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PubMed2000

Tinea capitis in Benghazi, Libya.

BACKGROUND: Tinea capitis is a worldwide problem. It affects mainly school age children. Late detection and improper treatment of the inflammatory type of this disease may result in disfigurement and permanent alopecia. The objectives of this study were to determine the prevalence, clinical types, and causative species of tinea capitis in Benghazi, Libya. METHODS: One hundred and ninety six patients with tinea capitis were enrolled in this study. Hair stumps and scales were collected from every case and exposed to direct microscopic examination using 10% potassium hydroxide solution, and cultivation on modified Sabouraud's dextrose agar with cyclohexamide and chloramphenicol. RESULTS: Tinea capitis accounts for 45% of all superficial fungal infection and 92% occurred in children below the age of 10 years. The gray patch type was the most common clinical variety (53.6%), followed by black dots, seborrhoid type, and kerion (25.5%, 10.2%, and 8.2%), respectively. Four patients with a clinical picture of alopecia areata-like lesion and one patient with a favus-type lesion were seen. Species identification revealed that Trichophyton violaceum was the most common causative agent, responsible for 49.4% of infection, followed by Microsporum canis (38.6%) and T. verrucosum (7.8%). From seven patients the isolate was a mixture of both T. violaceum and M. canis. CONCLUSIONS: There has been a dramatic decrease in the incidence of favus with complete disappearance of T. schoenleinii. T. verrucosum as a causative agent of tinea capitis in this area has been reported for the first time in this study.

Adolescent↗
PubMed2000

Tinea capitis: current concepts.

Tinea capitis is an important fungal infection that may at times be a clinical, diagnostic and therapeutic challenge. It is common in childhood around the world, becoming almost epidemic in some communities. The central European and American experience with it is somewhat variable, due to different etiologic fungi. The use of topical antifungal agents and other approaches is stressed as of value alongside the use of systemic antifungal medication.

Antifungal Agents↗
PubMed1999

Treatment of tinea capitis: beyond griseofulvin.

Tinea capitis is a common pediatric scalp infection caused by dermatophytes. Topical therapy alone is ineffective, so oral griseofulvin has traditionally been the standard treatment. The new antimycotic agents itraconazole, terbinafine, and fluconazole represent effective treatment alternatives that have fewer problems with tolerability and adverse effects. More comparative studies are needed to determine the optimal treatment with these agents and adjuvant therapies such as antifungal shampoos, topical antimycotic agents, and corticosteroids.

Administration, Oral↗
PubMed2005

Therapeutic options for the treatment of tinea capitis: griseofulvin versus fluconazole.

BACKGROUND: Tinea capitis is a relatively common fungal infection of childhood. Griseofulvin has been the mainstay of treatment for many years. However, newer oral antifungal agents are being used more frequently. OBJECTIVE: Our purpose was to evaluate the therapeutic efficacy of fluconazole in comparison with griseofulvin in the treatment of tinea capitis. METHODS: We performed a single-blind, randomized, prospective evaluation of 40 patients with a clinical and mycologic diagnosis of tinea capitis. One group received fluconazole for 4 weeks. The other group received griseofulvin for 6 weeks. Five clinical parameters were evaluated. Mycologic examinations were performed at baseline and at the end of 8 weeks. RESULTS: Patients ranged in age from 1 to 16 years; 80% were boys and 20% were girls. Mycologic examinations disclosed Trichophyton verrucosum in 40% of patients, T. violaceum in 40% and Microsporum canis in 20%. At week 8, the griseofulvin-treated group showed a cure rate of 76%, and the fluconazole-treated group 78%. The cure rates were not statistically significant. CONCLUSION: Fluconazole constitutes an alternative but, because of greater availability and lower cost, griseofulvin remains the treatment of choice for tinea capitis.

Administration, Oral↗
PubMed2006

An experience from an outbreak of tinea capitis gladiatorum due to Trichophyton tonsurans.

