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PubMed2004

Radio-induced malignancies of the scalp about 98 patients with 150 lesions and literature review.

INTRODUCTION: - The induction of malignant diseases is one of the most concerning late effects of ionizing radiation. The topic of this study deals with skin tumors developed in the irradiated areas in children given X-ray therapy for tinea capitis. MATERIAL AND METHODS: - All patients with malignant tumors of the scalp referred to Salah Azaiz Institute between 1970 and 2001 have been questioned in order to determine if there had been a prior X-ray irradiation for tinea capitis, its modality, and its consequences. The first scalp irradiation goes back to 1922 and the last was performed in 1963. RESULTS: - Ninety-eight patients with 150 radio-induced cancers of the scalp following irradiation for tinea capitis are reported (1.5 lesion per patient). The patients were irradiated in various hospitals and dispensaries throughout the country. Eighty-one patients (82%) had only one session of radiation. The average age at irradiation was 12 (+/-6) years, the latent period for radiation-induced skin cancers was 36 (+/-14) years. In 61 patients (62%), the scalp appeared normal and in 38% radiodermatitis was noted. Patient age at diagnosis of malignancy varied from 20 to 83 years with an average of 47 years. Basal cell carcinomas (125 cases) and spinocellular carcinomas (16 cases) were the most common, three other cases of annexial tumors, two malignant non-Hodgkin's lymphomas and four melanoma lesions are also present. Radiotherapy was used for the treatment of 74 patients (alone in 42 and associated with surgery in 32 patients); 14 patients had exclusive surgical excision. CONCLUSIONS: - Basal cell carcinomas are the most frequent tumors arising on chronic radiodermatitis. In spite of the long latency period, patients' young age at irradiation explained the occurrence of these cancers at a relatively young age. Literature review is suggesting recessive mutation of tumor-suppressor genes as the characteristic abnormality in radio-induced cancer.

Adult↗
PubMed2003

[Epidemiological survey of dermatophytosis in Spain (April-June 2001)].

INTRODUCTION: A three-month (April-June 2001) cross-sectional study was designed to assess the epidemiological profile of dermatophytosis in Spain. METHODS: Sixty-two medical centers belonging to 14 different autonomous regions of Spain took part in the survey. A total of 491 strains were sent the Mycology Unit of the National Microbiology Center together with a form containing information on each patient. Isolates were identified by routine methods. RESULTS: The average age of the patients was 38.7 years and 55.6% were men. The most frequent dermatophytoses were tinea unguium (39.1%), tinea corporis (25.1%), tinea pedis (12.6%), and tinea capitis (11.2%). Trichophyton rubrum (43%) was the most prevalent species. T. mentagrophytes (21.2%) and Microsporum canis (9.8%) were the second and third most common species, respectively. Tinea unguium was significantly associated with urban residence, and tinea corporis with rural residence and contact with animals. T. rubrum was related with urban dermatophytosis and T. mentagrophytes with rural cases. Tinea capitis due to T. tonsurans and T. violaceum was related with patients of North African origin. Tinea unguium was the most prevalent infection by autonomous region, except in Castilla-León, Asturias, Andalucía and Aragón, where tinea corporis was the most common dermatophytosis. Tinea capitis was the most frequent infection in Castilla-La Mancha and Extremadura. T. mentagrophytes was more prevalent than T. rubrum in Valencia, Castilla-La Mancha, Aragón and Murcia. CONCLUSION: This cross-sectional study shows regional differences in the clinical and microbiological features of dermatophytosis in Spain. Epidemiological surveys are an essential tool for developing strategies for infection control.

Adult↗
PubMed1992

Superficial mycoses in Saudi Arabia.

Between June 1988 and December 1990, 1018 cases of superficial mycoses were investigated. Diagnosis was confirmed by microscopic examination in 503 cases and the causal agent was isolated in 490 cases. Tinea capitis accounted for 47.7% (92.5% in children below 10 years of age). The frequency of other clinical types in descending order was pityriasis versicolor 25.8%, tinea corporis 9%, onychomycosis 5.8%, tinea pedis 4%, intertrigo 3.9% and tinea cruris 2.8%. Erythrasma was encountered three times and mixed piedra and trichomycosis axillaris once. Microsporum canis was the commonest aetiological agent, responsible for 46.9% of ringworm infections. Malassezia furfur was the next most common agent (26.5%) followed by Candida albicans (8.6%) and Trichophyton violaceum (8.2%). Other species were found less frequently. T.simii was isolated from four cases of tinea cruris and one each of tinea capitis and tinea corporis, and Piedraia hortae and Trichosporon beigelii from a case of mixed piedra infection.

