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PubMed2000

Epidemiology of tinea capitis.

This paper addresses the changing epidemiology of tinea capitis in the USA and in Europe that has occurred over the last several decades. Several dermatophytes are involved in the etiology, and the primary etiological agents of tinea capitis are limited to the genera Microsporum and Trichophyton. In addition, the sources of these infections are discussed and although geophilic dermatophytes occur worldwide, anthropophilic species and some zoophilic fungi may be geographically restricted, depending on host range. For example, tinea capitis due to geophilic organisms is rare in the USA.

Animals↗
PubMed2002

[An outbreak of tinea capitis in a child care center].

We describe an outbreak of tinea capitis in a kindergarten. Individuals with relation to the institution were examined clinically and mycologically (n = 98). Microsporum audouinii was cultured from 12 people, out of whom eight patients had tinea capitis and seven patients had tinea corporis. Three patients had both tinea capitis and tinea corporis. The problems with spread of anthropophilic infections and the difficulties with treatment of Microsporum dermatophytes are discussed.

Adult↗
PubMed2005

[Tinea capitis in an adult. Case report].

A tinea capitis and tinea faciei case in an elderly female patient with diabetes mellitus type 2 is presented. Her dermatological illness began on her face and later disseminated to her scalp. She received multiple medications which aggravated her condition. The diagnosis was established by means of direct examination and the isolation of Trichophyton tonsurans in culture. Treatment with 200 mg daily dose of itraconazol for two months resulted in clinical and mycological cure.

Aged↗
PubMed1996

Itraconazole in the treatment of tinea capitis.

Seventy-one patients with tinea capitis were treated with itraconazole (50 or 100 mg once daily) for a median period of six weeks in an open multicenter study. Many of the patients were children. Of those patients treated with itraconazole 100 mg, 93 percent showed a clinical response at the end of treatment. This increased to 94 percent two months later. The mycologic cure rate at the end of treatment was 57 percent. At the final visit this had increased to 89 percent. Patients taking 50 mg itraconazole also responded to treatment, but to a lesser degree: only 67 percent showed a clinical response at the final visit. The corresponding mycologic cure was 60 percent. Only one patient reported a side effect while taking itraconazole (papular eruption) and it is uncertain whether this was related to treatment. It was concluded that both treatment schedules were effective and safe for children with tinea capitis.

Administration, Oral↗
PubMed1996

The rapid diagnosis of tinea capitis using calcofluor white.

The clinical presentation of tinea capitis may be varied and confusing. This results in delays in diagnosis, loss to follow-up, and spread of the infection. This article describes the use of calcofluor white (CFW) as a method for rapid diagnosis of tinea capitis. One hundred children with scaling scalps were evaluated. Specimens were obtained for fungal culture from each patient. Scales and hair were tested using the CFW test. The CFW test was positive in 58 (76%) of those with positive fungal cultures and 10 (42%) with negative fungal cultures. The sensitivity and specificity of the test were 76 and 58%, respectively. The relative ease and rapidity of the CFW test allows for rapid diagnosis of tinea capitis, immediate treatment of patients, and decreased loss to follow-up.

Benzenesulfonates↗
PubMed2005

Tinea capitis in Diyarbakir, Turkey.

The incidence and types of tinea capitis in 234 children aged 1-12 referred to our laboratory with a preliminary diagnosis of tinea capitis infection in the past 5 years were investigated. Tinea capitis was determined in 149 (63.7%) of these patients, of which agents grew in culture in 124 (83.2%). The most frequently isolated agents, in order of frequency, are as follows: Trichophyton violaceum (43.6%), Microsporum canis (37.9%), T. mentagrophytes (8.1%) and T. verrucosum (4.8%).

Child↗
PubMedDate not supplied

Tinea capitis in Kwa-Zulu Natal, South Africa.

Tinea capitis is the most common dermatophyte infection in children. The hair involvement can be classified as endothrix, ectothrix, or favus, and the clinical appearance is variable. The goal of this study was to determine the demography, etiology, and clinical patterns of tinea capitis in South Africa. A prospective, cross-sectional study was conducted over a 1-year period. All cases were classified clinically and subject to Wood light examination, microscopy, and culture. One hundred patients were studied. The male:female ratio was 1.4:1. The mean age was 4.6 years (range 1-11 years). Trichophyton violaceum was isolated in 90% of positive cultures. Wood light was positive in one patient with Microsporum gypseum. The most common clinical variety was the "black dot" type, seen in 50% of patients. Twenty percent of the children presented with more than one clinical type simultaneously. We concluded that the most common cause of tinea capitis in South Africa is T. violaceum. The presentation is variable.

Child↗
PubMed1998

Increased incidence of Trichophyton tonsurans tinea capitis in Ontario, Canada between 1985 and 1996.

