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PubMed2000

Tinea capitis in Benghazi, Libya.

BACKGROUND: Tinea capitis is a worldwide problem. It affects mainly school age children. Late detection and improper treatment of the inflammatory type of this disease may result in disfigurement and permanent alopecia. The objectives of this study were to determine the prevalence, clinical types, and causative species of tinea capitis in Benghazi, Libya. METHODS: One hundred and ninety six patients with tinea capitis were enrolled in this study. Hair stumps and scales were collected from every case and exposed to direct microscopic examination using 10% potassium hydroxide solution, and cultivation on modified Sabouraud's dextrose agar with cyclohexamide and chloramphenicol. RESULTS: Tinea capitis accounts for 45% of all superficial fungal infection and 92% occurred in children below the age of 10 years. The gray patch type was the most common clinical variety (53.6%), followed by black dots, seborrhoid type, and kerion (25.5%, 10.2%, and 8.2%), respectively. Four patients with a clinical picture of alopecia areata-like lesion and one patient with a favus-type lesion were seen. Species identification revealed that Trichophyton violaceum was the most common causative agent, responsible for 49.4% of infection, followed by Microsporum canis (38.6%) and T. verrucosum (7.8%). From seven patients the isolate was a mixture of both T. violaceum and M. canis. CONCLUSIONS: There has been a dramatic decrease in the incidence of favus with complete disappearance of T. schoenleinii. T. verrucosum as a causative agent of tinea capitis in this area has been reported for the first time in this study.

Adolescent↗
PubMed2003

Use of terbinafine for tinea in Australian Aboriginal communities in the Top End.

Tinea of the skin and nails is a common problem in remote Aboriginal communities of the Top End of Australia. A retrospective study was performed on data collected from 104 patients from several indigenous communities. Worksheets were filled in by district medical officers and rural general practitioners, detailing the extent of the tinea. Patients were prescribed between 4 and 12 weeks of 250 mg daily oral terbinafine. Fifty-two patients were followed up, with 45 having a good response to treatment (87%) and with 22 of these patients having full clearance of tinea (42%). A prospective study with 44 subjects was performed. The extent of the tinea was documented and fungal scrapings/clippings were taken. Forty subjects were recruited and given oral terbinafine (2-12 weeks depending on skin/nail involvement) or topical terbinafine if oral treatment was contraindicated. Twenty-five of the 40 (63%) subjects were reviewed. Twenty-three (92%) subjects that were followed up improved clinically, with 8/25 (32%) clearing completely. Twenty (80%) of followed-up patients complied fully with treatment. Terbinafine was found to be a well-tolerated and effective treatment of tinea of the skin and nails.

Administration, Oral↗
PubMed2002

Tinea pedis in European marathon runners.

BACKGROUND: Epidemiological studies suggest that 15% of the population in industrial countries suffer from tinea pedis (athlete's foot) and that persons who do sports are a high-risk population. OBJECTIVE: To investigate the responsibility of dermatophytes in interdigital lesions of the feet in European marathon runners and to identify associated risk factors. SUBJECTS AND METHODS: Runners of the 14th Médoc Marathon (n = 147) were interviewed on risk factors for tinea pedis and underwent physical and mycological examinations. RESULTS: Interdigital lesions of the feet were found in 66 runners (45%). A dermatophyte was isolated in 45 runners (31%), 12 of whom were asymptomatic. Trichophyton interdigitale and T. rubrum accounted for 49% and 35.5%, respectively, of the cases of tinea pedis. Thirty-three (22%) of the 102 runners free of dermatophyte infection had lesions resembling those of tinea pedis. Increasing age and use of communal bathing facilities were predictive of T. rubrum culture. CONCLUSIONS: Marathon runners are at high risk for tinea pedis, but dermatophytes are responsible for only half of the foot lesions found in runners. The existence of asymptomatic carriers calls for prophylactic measures.

Adult↗
PubMedDate not supplied

Tinea capitis: an overview with emphasis on management.

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichophyton tonsurans now predominates over Micro-sporum audouinii. With this transition the utility of the Wood's light for diagnosis has been reduced since T. tonsurans infection is Wood's light negative. Griseofulvin has been the mainstay of therapy for the last 40 years. The newer antifungal agents-itraconazole, terbinafine, and fluconazole-appear to be effective and safe for the treatment of tinea capitis. When tinea capitis is due to T. tonsurans or other endothrix species the following regimens have been used: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen with capsules (5 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart), and itraconazole pulse regimen with oral solution (3 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart). With terbinafine tablets the continuous regimen (>40 kg body weight, 250 mg/day; 20-40 kg, 125 mg/day; and <20 kg, 125 mg/day) is given for 2 to 4 weeks. Fluconazole tablets or oral suspension (6 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once-weekly regimen may also be effective. When ectothrix organisms (e.g., Microsporum canis) are present, a longer duration of therapy may be required. The data suggest that the newer agents are effective, safe with few adverse effects, and have a high benefit:risk ratio. It remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection.