Adolescent↗
PubMed1985

Epidemiological trends of dermatophytoses and dermatophytes in Jerusalem between 1954 and 1981.

Data for dermatophyte infections analysed for five 3-year periods between 1954 to 1981 led to the following conclusions: Tinea pedis, tinea cruris and tinea manuum showed an increase in the 50's and 60's and declined in the 70's; Tinea unguium and tinea corporis showed an increase during the whole period; At all these sites, the percentage of Trichophyton rubrum, the main etiologic agent, increased steadily over the periods while the percentage of Trichophyton mentagrophytes, the secondary etiological agent, decreased. Epidermophyton floccosum, the third etiological agent in these sites, showed no sharp fluctuations; These three dermatophytes which show similar microclimatic requirements and favour the same microecological niches, were called 'glabrohydrophilic'. In tinea corporis they form a definite subset, their percentage being similar to that at other glabrous sites; Tinea capitis was at its peak in the 50's, decreased sharply until the second half of the 70's, its main etiological agent being Trichophyton violaceum. Since 1979, an increase of tinea capitis occurred due to the newly introduced Microsporum canis; Dermatophytes favouring scalp hair were called 'trichophilic'. In tinea corporis they form a definite subset, their percentage being similar to that of tinea capitis; A comparison with other studies from this country shows that macroclimate (i.e. humid warm coastal climate compared with dry cooler inland-mountain climate) is not an important factor in the etiology of tinea.

Arthrodermataceae↗
PubMed1995

Overview of the use of terbinafine (Lamisil) in children.

This review summarizes the efficacy and tolerability of terbinafine (Lamisil) in the treatment of dermatophytoses in children. In six clinical studies, 152 children who received terbinafine were evaluable for efficacy and 196 were evaluable for tolerability. In these studies, terbinafine was used for between 1 and 28 weeks. The median treatment was 4 weeks, the duration of treatment in the tinea capitis studies. As a result of extensive experience in adults at doses of 10 mg/kg and less, and the overall pharmacokinetic profile in children, including the lower volume of distribution of terbinafine into lipophilic tissue, the use of a dose of 125 mg/day for children weighing 20-40 kg, and 62.5 mg/day in children weighing less than 20 kg, has been proposed. This dose was shown to be well tolerated and effective. For children weighing > 40 kg, the adult dose of 250 mg is appropriate. Terbinafine was shown to be very effective (93% cured), in the treatment of children with tinea capitis, using a shorter treatment duration (4 weeks) than that usually employed with presently available antifungal drugs. It is also effective in children with various dermatophyte infections of the skin, with a cure rate of more than 90%. Terbinafine was shown to be well tolerated in children aged between 2 and 17 years. The recommended duration of treatment for tinea capitis is 4 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Efficacy and safety of itraconazole use in children.

Current dosing regimens for itraconazole are effective, safe, and versatile for use in superficial fungal infections in children, particularly tinea capitis. Good efficacy rates have been noted in both Trichophyton and Microsporum tinea capitis infections. Itraconazole has a high affinity for keratin, and accumulates to high levels at the site of superficial fungal infections. A pulse regimen may be chosen over continuous dosing, because the accumulation persists after dosing of itraconazole has been stopped. An oral solution of itraconazole is available, and may be more convenient for children who cannot swallow capsules. The oral solution also produces good rates of efficacy, but may be associated with a somewhat higher potential for gastrointestinal adverse events than the capsules. The range of adverse events noted with itraconazole capsules or oral solution use in children is similar to the range in adults. Events are generally mild and transient. Attention must be taken to note any medications that the child is using, because itraconazole is associated with a range of potential drug interactions. This safety of use, in combination with itraconazole's wide antifungal spectrum and pharmacokinetic properties, which allow for shorter dosing regimens, may make itraconazole a suitable alternative to griseofulvin for pediatric superficial fungal infections.

