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PubMed2002

Tinea capitis: epidemiology, diagnosis and management strategies.

Tinea capitis is a common superficial fungal infection of the scalp in children, particularly in those of African descent. Trichophyton tonsuran, an anthropophilic dermatophyte, is responsible for the majority of cases in North America. The clinical presentations are variable and include: (i) a "seborrheic" form that is scaling, often without noticeable hair loss; (ii) a pustular, crusted pattern, either localized or more diffuse; (iii) a "black dot" variety characterized by small black dots within areas of alopecia; (iv) a kerion, which is an inflammatory mass; and (v) a scaly, annular patch. Most experts still consider griseofulvin to be the drug of choice, but recommend a higher dosage of 20-25 mg/kg/day for 8 weeks because of the increase in treatment failures. Despite a history of having an excellent tolerability profile, the long treatment course and higher doses required for griseofulvin have led to consideration of new antifungal agents for this infection. Terbinafine, itraconazole, and fluconazole compartmentalize in skin, hair, and nails, thereby allowing shorter treatment courses of < or =4 weeks. All have generally been shown to be effective in the treatment of tinea capitis and appear relatively well tolerated, with gastrointestinal symptoms being the most common adverse effect. Monitoring for liver enzyme elevations is generally unnecessary if therapy is limited to </=4 weeks. As more data regarding efficacy, tolerability, and dose administration becomes available, one or more of these new antifungal agents may become first-line therapy for tinea capitis. For now, we recommend their use in cases of treatment failure or recurrent noncompliance. Our personal preference in the younger child is fluconazole. It has a favorable tolerability profile and is available in liquid form. In the older child who can take a tablet, terbinafine is recommended. More data is available on this drug in the treatment of tinea capitis than the other two, and it is the least expensive. Although the oral antifungal agents are the most important aspect of therapy, adjunctive therapy may be beneficial. Sporicidal shampoos, such as selenium sulfide, can aid in removing adherent scales and hasten the eradication of viable spores from the scalp in the hope of decreasing the spread of this infection. The use of corticosteroids for the treatment of kerions is controversial. Many of the studies have design flaws or show variable results. We recommend either a short burst of oral corticosteroids or topical corticosteroids in patients with the most severe disease.

Antifungal Agents↗
PubMed2005

Tinea capitis mimicking dissecting cellulitis: a distinct variant.

BACKGROUND: Tinea capitis is a common scalp dermatosis with several clinical patterns. Only two patients with a presentation of tinea capitis mimicking dissecting cellulitis have been described in the English literature. OBSERVATION: We report a patient with tinea capitis mimicking dissecting cellulitis who did not respond to griseofulvin therapy at 16 mg/kg/day but eventually cleared after a protracted course of higher dose griseofulvin. CONCLUSION: recognition of a dissecting cellulitis-like pattern of tinea capitis will increase clinical suspicion and avoid inappropriate management of a recalcitrant "dissecting cellulitis" in favor of prompt antifungal therapy of appropriate dosage and duration for patients with this unusual variant of tinea capitis.

Antifungal Agents↗
PubMedDate not supplied

Tinea capitis: fluconazole in Trichophyton tonsurans infection.

Tinea capitis is the most common dermatophyte infection in children. Trichophyton tonsurans is the most common etiologic agent in the United States, and for more than four decades the standard therapy has been griseofulvin. The availability of newer, and often more effective, antifungal drugs creates the opportunity for choice and the ability to optimally tailor treatment for a particular patient. Fluconazole is an azole antifungal drug available in a pleasant, well-tolerated, liquid formulation ideal for the pediatric population. It has a good safety profile and is approved in the United States for use in children, although not for tinea capitis. We present five patients with tinea capitis successfully treated with fluconazole.

Adolescent↗
PubMed1998

[Tinea capitis in Creteil. Trends over ten years].

