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PubMed1993

[Causal agents of tinea of the scalp in the region of Butare (Rwanda)].

One hundred children with clinical symptoms of tinea capitis have been examined. The samples were inoculated on Sabouraud medium and incubated at 25 degrees C. In 65 of 100 cultured samples at least one dermatophyte was isolated. In 42 cases Trichophyton violaceum and in 26 cases Microsporon langeroni was grown. The cultures of three patients resulted in the mixed growth of Trichophyton violaceum and Microsporon langeroni. Determination of the type of tinea capitis on clinical symptoms alone is difficult, especially when early lesions are concerned.

Adolescent↗
PubMed1983

Scaling scalp diseases in children.

Scaling scalp diseases in 142 children were evaluated. Included were seborrheic dermatitis, atopic dermatitis, tinea capitis, and psoriasis. Clinical signs were noted, and various treatments were then undertaken. Patients with seborrheic dermatitis responded well to treatment with antiseborrheic shampoo and topical corticosteroids. Atopic disease was more resistant to treatment, but did improve with less frequent shampooing and twice daily topical corticosteroid application. Selenium shampoo was a useful adjunct in the treatment of tinea capitis (cultures became negative at two weeks compared to persistent positivity in other treatment groups).

Adolescent↗
PubMed1984

Radiation-induced cerebral meningioma: a recognizable entity.

The authors retrospectively analyzed the clinical and histopathological findings in 201 patients with intracranial meningiomas operated on in the period 1978 to 1982. Forty-three of the patients (21.4%) had at some previous time received radiation treatment to their scalp, the majority for tinea capitis. The findings in these 43 irradiated patients were compared with those in the 158 non-irradiated patients. Several distinctive clinical and histological features were identified in the irradiated group, which suggest that radiation-induced meningiomas can be defined as a separate nosological subgroup. The use of irradiation in large numbers of children with tinea capitis in the era prior to the availability of griseofulvin may be responsible for a significantly increased incidence of intracranial meningiomas.

Adult↗
PubMed2004

Radiation-induced intracranial meningiomas: review of six operated cases.

It is well known that radiation can induce meningiomas. These tumors usually arise in patients with a history of low-dose radiation to the scalp for treatment of tinea capitis or high-dose radiation for a previous brain tumor. Radiation-associated meningiomas (RAMs) morphologically resemble their spontaneously arising counterparts. However, RAMs frequently present a more malignant phenotype and, as such, are diagnosed as "atypical" or "aggressive" meningiomas and occur predominantly in younger patients. This paper describes six cases of radiation-associated intracranial meningiomas in patients previously treated with low-dose radiation to the scalp for tinea capitis.

Cranial Irradiation↗
PubMed1996

Tinea caput medusa: an unusual presentation of Trichophyton mentagrophytes on the scalp.

Tinea capitis has a wide variety of clinical presentations in adolescents and adults. However, the occurrence of fingerlike projections in the scalp has not been previously described. A 14-year-old girl presented with a one-year history of a painful scalp mass. Debridement of this mass revealed slender papillomatous growths resembling those seen in elephantiasis nostras verrucosa. A fungal culture grew Trichophyton mentagrophytes. We describe the first case of this unusual clinical variant of tinea capitis and hypothesize on its pathophysiological basis.

Adolescent↗
PubMed1991

Dermatophytosis in children and adolescents: epidemiological, clinical, and microbiological aspects changing with age.

During a four year period, a total of 84 cases of dermatophytosis were seen in patients from 0 to 17 years of age attending our out-patient department. The sex distribution was about equal in preadolescents. Males predominated among adolescents. A peak incidence at early school age was due to cases of tinea capitis, mainly caused by Microsporum canis. A peak among adolescents was due to cases of tinea pedis, mainly caused by Trichophyton rubrum. In general, patients with Trichophyton rubrum infections were older than those with other types of dermatophytosis (p less than 0.05). Dermatophytosis due to Microsporum canis was most frequently seen in January and in September (p less than 0.01). Although onychomycosis due to dermatophytes was a comparatively rare disease, it did occur within all age subgroups. Entities which were very frequent in former times and which have become rare during the last decades, such as tinea capitis due to Trichophyton schönleinii, still contribute to the spectrum of dermatophytosis in childhood.