Administration, Oral↗
PubMed1984

A survey of dermatophytes isolated from human patients in the United States from 1979 to 1981 with chronological listings of worldwide incidence of five dermatophytes often isolated in the United States.

A survey of dermatophytes isolated from patients seeking medical advice was made from 1979 to 1981 in the United States. The survey included 54 locations with data from 40 cities and 2 states. Correlations of these data with that of the other localities of the world were made to illustrate the dynamic epidemiology of several common dermatophytes. The most often isolated dermatophyte in this survey was Trichophyton rubrum having 53.66% of the total for these three calendar years. In a chronological listing of ringworm infections caused by this organism, many areas of the world have reported similar increased incidence of this pathogen. Trichophyton tonsurans was isolated 27.85% of the total. A dramatic increase of this pathogen as a cause of tinea capitis has been observed in most cities of the United States. It has been isolated in 25 different countries of the world. The percentage of isolation of Trichophyton mentagrophytes was 8.56%. This percentage may not be near the true incidence of infection by this dermatophyte because the infections are mild and respond to treatment without the individual seeking medical advice. Since the 1950s the percentage of isolations of the total has dropped for T. mentagrophytes in the United States. Epidermophyton floccosum accounted for 4.36% of the total. In a few areas of the world it causes over 30% of the total of dermatophytoses. Microsporum canis was isolated 3.72% of the total in the United States. It has recently been reported to be the dominant agent of tinea capitis in several South American countries, Tucson, Arizona and Kuwait. Once the dominant pathogen of tinea capitis in children in the United States, it was replaced by Microsporum audouinii before 1960. Today in the United States, M. audouinii only accounts for 0.30% of the total. It is considered eliminated as a pathogen in England. In this survey, isolated less than 1.0% of the total were Microsporum gypseum. Microsporum ferrugineum , Microsporum nanum , Microsporum fulvum and Trichophyton schoenleinii . Trichophyton meginii and Trichophyton terrestre were reported isolated but no numerical data were available.

Arthrodermataceae↗
PubMed1997

The use of oral terbinafine (Lamisil) in children.

In an ongoing study of Lamisil in children, 21 patients have so far been enrolled and preliminary data are reported in this paper. Eighteen have tinea capitis and 1 has tinea corporis. So far, Trichophyton tonsurans has been identified in 17 and Trichophyton violaceum in 2. Lamisil has so far proved to be well tolerated, efficacious and cost-effective in a 2-week course in those children with a Trichophyton species. If Microsporum canis is isolated, a longer course is probably indicated. Lamisil has the distinct advantage of producing good results in a short time period, making patient compliance less of a problem.

Administration, Oral↗
PubMed2006

[An epidemiological survey of dermatomycoses in Japan, 2002].

An epidemiological survey of dermatomycoses and the causative fungus flora of dermatophytoses in Japan for 2002 was made on a total number of 72,660 outpatients who visited 14 dermatological clinics throughout Japan. The results were as follows: 1) Dermatophytosis was the most prevalent cutaneous fungal infection (7,994 cases) seen in these clinics, followed by candidiasis (755 cases) and then Malassezia infections (220 cases). 2) Among dermatophytoses, tinea pedis was the most frequent (4,813 cases: male 2,439, female 2,374), then in decreasing order, tinea unguium (2,123 cases: male 1,093, female 1,030), tinea corporis (497 cases: male 281, female 216), tinea cruris (299 cases: male 249, female 50), tinea manuum (248 cases: male 144, female 104) and tinea capitis including kerion (14 cases, male 6, female 8). 3) Tinea pedis and tinea unguium are seen to increase in summer season, among the aged population and among males in each clinic. When compared to the previous surveys (1992 and 1997) by clinical form, t. unguium patients increased from 1.9% of total outpatients in 1992, to 2.0% in 1997, then to 2.9% in 2002. 4) As the causative dermatophyte species, Trichophyton rubrum was the most frequently isolated among all dermatophyte infections except tinea capitis. 5) T. rubrum was isolated from 63.3%(1,431/2,262) of tinea pedis lesions, followed by Trichophyton mentagrophytes (36.6%, 829/2,262), and also 88.8% (325/366) of t. corporis, 95.4% (185/194) of t. cruris and 85.6% (462/540) of t. unguium. 6) Cutaneous candidiasis was seen in 755 cases (1.0%) of 72,660 outpatients. Intertrigo (347 cases) was the most frequent clinical form, followed by erosio interdigitalis (103 cases) and diaper candidiasis (102 cases). It has a tendency to affect the aged being complicated with topical predisposing factors. 7) Cutaneous Malassezia infections and other superficial fungal infections are seen in 220 cases, without any characteristic features by gender or clinical form.

