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PubMed1993

Tinea capitis in Trinidad.

Characteristics of clinically diagnosed cases of tinea capitis from Trinidad are described. Tinea capitis comprised 29.5% of all dermatophytoses seen at one general hospital out-patient dermatology clinic during a one-year period. Males were more often affected than females and there was a predominance of patients of African descent. Among the dermatophytes cultured Trichophyton tonsurans was the most prevalent (52.9%), followed by Microsporum canis (20.0%) and M. audouinii (18.6%). Less frequent isolates included M. gypseum (1.9%), T. mentagrophytes var granulare (1.4%) and T. rubrum (1.4%).

Africa↗
PubMed2006

Incidence of Tinea capitis in São Paulo, Brazil.

To determine the incidence of tinea capitis in São Paulo, Brazil, an investigation was performed in Private and Public Pediatrics Service involving 4,500 children from 0 to 15 years old during 5 years (1996-2000). Samples were taken from 132 children with suspected fungal infection of the scalp, for direct microscopy and culture. Tinea of scalp was mycologically confirmed in 112 patients (85%). Males were more affected than females in all age groups. Children below 8 years old accounted for more than 75% of the occurrences. Only three cases of tinea capitis were diagnosed in children from 12 to 15 years of age. Tinea capitis was prevalent in 103 cases (91.96%); inflammatory kerion type lesions were diagnosed in 9 patients (8.04%). Microsporum canis (70.5%) and Trichophyton tonsurans (23.2%) were the most common agents followed by T. mentagrophytes (3.6%), M. gypseum (1.8%) and T. rubrum (0.9%).

Adolescent↗
PubMed2000

Comparison of terbinafine and griseofulvin in the treatment of tinea capitis.

BACKGROUND: Griseofulvin has been used for many years in the treatment of tinea capitis. Increase in resistance to this medication has led to a search for new therapeutic alternatives. OBJECTIVE: Our purpose was to evaluate the therapeutic efficacy of terbinafine in comparison with griseofulvin in the treatment of tinea capitis. METHODS: We performed a double-blind, randomized, prospective evaluation of 50 patients with a clinical and mycologic diagnosis of tinea capitis. One group received 4 weeks of terbinafine followed by 4 weeks of placebo. The other group received 8 weeks of griseofulvin. We evaluated 5 clinical parameters. Mycologic examinations were performed at baseline and at the end of weeks 8 and 12. RESULTS: Patients' ages ranged from 1 to 14 years. Fifty-four percent were girls and 46% were boys. Mycologic examinations disclosed Trichophyton tonsurans in 74% of patients and Microsporum canis in 26%. At week 8, the griseofulvin-treated group showed a cure rate of 76%, and the terbinafine-treated group 72%. At week 12, the efficacy of griseofulvin decreased to 44%, whereas the efficacy of terbinafine was 76%. CONCLUSION: Terbinafine constitutes an alternative for the treatment of tinea capitis. Recurrences were less frequent. No significant side effects were reported.

Adolescent↗
PubMedDate not supplied

Trichophyton rubrum tinea capitis in a young child.

While the primary etiologic agent of tinea capitis in the United States has varied over the past century, the last several decades have been marked by a predominance of infection with Trichophyton tonsurans. Related anthropophilic organisms commonly isolated in other dermatophytoses are infrequently observed in tinea capitis. We report the unusual occurrence of tinea capitis in a young boy infected with Trichophyton rubrum.

Child, Preschool↗
PubMed2004

Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials.