Adolescent↗
PubMed1987

Randomized controlled trial of intralesional corticosteroid and griseofulvin vs. griseofulvin alone for treatment of kerion.

We studied 30 children with tinea capitis and kerion to define the epidemiology of the disease and to compare the efficacy of intralesional steroid injection and griseofulvin to griseofulvin alone for treatment of this disorder. Patients ranged in age from 1 year to 12 years, 1 month (mean, 5 years, 7 months). All patients were black and 23 (77%) were female. (The racial composition of our clinic population is 45% black, 18% Latin American, 34% Caucasian and 3% Asian.) Fungus cultures were positive in all but one patient and Trichophyton tonsurans was isolated from 26 of 30 (87%) of the pretreatment hair cultures. Direct microscopic examinations of KOH-treated hair samples were negative in 13 of 29 (43%) culture-positive patients. Patients were randomly assigned to receive intralesional steroid injection (2.5 mg) and griseofulvin (14 patients) or griseofulvin only (16 patients). The treatment groups were comparable with regard to age, sex, duration of lesions before treatment and type of lesions. There were no significant differences between the two treatment groups in the time to negative culture, time of onset of new hair growth, complete regrowth of hair and time to scalp clearing. We conclude that intralesional injection of corticosteroid is an unnecessary adjunct to therapy for patients with tinea capitis with kerion.

Child↗
PubMed2001

Thyroid cancer following scalp irradiation: a reanalysis accounting for uncertainty in dosimetry.

In the 1940s and 1950s, over 20,000 children in Israel were treated for tinea capitis (scalp ringworm) by irradiation to induce epilation. Follow-up studies showed that the radiation exposure was associated with the development of malignant thyroid neoplasms. Despite this clear evidence of an effect, the magnitude of the dose-response relationship is much less clear because of probable errors in individual estimates of dose to the thyroid gland. Such errors have the potential to bias dose-response estimation, a potential that was not widely appreciated at the time of the original analyses. We revisit this issue, describing in detail how errors in dosimetry might occur, and we develop a new dose-response model that takes the uncertainties of the dosimetry into account. Our model for the uncertainty in dosimetry is a complex and new variant of the classical multiplicative Berkson error model, having components of classical multiplicative measurement error as well as missing data. Analysis of the tinea capitis data suggests that measurement error in the dosimetry has only a negligible effect on dose-response estimation and inference as well as on the modifying effect of age at exposure.

Biometry↗
PubMed1991

A survey of dermatophytes from human patients in the United States from 1985 to 1987.

A survey of dermatophytes isolated from patients seeking medical advice was made from 1985 to 1987 in the United States. The survey included 54 locations with data from 45 cities and one state. Listing of the isolated dermatophytes and the frequency given by percentage of the total follows: Trichophyton rubrum 54.8%, T. tonsurans 31.3%, T. mentagrophytes 6.0%, Microsporum canis 4.0%, Epidermophyton floccosum 2.0%, M. gypseum 0.6%, and T. verrucosum 0.2%. Out of a total of 14,696 isolates M. audouinii was cultured 13 times, T. violaceum 12 times, M. nanum 6 times, T. terrestre 4 times, and T. soudanense twice. Single isolations were made of M. fulvum, M. ferrugineum and T. schoenleinii. Collection of dermatophyte data in Tucson, Arizona, began in 1966. In 1987, the first case of tinea capitis caused by T. tonsurans was observed. Other isolates of this organism as the cause of tinea capitis were made in this city during that year. These infections were in black children. With the recent growth of Tucson, the percentage of blacks in the population increased and this pathogen was introduced into the general population.

Arthrodermataceae↗
PubMed2005

Prevalence of scalp scaling in prepubertal children.