'Tinea corporis gladiatorum' describes a dermatophytosis transmitted mainly from close skin contact among wrestlers. Although tinea corporis is well recognized, no data are available for tinea capitis infections in wrestlers. After finding tinea capitis infection in a student wrestler, we aimed to search for possible ringworm infections among wrestlers in a wrestling boarding-school. Of the 32 wrestlers, 29, aged 12-18 years, were affected, of whom 22 had scalp involvement. Trichophyton tonsurans was isolated from 20 of the patients, and T. mentagrophytes from the remaining two. Isolated strains of dermatophytes were susceptible to terbinafine and itraconazole. The patients with tinea capitis received oral terbinafine for 4 weeks, and patients with more than two lesions but without scalp involvement received oral terbinafine for 2 weeks. Overall clinical and mycological cure rate was 72.4% and 70%, respectively, at assessment at week 6. The asymptomatic dermatophyte carrier rate was negative 1 year after control of the epidemic. Terbinafine seems to be an alternative drug for the treatment of tinea capitis caused by T. tonsurans; however, control of an outbreak may be very difficult and effective preventive measures should be considered.

Adolescent↗
PubMed2002

Tinea capitis: focus on African American women.

Tinea capitis is a common cutaneous fungal infection in US school children, but adults may be carriers of tinea pathogens in the scalp. However, few cases of actual tinea capitis in adults have been reported in the literature. A retrospective analysis of all adult patients with positive scalp fungal cultures from June 1997 to March 2000 were reviewed. Seventy-nine cases of tinea capitis were identified. Nine (11.4%) were adults, 7 of whom were African American women, who were an average of 46 years old (range, 25 to 64 years). Three of these patients had prior exposure to a child with tinea capitis. These results suggest that tinea capitis affects adult African Americans, particularly women. Widespread scalp culture is indicated for papulosquamous disease and alopecia in this segment of the population.

Adult↗
PubMed1979

A study of Tinea capitis in Libya (Benghazi).

Tinea capitis formed 20% of all superficial mycotic infections, which in turn represented 12% of all skin disease diagnosed at the skin outpatient department of Al-Jamaheria hospital in Benghazi. The majority (94%) of tinea capitis occurred in children. A sample of 200 cases cultured revealed Trichophyton schoenleinii to be the most prevalent species of dermatophyte (69.5%) followed by Microsporum audouinii. (23.8%).

Adolescent↗
PubMed1990

Itraconazole in the treatment of tinea capitis.

Fifty patients with tinea capitis were treated with itraconazole, 25 to 100 mg/day, for 20 to 73 days in six countries. Forty-seven patients (94%) responded clinically (healed or markedly improved) to therapy, of which 38 patients (76%) completely healed and 9 patients (18%) markedly improved. Three patients (6%) failed therapy. Forty-two patients were assessable for mycologic examination; 38 patients (93%) converted mycologically to negative and 4 patients (7%) remained positive for organisms. In one group of 20 patients treated for 30 days, 6 patients were clinically and mycologically healed. By the 2-week follow-up visit 9 additional patients were healed, and 4 weeks after treatment all 20 patients were both clinically and mycologically healed. The primary organisms reported were Microsporum canis and Trichophyton tonsurans. Only one patient reported a possible side effect (tired legs). Laboratory values were all within normal limits, except for one patient who had a transient and slight increase in serum transaminase level. Low-dose itraconazole appears to be safe and effective in the treatment of tinea capitis.

Antifungal Agents↗
PubMedDate not supplied

Tinea capitis: an overview with emphasis on management.