OBJECTIVE: Tinea capitis, a common pediatric infection in the United States, is caused mainly by Trichophyton species and affects many urban children. Although the current treatment of choice is oral griseofulvin, terbinafine has been shown to be variably effective in several comparative, randomized trials. The purpose of this study was to perform a meta-analysis of randomized, clinical trials comparing the efficacies of oral terbinafine and oral griseofulvin for the treatment of childhood tinea capitis. METHODS: The Medline database was searched for randomized, clinical studies comparing griseofulvin and terbinafine for the treatment of tinea capitis. Acceptance criteria included oral administration of griseofulvin for at least 6 weeks and the identification of a pathogenic dermatophyte from the scalp at the time of enrollment in the study. Scalp culture status at least 8 weeks after enrollment was used as the outcome. The common odds ratio (OR) with 95% confidence intervals (CIs), the Cochran-Mantel-Haenszel test for significance, and the Breslow-Day test for homogeneity were calculated. RESULTS: Six articles that satisfied all inclusion criteria were identified. These studies were combined by using outcomes at 12 to 16 weeks after enrollment. The common OR was 0.86 (95% CI: 0.57-1.27). When the 5 studies that identified Trichophyton species as the predominant pathogen were combined, using outcomes 12 weeks after enrollment, the results nearly favored terbinafine (OR: 0.65 [95% CI: 0.42-1.01]). For outcomes at 8 weeks after enrollment, no difference was found between the agents (OR: 0.84 [95% CI: 0.54-1.32]). Consclusions.A 2- to 4-week course of terbinafine is at least as effective as a 6- to 8-week course of griseofulvin for the treatment of Trichophyton infections of the scalp. Griseofulvin is likely to be superior to terbinafine for the rare cases caused by Microsporum species.

Antifungal Agents↗
PubMed2000

Once weekly fluconazole is effective in children in the treatment of tinea capitis: a prospective, multicentre study.

In an open, multicentre evaluation carried out in Brazil, Canada and South Africa we have demonstrated that fluconazole 8 mg kg-1 once weekly is effective in tinea capitis caused by Trichophyton and Microsporum species. There were 61 children, aged (mean +/- SE) 5.0 +/- 0.3 years; weight (mean +/- 5.6) 20.0 +/- 0.9 kg; 41 males, 20 females; one Asian, 57 Black, one Caucasian and two Hispanic. The organisms were Trichophyton violaceum (33 patients), T. tonsurans (11) and Microsporum canis (17). The extent of tinea capitis at pretherapy was: mild (18 patients), moderate (30) and severe (13). Patients with tinea capitis due to Trichophyton species were initially treated for 8 weeks with an extra 4 weeks of fluconazole if clinically indicated. All 44 patients with tinea capitis due to Trichophyton species were completely cured (clinically and mycologically) when evaluated 8 weeks after completion of active treatment, following 8 weeks of once weekly dosing in 35 patients and 12 weeks of once weekly dosing in nine patients. In Microsporum canis tinea capitis, an extra 4 weeks was administered at week 12 in patients where it was clinically indicated at the time. Sixteen of 17 patients with M. canis tinea capitis were completely cured (clinically and mycologically) when evaluated 8 weeks following the end of treatment when given for 8, 12 and 16 weeks in 12, one and three patients, respectively. Overall, complete cure (clinical and mycological) occurred in 60 of 61 patients at follow-up 8 weeks from the end of therapy. The duration of once weekly fluconazole in the 60 patients was 8 weeks (47 patients), 12 weeks (10 patients) and 16 weeks (three patients), respectively. Clinical adverse effects consisted of a mild, reversible gastrointestinal complaint in three (4.9%) of 61 children. A laboratory abnormality with elevated liver function tests was observed in one (5.9%) of 17 patients; this was asymptomatic, and reversible. No patient discontinued therapy. The data suggest that once weekly fluconazole dosing is effective, safe and associated with high compliance when used to treat tinea capitis.

Antifungal Agents↗
PubMed1998

Tinea capitis dermatophytes: susceptibility to antifungal drugs tested in vitro and in vivo.