Antifungal Agents↗
PubMedDate not supplied

Itraconazole is effective in the treatment of tinea capitis caused by Microsporum canis.

Tinea capitis is a relatively common superficial fungal infection in children which requires oral antifungal therapy. In a prospective, open study over 24 weeks, itraconazole 5 mg/kg/day, given as capsules or as an oral suspension for a period of 2-12 weeks, was used to treat children 1-12 years of age who had M. canis tinea capitis. Children with mycologic evidence of M. canis tinea capitis were entered into the study and asked to return at week 2 and then every 2 weeks thereafter until cured, with a maximum of 12 weeks of active treatment. At each visit the scalp was sampled and the material processed for light microscopy and culture examination. An extra 2 weeks of itraconazole was prescribed if the mycology from the sample obtained on the previous visit indicated that there was still presence of the organism. Patients were administered either 2, 4, 6, 8, 10, or 12 weeks of treatment. The final follow-up visit was at 12 weeks from the cessation of drug therapy. Laboratory blood testing was performed only if indicated by history, examination, or the development of side effects. There were 107 patients (49 boys, 58 girls; mean +/- standard error =5.6 +/- 0.2 years). Thirteen of the 107 children were given the oral suspension. At week 12 from the cessation of treatment there was complete (clinical and mycologic) cure in all 107 children. Increasing age of the patient correlated significantly with the length of itraconazole capsule therapy (p=0.03). The duration of itraconazole treatment also correlated significantly with the severity of tinea capitis at baseline (p=0.02). Adverse effects were observed in 5 children receiving itraconazole capsules (n=94). These were regarded as being possibly or probably due to the drug in two children (mild transient stomach ache in one and moderate diarrhea in one). The child with diarrhea stopped therapy at week 4 with complete resolution of symptoms. One of 13 children receiving the oral suspension had mild, transient diarrhea. There were no drop-outs in this group. Laboratory testing was not required in any patient. Compliance was very good in the patient group. Itraconazole 5 mg/kg/day given either as a capsule or an oral suspension for 4-8 weeks is effective and safe in the treatment of tinea capitis caused by M. canis.

Administration, Oral↗
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↗
PubMed1997

Nosocomial transmission of Trichophyton tonsurans tinea corporis in a rehabilitation hospital.

OBJECTIVE: Investigate the nosocomial transmission of Trichophyton tonsurans tinea corporis. DESIGN: Descriptive study of a nosocomial epidemic of tinea corporis. SETTING: A free-standing inpatient rehabilitation facility. PARTICIPANTS: Patients and healthcare workers present on an inpatient rehabilitation ward at the time of transmission of tinea corporis. RESULTS: T tonsurans tinea corporis was transmitted from one patient to four healthcare workers despite early diagnosis and treatment. Infection rates for healthcare workers having major, moderate, and minor contact with the index case were 30%, 17%, and 0%, respectively (overall rate, 25%). CONCLUSIONS: This study identifies rehabilitation inpatients as another population in which nosocomial transmission of T tonsurans tinea corporis can occur. The high attack rate and transmission, despite early diagnosis and treatment, emphasizes the need for isolation precautions.

Adult↗
PubMed2004

Frequency of culture-proven dermatophyte infection in patients with suspected tinea pedis.

BACKGROUND: This study examined the incidence of culture-proven tinea pedis in patients who presented with a foot rash clinically suspected to be tinea pedis. METHODS: Cultures were taken from 874 patients in 4 dermatology clinics across the country. The incidence of patients with positively cultured tinea pedis was compared with the total number of patients in the study. RESULTS: The surprisingly low percentage of patients correctly diagnosed with tinea pedis was determined to be 32%. The remaining 68% of patients either had a nonfungal foot dermatitis or tinea pedis with false-negative cultures. CONCLUSIONS: This study demonstrates the need for fungal cultures when patients present with scaling feet as well as the importance of a broad differential diagnosis to ensure timely and appropriate therapy.

Arthrodermataceae↗
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↗
PubMed2002

Immunohistochemical analysis of the infiltrated cells in tinea capitis patients.

Tinea capitis is a fungal infection of the skin and the hair with involvement of the hair shaft and the pilosebaceous unit. It may be the most common of all cutaneous mycoses in children. Tinea capitis can be inflammatory or noninflammatory. It is thought that humoral and cell-mediated immunities play a role in the formation of the clinical types of the disease. We studied twelve patients with acute inflammatory disease, four patients with chronic non-inflammatory disease, and one patient with a black-dot variant of tinea capitis. The composition of inflammatory infiltrates present in lesional skin was analyzed by antibodies to T cells (CD3) and B cells (CD20). Anti-CD3 revealed large numbers of T cells in twelve patients with acute, inflammatory dermatophytosis, whereas anti-CD20 revealed marked infiltrates of both B and T cells in all patients with chronic, non-inflammatory dermatophytosis. As a result, we thought that cell-mediated immunity might play a role in the acute, inflammatory type of tinea capitis and that humoral immunity might do so in the chronic, non-inflammatory type of tinea capitis.