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichophyton tonsurans now predominates over Micro-sporum audouinii. With this transition the utility of the Wood's light for diagnosis has been reduced since T. tonsurans infection is Wood's light negative. Griseofulvin has been the mainstay of therapy for the last 40 years. The newer antifungal agents-itraconazole, terbinafine, and fluconazole-appear to be effective and safe for the treatment of tinea capitis. When tinea capitis is due to T. tonsurans or other endothrix species the following regimens have been used: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen with capsules (5 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart), and itraconazole pulse regimen with oral solution (3 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart). With terbinafine tablets the continuous regimen (>40 kg body weight, 250 mg/day; 20-40 kg, 125 mg/day; and <20 kg, 125 mg/day) is given for 2 to 4 weeks. Fluconazole tablets or oral suspension (6 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once-weekly regimen may also be effective. When ectothrix organisms (e.g., Microsporum canis) are present, a longer duration of therapy may be required. The data suggest that the newer agents are effective, safe with few adverse effects, and have a high benefit:risk ratio. It remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection.

Antifungal Agents↗
PubMed1999

Tinea capitis in Basrah, Iraq.

Tinea capitis is the most common type of dermatophytosis constituting 35.2% (173/491) of all cases of dermatophytosis seen at two out-patients dermatological clinics of the Basrah General Hospital and at two private dermatological clinics between October 1994 and December 1995. Males were more commonly affected than females represented by 60 and 40%, respectively. Out of 173 mycologically positive cases, 143 specimens were culture-positive, represented by five dermatophyte species; Trichophyton violaceum was the most frequent causative agent (38.5%), followed by Trichophyton verrucosum (28.7%), Microsporum canis (26.5%), Trichophyton mentagrophytes var. mentagrophytes (5.6%) and Microsporum gypseum (0.7%). Six atypical cases appeared as cases of seborrheic dermatitis or dandruff and were proved to be atypical cases of tinea capitis caused by T. violaceum.

Adolescent↗
PubMed2004

Squamous cell carcinoma of the scalp after radiotherapy for tinea capitis.

BACKGROUND: Radiotherapy for tinea capitis was widely used in the 1930s and 1940s. There is a fourfold increase in the risk for developing nonmelanoma skin cancer in the scalp. Excision of lesions is challenging, as tissue around the wound is atrophic and susceptible to ischemia. OBJECTIVE: To discuss the risk of skin cancer in the older patient who received scalp radiotherapy in childhood and options for scalp reconstruction after excision. METHODS: A woman developed squamous cell carcinoma on the scalp 67 years after radiotherapy for tinea capitis. RESULTS: The large excision defect was successfully grafted, avoiding the need for complex scalp reconstruction. CONCLUSION: Patients who received scalp radiotherapy in childhood are at increased risk of developing nonmelanoma skin cancer. The unique anatomy of scalp tissue makes it difficult to close excisional defects. Skin grafting often fails, and complex flaps or the importation of vascularized tissue may be required.

Aged↗
PubMed2005

Pediatric tinea capitis: recognition and management.

Tinea capitis (ringworm of the head) is the most common dermatophytosis of childhood with an increasing incidence worldwide. If suspected clinically, further diagnostic procedures, including direct microscopy and culture, should be performed. Other scalp alterations, such as seborrheic dermatitis, atopic eczema, psoriasis, alopecia areata, folliculitis, and pseudopelade, may mimic ringworm of the head and must be identified. A proven fungal infection of scalp skin and hairs warrants immediate initiation of systemic treatment. At present, only oral griseofulvin is approved for therapy of scalp ringworm in children by health authorities. However, the advent of several newer antifungal agents such as itraconazole, fluconazole, and terbinafine has broadened the therapeutic armamentarium in recent years. These agents offer shorter treatment intervals, and their adverse effects and drug interaction profiles appear to be well within acceptable limits. In patients with tinea capitis, systemic therapy at weight-dependent dosages for an appropriate amount of time in conjunction with topical supportive measures will help to prevent disfiguring hair loss, permanent formation of scar tissue, spread of fungal organisms to other cutaneous regions, and infection of other persons.

Antifungal Agents↗
PubMed2004

[Epidemiology of tinea capitis in Abidjan, Cote d'Ivoire].