BACKGROUND: Tinea capitis is a worldwide-spread infection of the scalp caused by dermatophytes and is predominantly seen in children. The clinical manifestations range from mild scaling lesions to widespread alopecia or highly inflammatory suppurating lesions. Terbinafine and itraconazole seem to be promising therapies with shorter treatment durations than griseofulvin. OBJECTIVE: The objective of the present study was to test the sensitivity of different species of dermatophytes towards terbinafine and itraconazole, and to compare the results with a retrospective study on 35 immunocompetent patients with tinea capitis who were treated with terbinafine (Lamisil(R)). METHODS: Minimal inhibitory concentrations (MIC) were measured with an agar dilution method. RESULTS: Each tested species of dermatophyte was sensitive to terbinafine and itraconazole at different concentration ranges. The MIC for terbinafine ranged from 0.005 to 0.5 microg/ml and for itraconazole from 40 to 80 microg/ml. Microsporum canis was the dermatophyte least sensitive to terbinafine. Our retrospective study showed that the cure rate was excellent for Trichophyton violaceum and T. soudanense, variable for T. mentagrophytes and poor for M. canis and M. langeronii. CONCLUSIONS: (i) Regarding the results of susceptibility tests obtained with species involved in tinea capitis, clinical efficacy is not related to MIC measured in vitro; (ii) identification of the isolated dermatophyte from tinea capitis seems to be important for choosing the appropriate treatment.

Antifungal Agents↗
PubMed1985

Comparison of ketoconazole and griseofulvin for treatment of tinea capitis in childhood: a preliminary study.

Treatment of children with tinea capitis currently consists of griseofulvin given orally for 1 to 3 months. Ketoconazole, a newer antifungal, is effective therapy for a variety of systemic mycoses. A randomized double-blind, placebo-controlled study was undertaken to compare ketoconazole and griseofulvin treatments of children with tinea capitis. Twenty-two patients were enrolled, and 14 completed the protocol. All patients had positive initial mycologic cultures. Seven evaluated patients received each drug. The treatment groups were comparable in terms of age, weight, sex, race, duration of infection, length of therapy, and initial disease severity. Adverse reactions occurred in three ketoconazole-treated patients and in none receiving griseofulvin. After 6 weeks of therapy, ketoconazole-treated patients had improved as much as griseofulvin-treated patients and were as likely to have negative mycologic cultures. Ketoconazole shows promise as an alternative to griseofulvin for treating children with tinea capitis.

Adolescent↗
PubMed1994

Tinea capitis in Northwestern Europe 1963-1993: etiologic agents and their changing prevalence.

BACKGROUND: Although tinea capitis is endemic in many countries, its prevalence in Northwestern Europe (Belgium and the Netherlands) has not been established. MATERIALS AND METHODS: Scales, pus, and hair were examined from 435 cases of tinea capitis for etiologic agents and their relative percentages calculated for 5-year period between 1963 and 1992. RESULTS: There was a change in organisms associated with tinea capitis in the Netherlands from Trichophyton schoenleinii to Trichophyton violaceum. Increased immigration from the Mediterranean is held partly responsible for the increased prevalence of T. violaceum infections. Infection with zoophilic dermatophytes, such as T. canis, has also become more frequent in the Netherlands. CONCLUSIONS: The zoophilic dermatophytes have supplanted the anthropophilic dermatophytes as the cause of tinea capitis in the Netherlands.

Arthrodermataceae↗
PubMed2004

Tinea capitis in infants in their first year of life.

BACKGROUND: Tinea capitis is the most common type of dermatophytosis in children, but is uncommon in the first year of life. OBJECTIVES: To review clinical, mycological and epidemiological data in a series of 10 infants aged under 1 year diagnosed as having tinea capitis in three Spanish hospitals between 1998 and 2002. METHODS: A retrospective case note study. RESULTS: There were six boys and four girls with a mean of age 7 months (range 1.5-12). All the children were born in Spain, but in five cases the parents were immigrants from Africa. In these cases the isolated dermatophytes were two Trichophyton tonsurans, one T. verrucosum and two Microsporum audouinii. Four autochthonous cases were caused by M. canis and one by M. audouinii (but this one was in contact with African immigrants). In two of the five cases produced by anthropophilic dermatophytes other family members were infected by the same fungus. Most cases were treated successfully with griseofulvin. CONCLUSIONS: Although tinea capitis is rare in infants in their first year of life, the condition should be investigated if scaling and/or alopecia are present. A thorough epidemiological study of other family members is mandatory.