In Canada, since the 1990s, Trichophyton tonsurans has emerged as the main cause of tinea capitis. Prior to this the more common agents were T. verrucosum, Microsporum canis and M. audouinii. Over the past few years the incidence of T. tonsurans has increased such that in 1985 and 1996 the cases of mycologically confirmed tinea capitis due to T. tonsurans were 9% and 76%, respectively. The epidemic of T. tonsurans has reduced the role of Wood's lamp in diagnosis of tinea capitis. The age distribution of tinea capitis due to T. tonsurans closely matches that of mycologically confirmed tinea capitis, being most common in children under 14 years of age. There is no significant sex difference in children who develop T. tonsurans tinea capitis; however, subjects are significantly more likely to live in urban than rural areas. This should provide guidance regarding where to concentrate health resources and deliver patient/parent education to combat this epidemic of tinea capitis.

Adolescent↗
PubMed2005

A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis.

BACKGROUND: Griseofulvin is considered first-line therapy for tinea capitis, and the Physician's Desk Reference currently recommends 11 mg/kg per day microsize formulation for use in children. Diverse selective pressures have resulted in waning clinical efficacy of griseofulvin, such that higher doses and longer courses of treatment are required. These events have prompted the search for therapeutic alternatives. Fluconazole is one such treatment option, and a variety of studies using this drug have shown promise in the treatment of pediatric tinea capitis. OBJECTIVE: We sought to assess the efficacy, safety, and optimal dose and duration of fluconazole therapy compared with standard-dose griseofulvin (11 mg/kg per day microsize formulation) in the treatment of pediatric tinea capitis. METHODS: This randomized, multicenter, third-party-blind, 3-arm trial was designed as a superiority study to identify a therapeutically superior agent/regimen from the 3 treatment arms: (1) fluconazole 6 mg/kg per day for 3 weeks followed by 3 weeks of placebo, (2) fluconazole 6 mg/kg per day for 6 weeks, and (3) griseofulvin 11 mg/kg per day for 6 weeks. Efficacy variables included mycological, clinical, and combined outcomes. The primary efficacy variable was the combined outcome of the modified intent-to-treat population at week 6. Patient safety was assessed throughout the study. Statistical analysis of the efficacy variables was conducted by means of the Cochran-Mantel-Haenszel test. RESULTS: At the end of treatment, mycological cures were present in 44.5%, 49.6%, and 52.2% of the fluconazole 3-week, fluconazole 6-week, and griseofulvin groups, respectively. Analysis of the primary efficacy variable failed to identify any superior agent, and differences between the combined outcomes of the fluconazole 6-week and griseofulvin groups at week 6 were not significant (P = .32). Regarding mycological, clinical, and combined outcomes, no significant differences between the fluconazole 6-week and griseofulvin groups were detected at any time point in the study. No new safety concerns were raised by this trial, and the incidence of treatment-related adverse events noted in this study is concordant with previous reports. Patients in the fluconazole arms of the study fared similarly. At the end of the trial, the difference in mycological cures between the fluconazole arms was only 7.5%, and increases in the incidence of certain treatment-related adverse events were observed in the fluconazole 6-week group. LIMITATIONS: Adjunctive topical therapies and the impact of infected contacts were not assessed in this trial. CONCLUSION: Systemic therapy with fluconazole 6 mg/kg per day and standard-dose griseofulvin produces comparable but low mycological and clinical cure rates. The limited efficacy of standard-dose griseofulvin and the lack of consensus regarding dose and duration of griseofulvin therapy in tinea capitis emphasize the need for controlled trials to identify optimal treatment parameters. Although the efficacy of fluconazole is no better than that of standard-dose griseofulvin, it may still be useful in select patients with a contraindication or intolerance to high-dose griseofulvin. The outcomes observed in this trial highlight the need to more clearly define the relative importance of adjunctive topical therapies and the evaluation and treatment of infected contacts as factors affecting cure rates.

Antifungal Agents↗
PubMed2002

Tinea capitis in schoolchildren from lvory Coast (western Africa). A 1998-1999 cross-sectional study.