INTRODUCTION: We analyzed tinea capitis data in a Paris suburban area over a 11-year period from (1985-1995) to evaluate epidemiology trends. PATIENTS AND METHODS: The following data were collected for patients seen at the Créteil myco-dermatology clinic with cultures positive for tinea capitis: sex, age, ethnic origin, fungal culture. RESULTS: Tinea capitis was observed in 336 cases (56 p. 100 females). Eight percent of the patients were under the age of 10 years and 11 p. 100 over 20 years. Trichophyton soudanense was isolated in 45 p. 100 of the patients. Anthropophilic agents rose over the 10 year period while the number of zoophilic agents remained stable. Specific dermatophytes appeared to predominate in populations of different ethnic origin. There was a two-fold increase in the number of tinea capitis cases in the 1990-1995 period compared with the five previous years. DISCUSSION: The percentage of adults with tinea capitis (11 p. 100) is higher than the 5 p. 100 reported in the literature. The rise in the number of anthropophilic tinea capitis cases resulted from an increase in T. soudanense (originating in Africa), probably related to the increasing immigrant population. This agent was identified in 95 p. 100 of the patients of African origin. Differing lifestyles and transmission between school children makes it quite difficult to interpret the correlation between ethnic origin and specific dermatophytes.

Adult↗
PubMed2006

Kerion and dermatophytic granuloma. Mycological and histopathological findings in 19 children with inflammatory tinea capitis of the scalp.

BACKGROUND: Inflammatory tinea capitis or kerion is the result of a hypersensitivity reaction to a dermatophytic infection. Majocchi's granuloma, in contrast, usually begins as a suppurative folliculitis and culminates in a granulomatous reaction. OBJECTIVES: To present clinical, mycological and histopathological findings for 19 cases of kerion of the scalp in children. METHODS: Nineteen children were investigated (14 boys and five girls) with a mean age of 6.5 years. A potassium hydroxide (KOH) exam and culture in Sabouraud dextrose agar were performed, followed by a biopsy with hematoxylin and eosin, periodic acid-schiff (PAS) and Gomori-Grocott stains. The same investigations were carried out in four control cases of noninflammatory tinea capitis. RESULTS: Clinical history varied from 2 to 16 weeks (mean 6.6 weeks). Diagnosis was confirmed by a positive KOH exam: all cases except one had a positive culture. The following dermatophytes were isolated: Microsporum canis (32%), Trichophyton mentagrophytes (27%), Trichophyton tonsurans (21%), Trichophyton rubrum (10%) and Microsporum gypseum (5%). The histopathological findings were: suppurative folliculitis (SF) 11%, SF plus suppurative dermatitis 37%, suppurative and granulomatous dermatitis (SGD) 26% and SGD plus fibrosing dermatitis 26%. Fungi were observed in 63% of the histopathological sections. Perifollicular infiltrates (PF) around the parasitized hair follicles were identified in the four noninflammatory control cases due to M. canis. CONCLUSIONS: Kerion Celsi is an inflammatory or suppurative type of tinea capitis caused by zoophylic dermatophytes (M. canis and T. mentagrophytes), but also by antrophophylic (T. tonsurans and T. rubrum) and geophylic (M. gypseum) dermatophytes. Histopathological findings showed a spectrum from mild suppurative folliculitis to dense granulomatous infiltrates without a clear relationship with the clinical features.

Biopsy↗
PubMed2001

Tinea capitis update: a continuing conflict with an old adversary.

Infection with tinea capitis in childhood is a common, age-old problem that continues to plague patients and their families. As is true for most infectious diseases, the epidemiology of tinea capitis is in a constant state of flux and varies considerably with respect to geography and specific patient populations. Trichophyton tonsurans is now the most common cause of tinea capitis in the United States. A recent epidemiologic observation is a striking increase in the incidence of tinea capitis, particularly among African-Americans. Clinical studies over the past decade that have investigated the response of tinea capitis to griseofulvin, the mainstay treatment for this condition, suggest a decrease in sensitivity to this pharmacologic agent, in association with this new epidemiology. Important advances in the diagnosis and treatment of tinea capitis include a renewed interest in the use of the cotton swab method of diagnosing fungal cultures in children, and the ongoing investigation of promising new medications for the treatment of tinea capitis, including terbinafine, itraconazole, and fluconazole in this era of resistant organisms.