Antifungal Agents↗
PubMedDate not supplied

Tinea capitis: study of asymptomatic carriers and sick adolescents, adults and elderly who live with children with the disease.

Tinea capitis is a dermatophyte infection that occurs mainly in childhood; there are few reports, in Brazil, in adolescents and adults. The detection of asymptomatic carriers is of great importance in the disease control. From February 1998 to February 1999, a study was performed at the outpatient Dermatologic Unit of Instituto de Puericultura e Pediatria Martagão Gesteira (Universidade Federal do Rio de Janeiro, Brasil) to verify the frequency of asymptomatic carriers and tinea capitis between 79 adolescents, adults and elderly who lived in the same household of 56 children (0-12 years) with tinea capitis. Of these, one female and one male adults (2.5%) were asymptomatic carriers and the cultures revealed Trichophyton tonsurans and Microsporum canis respectively. One female adolescent and two female adults (3.8%) had tinea capitis and all cultures revealed Trichophyton tonsurans. The study has shown that adolescents and adults who live in the same household of children with tinea capitis may be sick or asymptomatic carriers.

Adolescent↗
PubMed1998

Griseofulvin and terbinafine in the treatment of tinea capitis in children.

AIM: To compare the effectiveness of griseofulvin and terbinafine in the treatment of tinea capitis in children. METHOD: Twenty four consecutive patients with culture proven tinea capitis were treated randomly with griseofulvin (10 mg/kg/day for 8 weeks) or terbinafine (62.5-250 mg/day for 4 weeks). Outcome was determined by absence of clinical signs, hair regrowth or negative mycology. RESULTS: Twenty four patients (16 male, 8 female) were treated. Age ranged between 2 and 15 years (mean 4.8). Seven patients presented with kerion, the remainder with a scaling and patchy alopecia pattern of tinea capitis. The responsible organisms were Microsporum canis (17 cases) and Trichophyton verrucosum (7 cases). Fourteen children were treated with griseofulvin and 10 with terbinafine. By three months follow up, 19 patients had cleared completely with good new hair regrowth. Three children had no active disease but only minimal new hair growth. One child (griseofulvin group) had no hair regrowth but was culture negative. She had sustained significant dermal and subcutaneous skin damage requiring plastic surgery. The other (terbinafine group) had ongoing active kerion. CONCLUSION: Both griseofulvin and terbinafine are equally effective in the treatment of tinea capitis.

Adolescent↗
PubMed1994

Itraconazole versus griseofulvin in the treatment of tinea capitis: a double-blind randomized study in children.

BACKGROUND: Tinea capitis is a fungal infection in which topical therapy is often unsuccessful. Griseofulvin has been considered to be a first-line therapy. Other antifungal agents are the azole derivatives. Among these, itraconazole was compared with griseofulvin in children in a double-blind study. PATIENTS AND METHODS: Thirty-four children and one adult with clinical signs and symptoms of tinea capitis and with positive culture and microscopy for dermatophytes have been included in a double-blind comparison between itraconazole, 100 mg daily, and ultramicronized griseofulvin, 500 mg daily. Both drugs were given for 6 consecutive weeks. The final evaluation was made 8 weeks after the end of treatment to allow the hairs to regrow. Seventeen itraconazole- and 15 griseofulvin-treated patients received the complete 6-week treatment course. Fifteen of these 17 itraconazole patients and 14 of the 15 griseofulvin patients had infections caused by Microsporum canis. Fifteen of 17 patients were cured by itraconazole (88%) and 15 of 17 patients by griseofulvin (88%). One of the patients who discontinued griseofulvin therapy after 4 weeks was clinically and mycologically cured. Two of the original 17 griseofulvin patients discontinued therapy because of vomiting. None of the itraconazole-treated children experienced side effects. CONCLUSIONS: Itraconazole is the first azole derivate that matches griseofulvin for the treatment of tinea capitis in children. The drug also appears to be better tolerated than griseofulvin.

Child↗
PubMedDate not supplied

Tinea capitis in a newborn caused by two organisms.