OBJECTIVE: To determine the prevalence and most common etiologies of scalp scaling in infants and prepubertal children and the specificity of head and neck lymphadenopathy for the diagnosis of tinea capitis associated with scalp scaling. DESIGN/METHODS: A cross-sectional study of 300 children, 200 from an urban general pediatric practice and 100 from 2 urban pediatric dermatology practices, was conducted. Half of the subjects were <2 years old, and half were 2 to 10 years old. Demographic data, medical history, and clinical data noting the presence of scalp scaling and other scalp signs and symptoms, as well as adenopathy of the head and neck, were collected. RESULTS: Scalp scaling was seen in 66 (22%) children. There was an insignificantly higher prevalence of scalp scaling in those <2 years old compared with the 2- to 10-year-old group. In those <2 years old with scalp scaling, the most common diagnoses were seborrheic dermatitis (thick, adherent, greasy scale predominantly in the frontal and/or vertex areas of the scalp) and atopic dermatitis/eczema. Among those 2 to 10 years old with scalp scaling, the most common diagnoses were nonspecific (fine, white) scaling, seborrheic dermatitis, and atopic dermatitis/eczema. Nine (3%) patients were culture-positive for a dermatophyte, all of whom were black, and grew Trichophyton tonsurans. More than half (52.7%) of all patients had head and neck adenopathy. The presence of posterior nodes was significantly associated with atopic dermatitis/eczema and marginally associated with a positive dermatophyte culture. The presence of scalp scaling plus posterior adenopathy was significantly associated with seborrheic dermatitis and a positive dermatophyte culture in the entire study population and with atopic dermatitis in the pediatric dermatology clinics. CONCLUSIONS: Scalp scaling was common in children 0 to 10 years old. Infantile-type seborrheic dermatitis was noted in both age groups: it was 3 times as likely in children <2 years old (18%) than in those 2 to 10 years old (6%). Contrary to traditional teaching, seborrheic dermatitis can be found in preadolescent children. Atopic dermatitis/eczema was associated with scalp scaling in both age groups. Head and neck adenopathy was very common and nonspecific for any 1 diagnosis. Posterior adenopathy with concurrent scalp scaling was significantly associated with seborrheic dermatitis, a positive dermatophyte culture, and atopic dermatitis. In this nonselected pediatric population, scalp scaling with adenopathy was not associated exclusively with tinea capitis.

Age Distribution↗
PubMed1979

Incidence of dermatophytosis in Kuwait.

Dermatophytosis in Kuwait was found to be associated with poor, over-crowded socioeconomic localities. This infection occurred in all age groups, but patients below 10 years of age were most susceptible. Tinea capitis was observed in 71.1% of 135 patients with dermatophytosis, with a higher incidence (48.2%) in males than in females. Microsporum canis caused 60.7% of all cases of dermatophytosis and 76% of tinea capitis. A high rate of failure to culture from microscopically positive specimens was observed in tinea cruris and onychomycosis.

Adolescent↗
PubMed1999

Terbinafine. An update of its use in superficial mycoses.