Antifungal Agents↗
PubMed2003

Tinea capitis in adult women masquerading as bacterial pyoderma.

Tinea capitis is generally thought to be a common disease in children but not in adults. Adults with tinea capitis generally present with scale and alopecia. We report 3 adults with inflammatory tinea capitis caused by Trichophyton tonsurans that resembled a bacterial infection. Of these patients, 2 were initially given a diagnosis of bacterial pyoderma. All patients were successfully treated with oral antifungal agents. One patient had significant eosinophilia that resolved with treatment. We conclude that tinea capitis should remain in the differential diagnosis of adults with alopecia and pyoderma-like presentations. A biopsy specimen was helpful in making the diagnosis in 2 of the 3 patients, but fungal culture confirmed the diagnosis in all cases.

Age Factors↗
PubMed2004

Adult tinea capitis due to Trichophyton violaceum in China.

Tinea capitis is rare in adults. We report a case of adult tinea capitis due to Trichophyton violaceum in China. The female patient was immunosuppressed with prednisone due to the underlying disease of vulgaris pemphigus and was treated successfully with terbinafine. We also reviewed published cases of adult tinea capitis in China and compared these data with the characteristics of published cases in other regions in the world.

Antifungal Agents↗
PubMed1991

Tinea capitis in three adults.

Three cases of tinea capitis in healthy adults are presented. In light of the very low incidence (less than 1%) of tinea capitis in nonimmunocompromised adults and the possibility of contagion from asymptomatic dermatophyte carriers in the pediatric and adult populations, the necessity for heightened clinical suspicion and diagnostic tenacity in the evaluation of adults with scalp dermatitis and/or alopecia for possible tinea capitis is underscored.

Female↗
PubMed2004

Tinea capitis favosa in Poland.

Tinea capitis favosa is uncommon in Europe. We describe two patients who had local alopecia caused by Trichophyton schoenleinii. In the first case, we observed good clinical response after griseofulvin treatment and in the second case after topical application of ciclopirox cream.

Antifungal Agents↗
PubMed2006

Tinea capitis: current concepts in clinical practice.

Tinea capitis is a common infection, particularly among young children in urban regions. The infection often is seen in a form with mild scaling and little hair loss, a result of the prominence of Trichophyton tonsurans (the most frequent cause of tinea capitis in the United States). T. tonsurans does not fluoresce under Wood light, unlike the common tinea capitis-causing fungal organisms seen in Europe and many other countries, which emit a green fluorescence. However, T. tonsurans, like other fungi, also may less often produce an intense inflammatory reaction, which is suggestive of an acute bacterial infection.

Alopecia↗
PubMedDate not supplied

Trichophyton rubrum as the causative agent of tinea capitis in three children.

Tinea capitis, which is caused by Trichophyton rubrum, is only rarely described in medical literature. Incidence of this disease appears to lie well below 1% in Europe. Microsporum canis, Trichophyton mentagrophytes and Trichophyton tonsurans are the predominant causative agents discussed here. In April 1993 T. rubrum was isolated from typical pathological changes to the capillitium area in three children from a Nigerian family, who had been living in Germany for 3 years. All three children revealed multiple, round or irregularly formed, partially infiltrated, partially pustular, hairless areas measuring up to 2 cm in diameter and covered with tightly clinging scales. The children's parents did not suffer from any dermatological complaints. The oldest child had had these pathological changes for about 5 months, the other two for a shorter length of time. Therapy with 10 mg kg(-1) body weight of griseofulvin led to rapid recovery over a period of 4 weeks.

Child, Preschool↗
PubMed1994

Tinea capitis in Lahore, Pakistan.

