. RESULTS: Of the 68 pupils included in the study, 60.9% and 39.1% were males and females, respectively. Prevalence of tinea capitis in the school was 33.3%. Peak age of infection was 10 years. Ratio of infected males to females was 2:1. There was a growth on culture in 76.1% of the cases all of which were endothrix. T. tonsurans was isolated in 77.8%, T. rubrum in four per cent of the cases. CONCLUSION: The prevalence of tinea capitis in this school was high. The most common cause of tinea capitis was T. tonsurans. Males were more infected than the females. RECOMMENDATIONS: Oral antifungal drugs with griseofulvin being the first line of treatment should be adopted. Health education on the aetiology, treatment and prevention of tinea capitis should be given.

Adolescent↗
PubMed1999

Management of tinea capitis. A status report.

Tinea capitis is the most common pediatric fungal infection, usually affecting school-age children. It is caused by a dermatophyte from the genus Trichophyton or Microsporum. The predominant pathogens vary according to geographic location. Infection rates are higher in urban regions, especially those with overcrowded living conditions. In the United States, the incidence is highest among African-American children and appears to be significantly lower among Asian Americans. Tinea capitis may persist into adulthood, especially in females with Trichophyton tonsurans infection. Tinea capitis also has been reported in neonates, infants, and elderly patients.

Administration, Oral↗
PubMed2002

Topical treatment of tinea capitis in a neonate.

Tinea capitis is the most common fungal skin infection in children. Given that this infection invades the hair shaft and the pilosebaceous unit, systemic antifungal therapy is the gold standard of treatment. Despite the neonate's increased susceptibility to infections, tinea capitis is rare in this population. We present the case of a 16-day-old infant with tinea capitis caused by Microsporum canis and effectively treated with topical bifonazole 1%.

Administration, Topical↗
PubMed1993

Tinea capitis in Saudi Arabia.

BACKGROUND: Tinea capitis is a dermatophyte infection of the scalp, eyebrows, and eyelashes caused by species of Microsporum and Trichophyton. The purpose of this study was to discover the incidence and causal agents of tinea capitis in Saudi Arabia. METHODS: Hair roots, skin scrapings, and pus swabs were collected from patients clinically diagnosed with tinea capitis and were processed for fungus. RESULTS: Of 372 patients with tinea capitis investigated in Saudi Arabia, 240 were found to be positive by direct microscopic examination, and the causal agent was isolated from 237 patients. Tinea capitis accounted for 47.7% of all superficial mycoses, and 97% of it occurred in children below 15 years of age. Inflammatory lesions were found in 35% of cases, and 10 of them presented with kerion celsi. Favus-type lesion was found in one. Microsporum canis was the most common etiologic agent, responsible for 82.3% of the infections. Trichophyton violaceum was the next most common agent (13.9%), followed by M. audouini (2.2%); T. mentagrophytes, T. rubrum, T. verrucosum, and T. simii were isolated from one patient each. This is the first report of T. simii infection in a Saudi man. CONCLUSIONS: Although none of the patients owned pets, the predominance of M. canis may be explained by the large number of cats in the neighborhood. The disappearance of favus due to T. schoenleinii may be due to improved socioeconomic conditions. Our results agreed with two previous reports.

Adolescent↗
PubMedDate not supplied

Itraconazole is effective in the treatment of tinea capitis caused by Microsporum canis.

Tinea capitis is a relatively common superficial fungal infection in children which requires oral antifungal therapy. In a prospective, open study over 24 weeks, itraconazole 5 mg/kg/day, given as capsules or as an oral suspension for a period of 2-12 weeks, was used to treat children 1-12 years of age who had M. canis tinea capitis. Children with mycologic evidence of M. canis tinea capitis were entered into the study and asked to return at week 2 and then every 2 weeks thereafter until cured, with a maximum of 12 weeks of active treatment. At each visit the scalp was sampled and the material processed for light microscopy and culture examination. An extra 2 weeks of itraconazole was prescribed if the mycology from the sample obtained on the previous visit indicated that there was still presence of the organism. Patients were administered either 2, 4, 6, 8, 10, or 12 weeks of treatment. The final follow-up visit was at 12 weeks from the cessation of drug therapy. Laboratory blood testing was performed only if indicated by history, examination, or the development of side effects. There were 107 patients (49 boys, 58 girls; mean +/- standard error =5.6 +/- 0.2 years). Thirteen of the 107 children were given the oral suspension. At week 12 from the cessation of treatment there was complete (clinical and mycologic) cure in all 107 children. Increasing age of the patient correlated significantly with the length of itraconazole capsule therapy (p=0.03). The duration of itraconazole treatment also correlated significantly with the severity of tinea capitis at baseline (p=0.02). Adverse effects were observed in 5 children receiving itraconazole capsules (n=94). These were regarded as being possibly or probably due to the drug in two children (mild transient stomach ache in one and moderate diarrhea in one). The child with diarrhea stopped therapy at week 4 with complete resolution of symptoms. One of 13 children receiving the oral suspension had mild, transient diarrhea. There were no drop-outs in this group. Laboratory testing was not required in any patient. Compliance was very good in the patient group. Itraconazole 5 mg/kg/day given either as a capsule or an oral suspension for 4-8 weeks is effective and safe in the treatment of tinea capitis caused by M. canis.

Administration, Oral↗
PubMed2006

Tinea capitis in eastern Nepal.

BACKGROUND: Tinea capitis is an increasing public health concern throughout the world. The clinical types and etiological agents vary from time to time and place to place. This study was undertaken to identify the etiological agents and to determine the clinico-etiological correlation of tinea capitis in eastern Nepal. METHODS: Sixty-nine clinically diagnosed cases of tinea capitis were enrolled in this study. Hair roots and skin scrapings were collected from each patient and subjected to microscopy and culture for identification of fungal hyphae and spores. RESULTS: Tinea capitis accounted for 4.6% of all dermatophyte infections: 68.1% occurred in patients below the age of 11 years with a male to female ratio of 1 : 1.9. "Gray patch" was the most common clinical type (52.2%), followed by "black dot" (17.4%), seborrhoeic dermatitis (13%), alopecia areata (11.6%) and pustular (4.3%). Direct microscopy of hair was positive in 62.3% of patients. Culture positivity was found in 56.7% of patients. Common isolated organisms were Trichophyton violaceum (48.71%), T. mentagrophytes (15.38%), T. tonsurans (12.82%), Microsporum canis (7.69%), T. rubrum and M. gypseum (5.12% each), and M. audouinii and M. nanum (2.56% each). CONCLUSIONS: Trichophyton violaceum was the most common pathogen of tinea capitis. The clinical manifestations were variable and "gray patch" was the most common clinical presentation in this part of the world.

Adolescent↗