UNLABELLED: Terbinafine is an allylamine antifungal agent which has fungicidal activity against a wide variety of dermatophytes, moulds and certain dimorphic fungi, and fungistatic activity against Candida albicans. Oral terbinafine 250 mg/day is effective in the treatment of superficial dermatophyte infections such as onychomycosis, tinea pedis and tinea corporis/cruris, generally achieving mycological cure in > 80% of patients. The drug is also effective in children with tinea capitis when administered orally in the dosage range 62.5 to 250 mg/day for 4 weeks. Comparative data indicate that oral terbinafine is more effective than continuous or intermittent intraconazole in dermatophyte onychomycosis, and is as effective as itraconazole 400 mg/day in tinea pedis. The drug has shown greater efficacy than griseofulvin in dermatophyte onychomycosis, tinea pedis and tinea corporis/cruris, and comparable efficacy in children with tinea capitis. Additionally, oral terbinafine is more effective than ketoconazole 200 mg/day in tinea corporis/cruris. Topical terbinafine 1% formulations are effective when applied once or twice daily for up to 2 weeks, achieving mycological cure in > 80% of patients with tinea pedis, tinea corporis/cruris, cutaneous candidiasis and pityriasis versicolor. Its formulations are at least as effective as miconazole 2% cream and naftifine 1% gel in tinea pedis, and more effective than clotrimazole 1% cream, bifonazole 1% cream and oxiconazole 1% lotion. Mycological cure rates achieved with terbinafine generally improve after treatment cessation, reflecting the drug's fungicidal mechanism of action and its residual effect in tissue. Terbinafine is well tolerated after oral or topical administration and has a relatively low potential for drug interactions. Pharmacoeconomic data support the use of terbinafine in dermatophyte infections of the skin or nails. CONCLUSIONS: Evidence suggests that oral terbinafine is the treatment of choice for dermatophyte onychomycosis, as it achieves high rates of mycological and clinical cure, is generally well tolerated and has a relatively low potential for drug interactions. It must also be considered a first-line treatment option, along with itraconazole, in cutaneous mycoses which warrant systemic treatment; topical terbinafine is a treatment of choice in less extensive mycoses. The use of terbinafine in non-dermatophyte or mixed infections has not been fully defined.

Animals↗
PubMed2002

Skin cancer after X-ray treatment for scalp ringworm.

Some 2,224 children given X-ray therapy for tinea capitis (ringworm of the scalp) have been followed for up to 50 years to determine cancer incidence, along with a control group of 1,380 tinea capitis patients given only topical medications. The study found a relative risk (RR) of 3.6 (95% confidence interval, 2.3-5.9) for basal cell skin cancer (BCC) of the head and neck among irradiated Caucasians (124 irradiated cases and 21 control cases), in response to a scalp dose of about 4.8 Gy. No melanomas of the head and neck have been seen, and only a few squamous cell carcinomas. About 40% of irradiated cases have had multiple BCCs, for a total of 328 BCCs. Although 25% of both the irradiated and control groups are African-American, only 3 skin cancers have been seen among them, all in the irradiated group, indicating the importance of susceptibility to UV radiation as a cofactor. Light complexion, severe sunburning and North European ancestry were predictive of BCC risk in the irradiated group, but chronic sun exposure was not. Children irradiated at young ages had the highest BCC risk. The RR for BCC risk is approximately constant with time since exposure, suggesting that risk will probably last for a lifetime.

Age Factors↗
PubMed1996

Unusual Microsporum canis infections in adult HIV patients.

Tinea capitis in men, even if infected with HIV, is infrequent. Microsporum species nail infections are extremely rare. In most cases Microsporum canis infection is usually easy to treat with antifungal agents. We describe two HIV-infected men with an unusual M. canis infection. Both patients had tinea capitis, presenting as alopecia in one and scaling of the scalp in the other. One patient also had tinea unguium caused by M. canis. Ketoconazole was ineffective in both patients; terbinafine was tried in one patient without benefit; itraconazole was effective in both, but treatment took many months and only one patient was cured.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Langerhans cell histiocytosis and dermatophytosis.

Langerhans cell histiocytosis (LCH) is regarded as a disorder of histiocytic cell proliferation of the Langerhans type, probably resulting from altered immunoregulation. Cutaneous involvement is frequent and often appears as a scaling papular eruption that resembles seborrheic dermatitis; when limited to the scalp, scaling and erythema may also be confused with tinea capitis. We describe four patients who had LCH and documented dermatophyte infection versus colonization of the scalp. Fungal cultures should be considered in patients who have LCH with scalp involvement who do not respond to standard treatment; similarly, it may be appropriate to obtain a skin biopsy specimen from patients with recalcitrant tinea capitis to rule out the presence of underlying LCH.

Child, Preschool↗
PubMed1987

A study of dermatophytoses in Esfahan (Iran).