BACKGROUND: The causative fungi of tinea capitis vary with geography and time. This study was planned to identify the etiologic agents and determine clinicoetiologic correlations of tinea capitis in Lahore, Pakistan. METHODS: From clinically suspected cases of tinea capitis, skin scrapings and hair samples were taken and subjected to microscopy and culture. RESULTS: Of 180 evaluable patients, 95% were children below 12 years of age with equal sex incidence. Noninflammatory lesions were seen in 62.2% of cases. Trichophyton violaceum was the most common etiologic agent responsible for 69.4% of infection, followed by T. tonsurans (16.7%), T. verrucosum (10%), Microsporum audouinii (2.2%), and T. mentagrophytes (1.7%). CONCLUSIONS: T. violaceum is the predominant pathogen causing tinea capitis in children and adults in this part of the world and gives rise to a varied clinical picture. Our findings agree with data from other parts of Pakistan and many countries abroad.

Adolescent↗
PubMed1998

Treatment of tinea capitis with itraconazole capsule pulse therapy.

BACKGROUND: The number of newly diagnosed cases of tinea capitis in children appears to be on the rise, particularly in urban centers. OBJECTIVE: The purpose of this study was to assess the effectiveness, safety, and compliance of itraconazole pulse therapy for tinea capitis. METHODS: Fifty subjects (48 children [less than 18 years of age] and 2 adults) with tinea capitis were treated with pulse itraconazole in a multicenter evaluation. Each pulse lasted 1 week, with 2 weeks between the first two pulses and 3 weeks between the second and third pulses. The decision to administer a second or third pulse was determined by the response of the subject at the time that the next pulse was due. During the 1-week pulse of active therapy, itraconazole (5 mg/kg/day) was dosed as follows: more than 40 kg, 200 mg per day (two capsules per day); 20 to 40 kg, 100 mg per day (one capsule per day); and 10 to 19 kg, 50 mg per day (one half of a capsule per day). The duration of the study was 12 weeks with mycologic evaluation at this time. Subjects who were classified as treatment failures at 12 weeks after the start of therapy were given the option of receiving an additional 1-week pulse of active therapy, with 3 weeks between successive pulses. RESULTS: The causative organisms were Trichophyton tonsurans (41 subjects), T violaceum (7), T. soudanense (1), and T rubrum (1). Thirteen subjects were lost to follow-up, with 37 subjects (35 children and 2 adults) available for evaluation 12 weeks after the start of therapy. At this time, cure (clinical and mycologic) was observed in 30 (81%) of 37 subjects. When the tinea capitis was mild, cure was obtained after one pulse in two subjects and after two pulses in five subjects. With tinea capitis of moderate extent, complete cure was obtained after one pulse in one subject, two pulses in eight subjects, and after three pulses in seven subjects. When tinea capitis was severe, two and three pulses produced complete cure in one and six subjects, respectively. Of the seven subjects whose conditions failed to respond (three subjects with moderate disease and four subjects with severe disease), five subjects chose to receive extra itraconazole. Clinical and mycologic cure was observed after four pulses in four subjects and after five pulses in one subject. There were no associated clinical adverse effects with itraconazole therapy. CONCLUSION: With tinea capitis, itraconazole pulse therapy is effective and safe and is associated with high compliance. The pulse regimen enables the duration of treatment to be individualized, according to the extent of disease and its rate of resolution.

Antifungal Agents↗
PubMed2006

[Tinea capitis in Madagascar: a survey in a primary school in Antsirabe].