BACKGROUND: Tinea capitis is a worldwide public health problem that poses specific therapeutic challenges. This dermatophytosis of the scalp is endemic in Africa. The objectives of this study were to determine the prevalence, the associated demographic factors, causative species, and clinical types of tinea capitis in Abidjan, Ivory Coast. METHODS: From June 1998 to March 1999, 1913 children aged between 4 and 15 years, and schooling in seven urban primary schools of Abidjan (Ivory Coast), were examined clinically for tinea capitis. Among all children showing symptoms suggestive of scalp ringworm, hair stumps and scales were collected and exposed to direct microscopic examination using 30% potassium hydroxide solution, and cultivation on Sabouraud's dextrose agar with or without actidione. RESULTS: Among 227 symptomatic children, cultures positive for fungi were found in 217, yielding an overall tinea capitis prevalence of 11.34% [95% Confidence Interval (CI), 9.97-12.85]. By univariate analysis, tinea capitis was significantly associated with boys [odds ratio (OR) 7.85; CI 5.22-11.81] and in children belonging to the intermediate 8-11 years age group (OR 1.93; CI 1.29-2.90). Trichophyton soudanense and Microsporum langeronii were the most prevalent etiologic agents (63.6% and 31.3%, respectively), whereas a mixture of both T. soudanense and M. langeronii was observed in a 2.8% proportion. Finally, 2.3% of isolated species were represented by T. violaceum. CONCLUSIONS: Our survey provided evidence that tinea capitis is endemic in Ivory Coast, constituting a substantial infectious dermatological disturbance. T. soudanense was the most frequent causative agent, whereas T. violaceum was isolated for the first time in this sub-Saharan western African country.

Adolescent↗
PubMed2003

[Tinea capitis from here and elsewhere. Geographic variables in prevention].

Few diseases exhibit such regional variability in their epidemiology, even in an area as limited as Belgium, as tinea capitis. Thus, anthropophilic tinea capitis is highly predominant in areas where new immigrants from Black Africa and North Africa have settled. By contrast, zoophilic tinea capitis is found largely in areas where the cat population is infected. Kerion often affects professions in which contact with infected livestock is involved. Prevention of tinea capitis thus has distinct regional features. Treatment, on the other hand, has a universal basis.

Africa↗
PubMed1997

Treatment of tinea capitis.

OBJECTIVE: To review the epidemiology, pathogenesis, mycology, clinical presentation, and pharmacotherapy of tinea capitis, and describe the role of newer antimycotic agents. DATA SOURCES: A MEDLINE search restricted to English-language articles published from 1966 through 1996 and journal references were used in preparing this review. DATA EXTRACTION: The data on mycology, pharmacokinetics, adverse effects, and drug interactions were obtained from controlled studies and case reports appearing in the literature. Both open-label and comparative studies were evaluated to assess the efficacy of antimycotics in the treatment of this infection. DATA SYNTHESIS: Griseofulvin is the drug of choice in the treatment of tinea capitis. Newer agents with greater efficacy or shorter treatment durations continue to be explored. Ketoconazole, the first azole studied for efficacy in tinea capitis, has not demonstrated any clinical advantage over griseofulvin in several controlled clinical trials. Itraconazole is effective, but the available data are limited to case reports and a single uncontrolled study. Terbinafine similarly has shown promise in the treatment of tinea capitis, but the oral formulation was only recently approved in the US. Existing studies reflect the results in infection with pathogens not seen in the US. Both itraconazole and terbinafine achieve high concentrations in the hair and stratum corneum that persist for several weeks following drug administration. This may enable shorter courses of therapy; however, comparative studies need to be conducted in the US. CONCLUSIONS: Tinea capitis remains the most common dermatophyte infection in young urban children. Oral antifungal therapy is required for effective treatment, often for several months. The combination of griseofulvin with a selenium sulfide shampoo continues to be the mainstay of therapy until more experience is gained with the newer antimycotics.

Administration, Oral↗
PubMed2000

Successful treatment of tinea capitis with 2% ketoconazole shampoo.

BACKGROUND: Oral antifungal drugs are required for effective treatment of tinea capitis. Topical antifungal shampoo's, namely ketoconazole 2% shampoo or products with selenium sulfide or salicylic acid are recommended as adjunctive therapy. Topical antifungal monotherapy has not been successful in the treated of tinea capitis. The purpose of this open study was to evaluate ketoconazole 2% shampoo as a monotherapy for the treatment of tinea capitis. METHOD: A total of 16 black children, aged 3-6, all with proven tinea capitis caused by Trichophyton tonsurans, were treated daily for 8 weeks with 2% ketoconazole shampoo for a total of 56 treatments. Clinical and mycologic examinations were performed every 2 weeks and again at 4 weeks following treatment. The number of colonies were counted on each plate after each visit. Patients with positive cultures after 8 weeks were placed on oral griseofulvin; those with negative cultures were followed monthly by culture for an additional 12 months. RESULTS: Marked clinical improvement occurred in all patients within 2 weeks and absence of pruritus was noted by the patients as early as 2-6 days. After 8 weeks of shampoo, 14 of the 15 (93%) children were clinically healed. Mycologically, the cultures dropped from a confluent growth of T. tonsurans to less than 100 colonies within 2 weeks; fewer than 50 at week 4 and 20 colonies or fewer after week 6. At 8 weeks of treatment the number of colonies remained at 20 or fewer. Six of the 15 children (40%) had negative cultures after 2, 4, and 6 weeks. One child relapsed at the first 4-week follow-up visit. Five of 15 (33%) of the children remained culturally negative for 12 months post-treatment. CONCLUSIONS: Ketoconazole 2% shampoo alone reduces the number of viable arthroconidia in children with tinea capitis thus reducing the transmissibility and contagious nature of the disease. Unexpectedly, complete cure was obtained in 5/15 (33%) of the children. The children remained clinically and mycologically clear as long as one year after treatment.

