[Mycological observations on tinea capitis, tinea corporis and tinea ungium in Guayaquil].
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Tinea capitis.
Tinea capitis is a common dermatophyte infection of the scalp in children. Dermatophytes are classified into three genera; tinea capitis is caused predominantly by Trichophyton or Microsporum species. On the basis of host preference and natural habitat, dermatophytes are also classified as anthropophilic, geophilic and zoophilic. The etiological agents of tinea capitis usually fall in the first and last categories. In North America, tinea capitis is now predominantly due to Trichophyton tonsurans. During the past 100 years the most common North American organism for tinea capitis was initially Microsporum canis followed later by M. audouinii. In other parts of the world the epidemiology varies. Tinea capitis is generally observed in children over the age of 6 years and before puberty, with African Americans being the most affected group. Clinical presentations are seborrheic-like scale, 'black dot' pattern, inflammatory tinea capitis with kerion and tiny pustules in the scalp. The clinical diagnosis should be confirmed by mycological examination. Wood's light examination was of value in diagnosing tinea capitis due to M. canis and M. audouinii; however, it is not helpful in T. tonsurans tinea capitis. Asymptomatic carriers may be a significant reservoir of infection and spread of spores may also involve inanimate objects. Carriers may benefit from shampooing their hair. Treatment of tinea capitis requires an oral antifungal agent. The data from the use of terbinafine, itraconazole and fluconazole are promising and suggest that these agents have an efficacy similar to griseofulvin while shortening the duration of therapy. Both griseofulvin and the newer antimycotics have a favorable adverse-effect profile and are associated with high compliance.
Antifungal Agents↗
Therapeutic options in the treatment of tinea capitis.
Tinea capitis is primarily a disease of pre-adolescent children. In North America and the UK, Trichophyton tonsurans is responsible for > 90% of cases. Microsporum canis is the predominant pathogen in certain parts of Europe. The standard of care for the treatment of tinea capitis is oral griseofulvin and so far, it remains the only medication approved by the US FDA for this condition. The newer oral antifungal agents, such as terbinafine, itraconazole and fluconazole, appear to be effective, safe and have the advantage of a shorter treatment duration. Although a significant number of clinical trials and reports have documented experience with terbinafine and itraconazole for the treatment of tinea capitis, it should be noted that only a few trials have been conducted utilising fluconazole. Both 2% ketoconazole and 1% selenium sulfide shampoos have been shown to reduce surface colony counts of dermatophytes in infected individuals, and these agents are often recommended for adjuvant therapy. This article reviews data currently available on various therapeutic alternatives for the treatment of tinea capitis and summarises all relevant clinical trials that have thus far investigated the use of these drugs for tinea capitis in the paediatric population.
Antifungal Agents↗
Prevalence of tinea capitis and tinea pedis in Barcelona schoolchildren.
BACKGROUND: Although dermatophytoses can appear at any age, some types are particularly prevalent in children. There are no prior data on the prevalence of tinea capitis and tinea pedis in Barcelona, Spain. To identify the prevalence of tinea in school children in the area with the highest immigrant population in this city, a cross-sectional study was performed. A second objective was to identify the etiologic agent to study the possibility of the introduction of foreign dermatophyte species and to evaluate the possibility of encountering healthy hosts. METHODS: From October 2002 until June 2003, we evaluated 1305 schoolchildren, ages 3-15 years, belonging to 21 schools located in the inner city of Barcelona to determine the prevalence of tinea capitis and pedis in school children. Cultures of scalp and feet were done in each child. RESULTS: 36(2.8%) children had tinea pedis and 3 (0.23%) had tinea capitis. One child had tinea capitis and tinea pedis, caused by different species (t. capitis caused by Trichophyton mentagrophytes and tinea pedis caused by Trichophyton rubrum). Of the 39 positive cases for dermatophytes, the etiologic agent in 18 (46.1%) was T. mentagrophytes, 17 (43.5%) T. rubrum, 2 (5.5%) Epidermophyton floccosum and 2 (5.5%) Trichophyton tonsurans. Of these 39 cases of tinea, 15 (38.5%) were Spanish natives and 22 (56.4%) were immigrants. CONCLUSION: The prevalence of tinea capitis was lower that we had expected, and it was noted that there was a greater prevalence of tinea pedis among schoolchildren 13-15 years of age (64.10%), the great majority of them male. The number of cases of tinea was significantly greater in immigrants.
Adolescent↗
The evolving role of itraconazole, fluconazole and terbinafine in the treatment of tinea capitis.