BACKGROUND: Tinea capitis is a common infection among schoolchildren in developing countries. This condition is still under-reported in Madagascar. In order to assess the prevalence of Tinea capitis in Madagascar, we conducted a study in a primary school in Antsirabe, a town located in the country's high central territories. METHODS: Samples were taken from 210 children in the 4 school classes aged between 6 and 14 years. Only children with scaling lesions or with alopecia were sampled. No microsporic gray-patch ringworm was found in any of the children. Samples were obtained from a total of 83 children. Cotton swabs moistened with distilled sterilized water were rubbed on the children's scalps for 15 seconds and the scales thus collected were then seeded on 2 separate tubes of Sabouraud-Dextrose-Agar media containing chloramphenicol, one with and the other without cycloheximide. The tubes were incubated at a temperature of 27 degrees C for 4 weeks. All the micromycetes were identified (dermatophytes, yeasts and molds). RESULTS: Three species of dermatophytes were isolated: one anthropophilic species, responsible for black-dot ringworm (Trichophyton tonsurans), and 2 geophilic dermatophytes, unusual in human disease (Microsporum boullardii and Trichophyton terrestre). Of the 83 children sampled, 17 had 20 dermatophytes (in 3 children, 2 different species of dermatophytes were associated). We collected 15 Trichophyton tonsurans (2 Trichophyton tonsurans were associated with Microsporum boullardii, and 1 with Trichophyton terrestre), and 2 Microsporum boullardii. The prevalence of carriers of dermatophytes was 8 p. 100 for all children and 20.5% for the sampled children. DISCUSSION: Children in Madagascar, unlike those in Central Africa, do not develop microsporic gray-patch ringworm caused by Microsporum langeronii. However, they may present tinea capitis with small alopecic lesions, or they may frequently have Trichophyton tonsurans and seem to have healthy scalps. In contrast with Central Africa, where T. soudanense is the main cause of black-dot ringworm, and with North Africa, where T. violaceum is most frequently seen, these 2 species are not found in Antsirabe. Studies carried out in coastal regions with a more tropical climate could perhaps show other dermatophytes responsible for tinea capitis. Anthropophilic tinea capitis caused by Trichophyton tonsurans is endemic in the Antsirabe area. The lesions are inconspicuous with diffuse scaling, like those reported in surveys conducted in the USA. Mycological investigation followed up by topical treatment with a fungicide could diminish the spread of this anthropophilic, and thus contagious, dermatophyte. Trichophyton tonsurans has also reappeared regularly in France over the past few years.

Adolescent↗
PubMed2002

[Tinea capitis. Therapeutic options in the post-griseofulvin era].

Tinea capitis is the most common dermatophyte infection during childhood. In Germany, only griseofulvin is approved for therapy by regulatory agencies. In recent years, several newer antifungal agents such as itraconazole, fluconazole and terbinafine have broadened the therapeutic armamentarium and are used for the treatment of childhood tinea capitis. Itraconazole and terbinafine seem to be equally or more effective in treatment of tinea capitis within a shorter period of time than griseofulvin. Fluconazole is probably also effective for this indication, although supporting data is limited. Encountered side effects as well as interactions with other drugs appear to be well within acceptable limits for all three drugs. In conclusion, systemic therapy of scalp ringworm with itraconazole and terbinafine, as well as perhaps fluconazole, seems to be an equivalent or a superior therapeutic approach as compared to the use of griseofulvin. For the future, regulatory approval for the use of these newer antifungal agents in tinea capitis of childhood is recommended.

Antifungal Agents↗
PubMedDate not supplied

Tinea capitis due to Trichophyton rubrum in a neonate.

Tinea capitis is a common infection of school-aged children, but there have been only a few reports of tinea capitis in newborns. Furthermore, Trichophyton rubrum as a causative organism of tinea capitis is documented very rarely. We report herein a neonate in whom T. rubrum was the causative agent. This boy was successfully treated with three pulses of oral itraconazole solution.

Administration, Oral↗
PubMed2004

Tinea capitis caused by Microsporum canis treated with terbinafine.

Tinea capitis is a disease found throughout the world. It frequently affects children and only rarely adults, usually post-menopausal women. Numerous dermatophytes of the genus Microsporum and Tricophyton can cause tinea capitis and griseofulvin is still today the treatment of choice. To study the effectiveness and tolerability of terbinafine treatment in tinea capitis caused by Microsporum canis we treated 26 patients - 22 children and four women - for a period of 12 weeks. Dosage adopted was 62.5 mg day(-1) in patients weighing less than 20 kg, 125 mg day(-1) in those weighing between 20 and 40 kg, and 250 mg day(-1) in patients weighing more than 40 kg. Clinical and mycological healing was achieved in 22 patients (84.6%), tolerability was excellent and in no cases were side effects or abnormal results in blood chemistry tests observed.

Aged↗