Adolescent↗
PubMed1985

[49 cases of tinea of the scalp observed in a tropical disease clinic in Paris].

Tinea capitis among school children population is still a public health problem. We described 49 cases of tinea capitis that have been diagnosed at the out patient clinic of Claude-Bernard Hospital, Paris. 44 of them were recently immigrated african children. 4 of them were children born in France from african parents. One case occurred on a caucasian girl, who never left metropolitan France. The pathologenic agent that heve been identified were: T. soudanense, M. audouinii var. Langeronii, T. schoenleinii and M. canis. The result of treatment with ketoconazole or griseofulvine are discussed.

Adolescent↗
PubMed1995

Superficial fungal infections. Getting rid of lesions that don't want to go away.

Systematic analysis of possible dermatophyte and candidal skin infections leads to an accurate diagnosis and prompt treatment with a specific regimen. The first steps are thorough skin examination and evaluation with a potassium hydroxide preparation. Tinea corporis, tinea cruris, tinea pedis, cutaneous candidiasis, and tinea versicolor can be treated with many topical antifungal agents, whereas tinea capitis requires oral griseofulvin therapy. Frequently used topical medications for tinea and candidal infections include clotrimazole (Lotrimin, Mycelex), econazole nitrate (Spectazole), ketoconazole (Nizoral), miconazole nitrate (Monistat-Derm, Micatin), oxiconazole nitrate (Oxistat), and ciclopirox olamine (Loprox). Topical selenium sulfide lotion can also be used for tinea versicolor, which is often a recalcitrant problem.

Candidiasis, Cutaneous↗
PubMed1987

Scalp infections in black children: think kerion.

Treatment of tinea capitis consists of a 5-week course of griseofulvin. A 1-week course of a systemic corticosteroid may be considered in addition to griseofulvin therapy to accelerate the subsidence of inflammation in kerion lesions. Kerion is an inflammatory form of tinea capitis which may progress rapidly into a fulminant infection if untreated. This case report underscores the need for prompt recognition and appropriate treatment of this disorder.

Abscess↗
PubMed1980

Fungal infections of the scalp in Western Australia.

Between 1963 and 1972, 1,212 fungi were isolated from patients with tinea capitis (ringworm of the scalp) in Western Australia. The clinical diagnosis was confirmed by microscopic examination examination and/or culture of hairs, scale or pus. Microsporum canis, a zoophilic fungus, was found to be the most common agent of tinea capitis in Western Australia, causing 1,100 infections and accounting for 90.8% of the total isolates. The highest incidence of M. canis infections occurred in children between the ages of 2 and 8 years. Males accounted for 57.7% of scalp infections, and there were comparatively few cases in either males or females over the age of 10 years. Trichophyton tonsurans was found to be the main cause of endothrix scalp infections in Western Australia.

Adolescent↗
PubMedDate not supplied

Dermatophytoses in Cusco (Peru).

A total of 90 cases of suspected dermatophytoses was observed over a period of 9 months in the city of Cusco (Peru) and in its environs. The age groups most commonly infected were 1-10 and 11-20 year old. The most common tineae diagnosed were tinea capitis (13.3%) and tinea unguium (11.1%). Only four species of dermatophytes were isolated: Microsporum canis (52.4%), Trichophyton mentagrophytes (35.7%), Tr. rubrum (9.5%) and Epidermophyton floccosum (2.4%). Dry weather, low temperature and high altitude do not seem to affect proliferation and infections by dermatophytes.

Adolescent↗
PubMed2005

Superficial mycoses due to Trichophyton violaceum in Athens, Greece: a 15-year retrospective study.