The present study determined the extent and causative agents of dermatophytoses in Esfahan, a large city of Iran. Specimens from patients were examined for etiologic agents by direct microscopic procedure and by culture. Out of 12,000 patients with skin diseases, 10.8% were affected with dermatophytoses. Among the 10.8% group, lesions of tinea capitis were most common (72.1%) and Trichophyton verrucosum was the most frequent (43.8%) dermatophyte isolated from the patients. We found a relationship between the spread of dermatophytoses and live-stock infected with dermatophytoses.

Animals↗
PubMed2006

Basal cell carcinoma of scalp in patients with history of childhood therapeutic radiation: a retrospective study and comparison to nonirradiated patients.

BACKGROUND: Basal cell carcinoma (BCC) is the most common human malignant neoplasm. Some patients with scalp BCC have had a history of childhood scalp radiation for the treatment of tinea capitis. It is not clear whether BCC in these cases has a more aggressive nature and requires a more aggressive resection. We performed a retrospective study to compare BCC tumor specification and treatment results between irradiated and nonirradiated patients. MATERIALS AND METHODS: From 1995 to 2005, a total of 74 patients were diagnosed with scalp BCC. Thirty-eight patients (group A) had a history of childhood radiation to the scalp for the treatment of tinea capitis, and the other 36 (group B) did not. We compared these 2 groups in 16 different parameters, which included general information (age, sex), disease history (time interval from onset of lesion to the first office visit, number of admissions, total length of hospital stay), tumor specifications (number of primary lesions, invasion depth, histologic subtypes, location), surgical history (number of operations in our center and other hospitals, type of surgical treatment, margins of resection), recurrences, new lesions, and metastasis. Statistical analysis was performed using SPSS 13.0 software. RESULTS: No significant difference in gender and age was observed between the 2 groups (P = 0.06 and P = 0.35, respectively). Patients in group A had a longer history of scalp lesions (P = 0.001). They also had more hospital admissions (P = 0.008) and operations (P = 0.01) in our center, with a longer period of hospitalization (P = 0.01). Mean number of primary lesions, the location of tumor, and the depth of invasion did not differ significantly between the 2 groups (P = 0.34, P = 0.78, and P = 0.73, respectively). There was no meaningful difference in safe resection margin for the first lesion between the 2 groups (P = 0.27); however, the number of recurrent lesions was significantly higher in group A (P = 0.003). Also, need for more aggressive resection and more complicated reconstruction was more in group A patients (P = 0.01 and P = 0.015, respectively). Only in group A new lesions and metastasis were found. CONCLUSION: BCC in irradiated scalp has a more aggressive behavior and may need a more aggressive surgical resection. Also, these patients should be under close observation because there is a higher chance for tumor recurrence and also new lesions occurring elsewhere in the scalp.

Adult↗
PubMed2003

Pityriasis amiantacea: a clinical and etiopathologic study of 85 patients.

BACKGROUND: Studies on pityriasis amiantacea (PA) in the literature are limited and mostly retrospective. We prospectively analyzed the clinical and etiopathologic factors in a large series of PA diagnosed at our department within a defined period (2000-01). METHODS: All PA patients who attended our department were evaluated clinically and underwent bacteriologic, mycologic, and histopathologic examinations. Forty healthy control persons were similarly subjected to bacteriologic and mycologic investigations of their scalp hairs. RESULTS: A total of 85 PA patients were collected and studied. Pathological diagnosis of scalp psoriasis was confirmed in 35.3% of cases. Eczematous features suggesting a diagnosis of seborrheic and atopic dermatitis were detected in 34.2%. Diagnosis of tinea capitis, diagnosed by potassium hydroxide preparation, fungal culture, and periodic-acid Schiff staining, was detected in 12.9% of the PA patients. Staphylococcus isolates were detected in 96.5% of the PA patients compared with 15% in healthy persons as the control (P > 0.00001). CONCLUSIONS: Pityriasis amiantacea represents a particular reaction pattern of the scalp to various inflammatory scalp diseases. The most frequent skin diseases associated with PA are psoriasis and seborrheic dermatitis. It is important to keep the diagnosis of tinea capitis in mind when evaluating PA patients. Staphylococci on the scalp could participate in the pathogenesis of PA.

Adolescent↗