Tinea capitis is a dermatosis of the scalp due to dermatophytes that can cause hair loss. It remains a significant endemic problem mainly in school children in tropical regions. The purpose of this case-control study carried out in the Dermatology Center of Treichville Hospital was to identify risk factors for tinea capitis in Abidjan, Cote d'Ivoire. A total of 80 cases were recruited on the basis of clinical findings showing one or several plaques showing desquamation or parakeratosis suggestive of tinea capitis. Diagnosis was confirmed by mycology using samples seeded on Sabouraud-chloramphenicol glucose agar and incubated at 27 degrees C for a mean period of 15 days. Species identification was based on growth rate, macroscopic aspect of isolates, production and potential diffusion of pigment, and microscopic examination. Controls were the next patient of the same age and sex with no evidence of mycosis. All subjects were questioned about previous history of mycosis, duration of tinea capitis lesions, functional signs, grooming habits, and pet-keeping. Size of selection was calculated by epi info 6.04 fr according to following estimations: percentage of exposed subjects in control group: 30%; percentage of exposed subjects in case group: 50%; probability threshold of 5% to find a difference between case and control groups even though there was no difference; and probability threshold of 20% to find no difference between cases and controls even though there was a difference. Study findings demonstrated a 3 times higher incidence of tinea capitis in boys than in girls and a peak during childhood especially between the of 5 to 9. The most frequent etiologic agents were Trichophyton soudanense and Microsporum langeroniise. Subjects at highest risk lived in dwellings having less than 4 rooms, used soap to wash the hair, cut their hair with a blade, and had low income.

Adolescent↗
PubMed2002

A randomized, double-blind, parallel-group, duration-finding study of oral terbinafine and open-label, high-dose griseofulvin in children with tinea capitis due to Microsporum species.

BACKGROUND: Tinea capitis, a common clinical pattern of dermatophyte infection in children is becoming a public health hazard in some countries. Several studies have reported terbinafine to be a safe and well-tolerated fungicidal drug for the treatment of this infection. However, the optimal treatment duration for its use in the treatment of tinea capitis caused by Microsporum species has not yet been determined. OBJECTIVE: (i) To establish the optimal duration for terbinafine treatment to bring about complete cure of tinea capitis due to Microsporum infection in a large paediatric population, and (ii) to obtain information on the maximum therapeutic effect of the existing therapy. PATIENTS AND METHODS: This parallel-group, double-blind, multicentre study was conducted in Europe and South America. Patients were randomized to one of four oral terbinafine treatment arms (6, 8, 10 or 12 weeks treatment) or to an open label, 12-week, high-dose griseofulvin (20 mg x kg(-1) x day(-1)) arm at a 1 : 1 : 1 : 1 : 1 ratio. All patients were followed up for 4 weeks after the end of the treatment phase. RESULTS: In this group of 134 intention-to-treat patients, effective treatment was observed at the end of study in 62% of patients treated with terbinafine for 6 weeks and in 63% treated for 8 weeks. Mycological cure was obtained in 59% and 57%, respectively, and clinical cure in 76% and 80%. In the griseofulvin group, effective treatment was 88%, mycological cure was 76% and clinical cure 96%. However, these high rates were believed to be due to the high dosage of this drug and the prolonged course of treatment. Complete cure was observed at the end of study in 62% patients treated with terbinafine for 6 weeks, in 60% treated for 8 weeks and in 84% patients treated with griseofulvin for 12 weeks. CONCLUSIONS: Although there was no statistical trend between the duration of terbinafine treatment within the groups for complete cure at the end of study, there was a positive correlation between the daily dose of terbinafine (mg x kg(-1)) and complete cure. Terbinafine therapy for 6 weeks could represent an alternative to griseofulvin for the treatment of Microsporum tinea capitis. However, further clinical trials are required in order to optimize the dose regimen to allow higher cure rates to be reached.