This is a retrospective study on the superficial mycoses due to Trichophyton violaceum in the greater Athens area for the last 15 years - 1989-2003. During this period 104 patients were found to have an infection due to T. violaceum- an incidence rate of 0.75% of all dermatophytosis. Of the patients 59 were Greeks, 15 Greek Gypsies and 30 immigrants mostly from Albania (50%). Of them 58 were children, 46 adults (mainly women, 34 cases). Trichophyton violaceum infection was presented with a variety of manifestations (127 cases). The prevailing was tinea capitis present in 85 patients - 57 children, 24 women and four men (women : men 6 : 1). Tinea capitis together with other forms of the infection was found in 14 patients. Tinea facie, corporis, manuum, barbae and unguium were seen in nineteen patients. The isolation rate of T. violaceum infection in the Greek population remained at a low level for three decades after the mid-1960s. However, a substantial increase in the isolation rate is observed in the mid-1990s attributed mainly to the influx of economic immigrants from countries where the infection is endemic.

Adolescent↗
PubMed2004

Serum sickness-like reaction associated with griseofulvin.

OBJECTIVE: To describe a serum sickness-like reaction associated with griseofulvin in a child being treated for tinea capitis. CASE SUMMARY: A previously healthy 5-year-old boy presented with tactile fever, rash on his legs and back, swelling of his toes and fingers, and leg pain. He was being treated at the time with griseofulvin for tinea capitis. Laboratory evaluation including immunologic workup revealed no abnormalities. Replacement of griseofulvin with itraconazole, along with an antihistamine and a nonsteroidal antiinflammatory drug, led to complete resolution of the patient's symptoms. An objective causality assessment revealed that the adverse reaction was probable. DISCUSSION: Serum sickness-like reactions may occur 7-21 days following exposure to an offending agent. Clinical manifestations are similar to those of serum sickness, with fever, malaise, and cutaneous eruption. However, on laboratory workup, complement levels are normal. Management of serum sickness-like reaction includes replacing the offending agent and providing symptomatic relief. CONCLUSIONS: Clinicians should be aware of the possibility of serum sickness-like reaction associated with griseofulvin therapy and consider the possibility when choosing between griseofulvin and newer, more expensive drugs.

Antifungal Agents↗
PubMed1979

Intracranial meningiomas related to external cranial irradiation.

Three cases are presented of meningiomas following small-dose external cranial irradiation in which several features clearly indicate a causal relationship between radiotherapy and tumour development. In two of them, multiple meningiomas followed X-ray treatment for Tinea capitis. The length of the latent period separates meningiomas following high-dose irradiation, usually administered for intracranial tumours, from those which followed small-dose irradiation. Therefore the oncogenic mechanism seems to act differently in the two groups. This demonstration that multiple meningiomas can occur in patients irradiated for Tinea capitis should enable other similar cases to be recognized.

Adult↗
PubMed2005

Prevalence of dermatophytic fungal infections in children: a recent study in Anambra state, Nigeria.

We conducted a recent survey of dermatological fungal infections amongst children in both urban and rural parts of Anambra State in the south-east geographical flank of Nigeria during the period January 2003 to December 2003. Samples were collected from 1624 children with clinically suggestive lesions and also between the ages of 4 and 16. Young children aged 7-11 and 4- 6 years had significantly higher incidences (P < 0.05) than their older colleagues aged 12-16 years among samples proved to be mycologically positive by microscopy, culture or both. There was a significant difference in the incidence of dermatophytoses amongst children in urban and rural areas investigated (P < 0.05). Tinea capitis was the predominant clinical type. Trichophyton tonsurans was the most prevalent etiological agent while Microsporum audouinii was the least in occurrence. We compared our result with a recent study in the northern geographical zone and observed that although incidence of dermatophytoses is higher in northern Nigeria, tinea capitis was the predominant clinical type in both regions. In addition, the etiological agents appear to vary from time to time in their occurrence and the reasons for these observations are discussed. A regular surveillance and assessment of the etiologic agent and its prevalence by medical mycologists is strongly recommended to facilitate monitoring, reduce/prevent transmission and spread of dermatophytes in countries like Nigeria where they constitute a public health problem.

Adolescent↗