Administration, Topical↗
PubMed2001

Clinico-myocological profile of tinea capitis in North India and response to griseofulvin.

There is a paucity of literature on tinea capitis from North India. The response to griseofulvin has not been studied as well. We studied 153 consecutive patients of tinea capitis for clinical patterns, causative dermatophytic species, clinico-etiological correlation, and response to griseofulvin. Culture and sensitivity were done on all patients. All patients were treated with griseofulvin for 6-8 weeks; non-responders were further treated with fluconazole. Ninety percent of the patients were less than 15 years of age, 75% belonged to poor socioeconomic groups and 19% had a family history of tinea capitis. The seborrheic variant was the commonest clinical pattern seen in 47.8% of patients, followed by grey patch, black dot, kerion, and alopecia-areata-like tinea capitis in 35.9%, 8.5%, 6.5% and 1.3% of patients, respectively. Only 66% of patients had a positive culture. T. violaceum was the commonest dermatophytic species isolated in 38% patients. M. audouinii, T. schoenleinii, T. tonsurans, M. gypseum, T. verrucosum and T. mentagrophytes were isolated in 34%, 10%, 9%, 3%, 3% and 3% of patients, respectively. Of the isolates 94% were susceptible to griseofulvin, and 100% were susceptible to fluconazole. By using griseofulvin for 6-8 weeks 97.4% of the patients were cured; nonresponders required therapy with fluconazole for cure. To conclude, tinea capitis is still a disease of younger people of poor socioeconomic status. T. violaceum and M. audouinii are the most common responsible dermatophytes. The response to griseofulvin was excellent, and it should be used as a first line therapy.

Adolescent↗
PubMed2000

Trichophyton rubrum tinea capitis in an 85-year-old woman.

BACKGROUND: Tinea capitis is a worldwide problem and occurs most commonly in young children. Certain common fungal types are most often recognized as the responsible infecting organism. OBJECTIVE: This article presents the case of an elderly woman with tinea capitis caused by a fungal organism that rarely infects hair. A review of the world literature provides evidence of only a few other similar cases. CONCLUSIONS: Trichophyton rubrum causing tinea capitis in adults is a rare but now increasingly recognized entity. This possibility should be kept in mind when caring for adults with nonhealing scalp conditions.

Administration, Topical↗
PubMed1999

Tinea capitis in two black african adults with HIV infection.

Tinea capitis is rare in adults, although a few cases have been described in HIV-infected patients. We present two cases in black African adults who were HIV positive. In one, the condition led to the diagnosis of HIV infection. It is possible that the rarity of tinea capitis in HIV-positive adults could be related to increased colonization of their scalp by Pityrosporum (Malassezia) spp. In patients well controlled with an antiviral therapy, the treatment of tinea capitis seems no more difficult than in non-immunosuppressed patients. There is possibly a relation between clinical presentation and degree of immunodeficiency.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Itraconazole responsive tinea capitis in an HIV-infected child.

Tinea capitis has not been reported to be a prevalent or serious affliction in pediatric patients infected with the human immunodeficiency virus (HIV). We report tinea capitis due to Microsporum canis in a boy infected with HIV. After failing conventional therapy, he was treated successfully with a four-week course of itraconazole. His immunologic status improved during therapy. The possible relationship of this response to the ultimate resolution of disease is discussed.

AIDS-Related Opportunistic Infections↗
PubMed1989

A study of tinea capitis in Sri Lanka.

Between January 1978 and December 1987, 106 cases of tinea capitis were detected in Sri Lanka. Diagnosis was confirmed mycologically by microscopic examination and by culture. Tinea capitis accounted for 3.4% of all superficial fungal infections seen during this period. This figure is low when compared with the incidence of this disease reported in other countries. Five main types of clinical manifestation were encountered. Inflammatory lesions were observed in 50% of the patients. Eighty-five percent of infections occurred in children below 15 years of age and 76% in children under 10 years of age. The 6-10 year age group was the most vulnerable. The zoophilic fungi Trichophyton mentagrophytes, Microsporum canis and the geophilic species Microsporum gypseum were together responsible for 81% of tinea capitis infections, and the zoophilic fungus Trichophyton simii accounted for a further 10% of infections. It is postulated that the Sri Lankan custom of frequent head baths with soap and water, especially among children, may account in part for the low prevalence of tinea capitis in the community.

Adolescent↗