Adolescent↗
PubMed1995

Tinea capitis: new perspectives on an old disease.

Tinea capitis caused by Trichophyton tonsurans is a common infection in children, and has become a significant public health problem in the United States. Epidemics of tinea capitis occur both in families and in institutions such as schools and day care centers. Infection is often difficult to eradicate. Fomites and asymptomatic carriers likely contribute to the spread of the disease and to re-infection of treated patients. The morphology of tinea capitis is diverse, from seborrhea-like scaling to tender, inflammed nodules on the scalp. Because a lengthy course of systemic griseofulvin is required to treat this infection, management of tinea capitis can be challenging. As newer antifungal agents are developed, more effective and convenient therapy for tinea capitis may become available.

Adult↗
PubMed2000

Optimizing the therapeutic approach in tinea capitis of childhood with itraconazole.

BACKGROUND: Tinea capitis is the most common dermatophytosis of childhood with increasing incidence. Whereas griseofulvin is considered by many as the mainstay of treatment, newer oral antifungal agents, including fluconazole, itraconazole and terbinafine have demonstrated higher efficacy, resulting in shorter treatment durations. OBJECTIVES: We aimed to determine the optimum regimen for the treatment of childhood tinea capitis with itraconazole. METHODS: A mycological culture outcome-dependent combination of a 28-day continuous and facultative additional 14-day courses with itraconazole was used in 42 children (20 girls; 22 boys) aged 12-140 months (mean 66) with tinea capitis due to Microsporum canis (n = 26) and Trichophyton violaceum (n = 16). The drug was given orally according to the patients' body weight (50 mg daily for < 20 kg; 100 mg daily for > or = 20 kg) over 4 weeks. Direct microscopy and fungal culture as a parameter for efficacy were repeated 2 weeks after termination of treatment. Assessment of efficacy was based on the evaluation of results from light microscopy and culture at 8 weeks after initiation of treatment, and in the case of a further positive mycological culture at 14 and 20 weeks, respectively. A positive fungal culture at these times resulted in an additional course for 2 weeks with the initially chosen itraconazole dosage. RESULTS: In 34 of 42 patients a single 4-week course of itraconazole resulted in a complete mycological cure of lesions as demonstrated by light microscopy and mycological culture. Four of 42 patients had to be treated by a second itraconazole course for 2 weeks, and four children received a third course of itraconazole for 2 weeks until all lesions showed negative direct microscopy and mycological culture. No abnormal haematological or biochemical results occurred. Apart from transient, completely reversible indigestion in two children, no side-effects were observed. CONCLUSIONS: A culture-based 28-day continuous therapeutic regimen plus facultative cultural outcome-dependent additional 14-day courses of a body weight-adapted dosage of itraconazole in tinea capitis due to M. canis and T. violaceum is discussed; this offers the advantage of an effective therapy with complete negative direct microscopy as well as negative cultural results, within a shorter active treatment period (cf. previous studies with continuous administration of itraconazole).

Adolescent↗
PubMed1989

A contribution to the study of tinea capitis in Lusaka, Zambia.

A study of tinea capitis in urban and rural schools of Lusaka revealed two dermatophytes, vis., Microsporum langeroni and Trichophyton violaceum as the causative agents of tinea capitis among school children. Tinea capitis was more common among boys (18.0%) than girls (14.7%), with prevalence of 16.8% and a peak infection at 9-11 years for both sexes. Clinically, most cases due to both M. langeroni and T. violaceum were non-inflammatory. The inflammatory cases were caused by T. violaceum. The higher number of infected children from squatter and low-cost areas was statistically highly significant compared to children from high-cost areas. A higher number of rural children were infected with tinea capitis than children in urban Lusaka. T. violaceum was the only dermatophyte species isolated in rural Lusaka, while in urban Lusaka, both T. violaceum and M. langeroni were isolated.

Adolescent↗