Acute Disease↗
PubMed2006

Isolation of Microsporum canis from the hair coat of pet dogs and cats belonging to owners diagnosed with M. canis tinea corporis.

Microsporum canis has been frequently isolated from human cases of tinea capitis and tinea corporis. The infection may be acquired from infected animals with cutaneous lesions but also from asymptomatic carriers or from the environment. As asymptomatic M. canis carriers are considered to be a critical factor in the epidemiology of dermatophytosis in humans, this study investigated the relationship between the presence of dermatophytes on the hair coats of dogs and cats without cutaneous lesions and the occurrence of the disease in their respective owners. A total of 136 dogs and 248 cats were sampled from January 1999 to January 2005. Seventy-eight animals (22 dogs and 56 cats) belonged to individuals affected by tinea corporis caused by M. canis and 306 (114 dogs and 192 cats) to individuals without dermatophytosis. Age, sex, breed, habitat and season were recorded for each animal and examined as potential risk factors. Dermatophytes were isolated from 20.5% of the dogs and 28.2% of the cats. Microsporum canis was isolated from 36.4% of dogs cohabiting with owners diagnosed with tinea corporis but it was never isolated from dogs whose owners had no lesions. By contrast, M. canis was isolated from 53.6% of cats cohabiting with owners diagnosed with tinea corporis and from 14.6% of cats whose owners had no signs of the disease. These results clearly indicate that both cats and dogs should be considered as a major source of pathogenic dermatophytes for humans even when they do not present clinical signs of dermatophytosis.

Animals↗
PubMed1993

Tinea capitis in Saudi Arabia.

BACKGROUND: Tinea capitis is a dermatophyte infection of the scalp, eyebrows, and eyelashes caused by species of Microsporum and Trichophyton. The purpose of this study was to discover the incidence and causal agents of tinea capitis in Saudi Arabia. METHODS: Hair roots, skin scrapings, and pus swabs were collected from patients clinically diagnosed with tinea capitis and were processed for fungus. RESULTS: Of 372 patients with tinea capitis investigated in Saudi Arabia, 240 were found to be positive by direct microscopic examination, and the causal agent was isolated from 237 patients. Tinea capitis accounted for 47.7% of all superficial mycoses, and 97% of it occurred in children below 15 years of age. Inflammatory lesions were found in 35% of cases, and 10 of them presented with kerion celsi. Favus-type lesion was found in one. Microsporum canis was the most common etiologic agent, responsible for 82.3% of the infections. Trichophyton violaceum was the next most common agent (13.9%), followed by M. audouini (2.2%); T. mentagrophytes, T. rubrum, T. verrucosum, and T. simii were isolated from one patient each. This is the first report of T. simii infection in a Saudi man. CONCLUSIONS: Although none of the patients owned pets, the predominance of M. canis may be explained by the large number of cats in the neighborhood. The disappearance of favus due to T. schoenleinii may be due to improved socioeconomic conditions. Our results agreed with two previous reports.

Adolescent↗
PubMed2004

Tinea capitis in a dermatology center in the city of Fortaleza, Brazil: the role of Trichophyton tonsurans.

BACKGROUND: Over a 3-year period (March 1999 to March 2002), 944 patients with scalp lesions attended a dermatology reference center in the city of Fortaleza, Ceará, Brazil. Clinical specimens were examined at the Specialized Medical Mycology Center, Federal University of Ceará, Fortaleza-CE, Brazil, to detect patients with tinea capitis. METHODS: Specimens were obtained from pus, scales, and hairs from suspected lesions of tinea capitis. Mycologic analyses were conducted by direct microscopy and by fungal culture on Sabouraud dextrose agar, with or without chloramphenicol and Mycosel agar. The culture tubes were incubated at 28 degrees C and examined daily for 1 month. RESULTS: Fungi were seen in 438 (46.4%) of the 944 clinical specimens. The percentage of positive direct microscopic examinations of the clinical specimens was 83.7%. Of those patients with tinea capitis, 157 (35.8%) were males and 281 (64.2%; P < 0.001) were females. The distribution of dermatophyte species in males, from 136 positive cultures, was Trichophyton tonsurans (54.41%), Microsporum canis (38.97%), T. rubrum (4.41%), T. mentagrophytes var. mentagrophytes (1.47%), and M. gypseum (0.74%). On the other hand, only three species, from 251 positive cultures, were present in females: T. tonsurans (80.08%), M. canis (17.53%), and T. rubrum (2.39%). There was a high proportion of positive results in children under 10 years of age (n = 309). No significant difference was detected in the seasonal distribution of tinea capitis. CONCLUSIONS: Our data show that T. tonsurans is the main etiologic agent of tinea capitis, and is more likely to be found in females and in the prepubertal population.