Tinea capitis is a common infection of childhood. There have been several reports of tinea capitis in newborns. Our patient presented at 19 days of age to the emergency room with a scalp lesion of 5 days duration. The fungal culture grew both Trichophyton rubrum and Trichophyton mentagrophytes. The patient was successfully treated with oral griseofulvin.

Administration, Oral↗
PubMed2002

Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study.

OBJECTIVES: Terbinafine has been shown to be effective in tinea capitis, using different treatment durations. However, no direct comparison of treatment duration has previously been investigated. This randomized, double-blind, parallel-group, multicenter study was designed to assess the effect of terbinafine treatment duration on the outcome of Trichophyton tinea capitis in a North American population. METHODS: A total of 176 patients with a clinical diagnosis of tinea capitis were enrolled in this study and treated with oral terbinafine (3-6 mg/kg/d) for 1, 2, or 4 weeks. All patients were to be followed until week 12. A total of 159 patients had culture-confirmed tinea capitis attributable to Trichophyton species and constituted the intent-to-treat population used for efficacy analysis (50, 55, and 54 patients in the 1-, 2-, and 4-week arms, respectively). RESULTS: At the end of study, effective treatment, defined as negative culture and low scores on signs and symptoms, was achieved in 56%, 69%, and 65% of patients who were treated with terbinafine for 1, 2, and 4 weeks, respectively. A negative culture was achieved in 60%, 76%, and 72%, respectively. Overall, the efficacy data showed that both the 2- and 4-week treatment regimens are clinically superior to the 1-week regimen. Terbinafine was well tolerated, and the incidence of adverse events showed no relationship to the duration of therapy. CONCLUSION: When efficacy, cost, and compliance are taken into consideration, 2 weeks of terbinafine therapy appears to be the optimal treatment duration for patients with Trichophyton tonsurans tinea capitis.

Administration, Oral↗
PubMed1992

Brush-culture method for diagnosing tinea capitis.

Using traditional methods to verify the existence of a fungal infection in children with suspected tinea capitis is a cumbersome process. Scraping scale and pulling hairs for culture or microscopic examination can be time-consuming and uncomfortable for the child. This study is the first comparison of this method with an alternate brush-culture method for diagnosing tinea capitis. In 70 children with symptoms suggestive of tinea capitis, there was strong agreement between methods in detecting disease or lack thereof (McNemar's test, P less than .2). In the 51 paired positive cultures, those obtained by brush culture turned positive significantly faster (t test, P less than .01) than samples obtained by the traditional method. The brush method is a reliable, painless, and more expedient way to obtain cultures from children with suspected tinea capitis.

Adolescent↗
PubMed2004

Increasing tinea capitis prevalence in Stockholm reflects immigration.

The aim was to describe the mycological and clinical data in children diagnosed with tinea capitis in a hospital setting in Stockholm. Information concerning demography, symptoms, mycology and treatment were obtained, retrospectively, from medical records of all children up to 15 years of age diagnosed with tinea capitis during two 3-year periods, 1989--1991 and 1999--2001, at the Pediatric Dermatology Unit of the Karolinska Hospital in Stockholm. Between 1989 and 1991, five children were diagnosed with tinea capitis. Between 1999 and 2001, there were 92 children, the vast majority (86%) being of foreign extraction, mostly African (83%). Trichophyton violaceum was the most prevalent pathogen, affecting 68% of the children. Of the anthropophilic infections, 62% were linked to relatives. In 71% of all positive cultures, microscopy was positive. The most common clinical findings were scaling of the scalp (80%), itching (54%) and patches of alopecia (52%). The treatment consisted of the oral antimycotics terbinafine (n = 48) or griseofulvin (n = 49). During the last decade there has been an increase in tinea capitis in Stockholm, most commonly caused by Trichophyton violaceum, corresponding with the increased immigration from Africa. Spread within the family seems to be of importance, and family members are preferably screened in an effort to prevent continued transmission. It is important to bear the diagnosis of tinea capitis in mind, especially as, untreated, some cases can develop permanent alopecia and may also cause further spreading of this infection.

Adolescent↗