Adolescent↗
PubMed2006

Tinea capitis in eastern Nepal.

BACKGROUND: Tinea capitis is an increasing public health concern throughout the world. The clinical types and etiological agents vary from time to time and place to place. This study was undertaken to identify the etiological agents and to determine the clinico-etiological correlation of tinea capitis in eastern Nepal. METHODS: Sixty-nine clinically diagnosed cases of tinea capitis were enrolled in this study. Hair roots and skin scrapings were collected from each patient and subjected to microscopy and culture for identification of fungal hyphae and spores. RESULTS: Tinea capitis accounted for 4.6% of all dermatophyte infections: 68.1% occurred in patients below the age of 11 years with a male to female ratio of 1 : 1.9. "Gray patch" was the most common clinical type (52.2%), followed by "black dot" (17.4%), seborrhoeic dermatitis (13%), alopecia areata (11.6%) and pustular (4.3%). Direct microscopy of hair was positive in 62.3% of patients. Culture positivity was found in 56.7% of patients. Common isolated organisms were Trichophyton violaceum (48.71%), T. mentagrophytes (15.38%), T. tonsurans (12.82%), Microsporum canis (7.69%), T. rubrum and M. gypseum (5.12% each), and M. audouinii and M. nanum (2.56% each). CONCLUSIONS: Trichophyton violaceum was the most common pathogen of tinea capitis. The clinical manifestations were variable and "gray patch" was the most common clinical presentation in this part of the world.

Adolescent↗
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 pedis survey in members of the Japanese Self-Defense Forces undergoing ranger training.

The conditions surrounding tinea pedis infection were surveyed--the degrees of infection and of aggravation attendant upon training, and the skin temperature within the leather boots of members of the Japanese Self-Defense Forces undergoing winter and summer ranger training. Before winter training, tinea pedis was diagnosed in 8 of the 15 subjects. The mean atmospheric temperature was 7.1 degrees C, the total precipitation, 23 mm, and the mean skin temperature of the feet during training, 33.7 degrees C. After training, 1 further subject had contracted tinea pedis, 5 of the 8 showed slight aggravation, and 3 showed no change. Before summer training, tinea pedis was found in 9 of another 15 subjects. The mean atmospheric temperature was 20.0 degrees C, total rainfall, 353 mm, and the mean skin temperature of the feet during training, 36.6 degrees C. After the training, aggravation had occurred in 3 of the 9, and slight aggravation in the other 6. In these 9, vesiculation, pustules and erosion were seen, so that summer training had a more severe effect than winter training. Investigation of the predisposing factors for tinea pedis due to the wearing of boots and shoes is considered extremely important for the prevention and treatment of this disease.

Adult↗
PubMed2006

Efficacy of topical griseofulvin in treatment of tinea corporis.

Tinea infections are among the most common dermatological conditions throughout the world. Griseofulvin is a classical oral fungistatic antibiotic, active against Epidermophyton floccosum, Trichophyton and Microsporum species, the causative fungi of tinea corporis. To evaluate the efficacy of topical griseofulvin in the treatment of tinea circinata using three different vehicles for drug delivery. Sixteen patients with tinea circinata were instructed to apply either griseofulvin gel form in group A or a similar placebo gel for control group; a niosomal gel formulation of griseofulvin for group B or; a liposomal gel formulation of griseofulvin for group C. Patients were evaluated both clinically and mycologically after 3 weeks. Marked improvement was seen for groups A, B and C both clinically and mycologically while no improvement was observed in the placebo group. Mild and transient irritation was reported in four patients. Our results show that topical griseofulvin preparations may be effective and safe in treating tinea circinata and that further large-scale studies may establish the high efficacy of the niosomal gel formulation.

Administration, Topical↗
PubMed1983

The rise and fall of fluorescent tinea capitis.

The epidemiology of tinea capitis has had a remarkable change in the past 20 years. It is important for physicians to realize that most tinea capitis in the United States is caused by Trichophyton tonsurans and that these lesions cannot be diagnosed by the Wood's lamp. Trichophyton tonsurans tinea capitis is frequently misdiagnosed because the lesions mimic such common scalp conditions as dandruff and seborrhea. Further, this organism can cause chronic tinea capitis in women that may become a infectious reservoir for other family members. A negative potassium hydroxide preparation will not rule out infection with T tonsurans and cultures are necessary. Scalp lesions in children should be considered tinea capitis until culturally proved otherwise.

Adult↗