Tinea capitis has become an increasing public health concern in the last decade. The increased incidence of the disease; its sometimes subtle, nonspecific clinical presentation; and the development of tolerance to griseofulvin therapy have led to the need for alternative safe, efficacious, inexpensive therapies that work rapidly. Itraconazole, fluconazole and terbinafine all possess pharmacologic and pharmacokinetic characteristics that theoretically would make them ideal therapies for tinea capitis. However, few randomized double blind controlled studies using these agents have been published. Thus far none have been conducted in the United States. The best available data support the utility and safety of the new antifungals in the treatment of tinea capitis. However, one must keep in mind that they are not yet approved by the Food and Drug Administration for this indication. Safety and cost considerations favor terbinafine for the treatment of T. tonsurans infections. M. canis infections may respond better to itraconazole, but good controlled studies to confirm this speculation have not been conducted. Short course and pulse dosing are particularly exciting options that may decrease cost and lower the risk of adverse side effects. Further useful information will hopefully come from future randomized double blind studies that will include patients from the United States. Studies using standardized definitions of disease, cure and appropriate follow-up evaluation of clinical and mycologic cure will best identify the optimal therapy for pediatric tinea capitis infections. The new systemic antifungals may provide more therapeutic options for fungal infections of the scalp. Note added in proof A recent trial comparing short course terbinafine and intraconazole therapy demonstrated that 2-week therapy with either drug provided good results and high cure rates (Jahangir M, et al. Br J Dermatol 1998;139:672-4).
Antifungal Agents↗
Tinea capitis.
Tinea capitis is dermatophytosis of the scalp hair follicles, generally producing inflammatory or noninflammatory alopecia. Infection occurs predominantly in prepubertal children older than 6 months, although infection can occur in all age groups. Tinea capitis is one of the most common infectious conditions in children, and it occurs worldwide.
Anti-Bacterial Agents↗
Current status of the identification and management of tinea capitis.
Tinea capitis due to Trichophyton tonsurans has become a significant health problem affecting children and adolescents. This infection has several different distinctive clinical patterns which, if not recognized, may result in delayed diagnosis and therapy. This review is designed to emphasize the differences between tinea capitis caused by T tonsurans and that caused by other organisms. Current diagnostic and therapeutic measures are discussed.
Child↗
Trichophyton tonsurans exocellular protease expression: correlation with clinical presentation in tinea capitis.
Tinea capitis remains an overwhelmingly prevalent disease in children. Despite the fact that it was described over a century ago, disease pathogenesis remains incompletely characterized. This investigation was designed to evaluate whether inter-strain variability in fungal protease expression for clinical Trichophyton tonsurans isolates correlates with disease severity. Children with tinea capitis were enrolled and a clinical severity score (CSS) determined for all subjects by grading eight symptoms on a 4-point scale. Fungal specimens were collected by brush culture, placed in aqueous medium and incubated at 32 degrees C for 5 days. The culture supernatant was lyophilized and aliquots used to characterize protease activity. Enzyme activity, normalized to total soluble protein, varied 550-fold, 150-fold and 6-fold for collagenase, elastase and keratinase, respectively. A significant decrease in elastase and collagenase activity was observed with increasing duration of infection. In one-half of the children, CSS increased in direct response to collagenase and elastase production, while CSS was independent of enzyme activity in the remaining children. The relationship between enzyme activity and time course of disease are consistent with theories on enzyme regulation in dermatophytoses; however, the finding that two potential subsets of children exist with varied response to fungal antigens has yet to be described.
Child↗
Trichophyton tonsurans tinea capitis and tinea corporis: treatment and follow-up of four affected family members.
We report a Caucasian family of two veterinary practitioners and their two children, ages 2 years and 6 months, simultaneously infected with the dermatophyte Trichophyton tonsurans, causing tinea capitis and tinea corporis in the children and tinea corporis in the parents. The parents and older child were successfully treated with oral terbinafine. The infant clinically responded to treatment with topical terbinafine and ketoconazole shampoo but presented with recurrent tinea capitis 12 months later, from which T. tonsurans was cultured. At this time, scalpbrush samples from the other family members failed to culture any fungi, and neither were fungi isolated from the family hairbrushes. The infant then received oral terbinafine, resulting in clinical and mycologic cure. After a further 12 months follow-up, there has been no mycologic evidence of recurrence in any family member.
Administration, Oral↗
Tinea capitis.
Tinea capitis (TC) is a common fungal infection of the scalp, hair follicles, and hair shafts that can affect any age group but is particularly common in schoolchildren. The prevalence of TC has risen in the past 2 decades. Griseofulvin, the gold standard of therapy, does not cure about 20% of patients with TC, which has led to recent clinical trials on alternative agents for TC. This article reviews the pertinent new advances in the understanding of the disease and its therapy.
Antifungal Agents↗
Trichophyton rubrum invasion of human hair apparatus in tinea capitis and tinea barbae: light- and electron microscopic study.
We have previously reported morphological changes of Trichophyton violaceum and Microsporum canis in hair apparatuses in tinea capitis. To investigate the morphology of Trichophyton rubrum in the human hair apparatus, two cases of tinea capitis and one case of tinea barbae were examined by light- and electron microscopy. The fungal elements, which were located in the lower keratogenous zone, showed non-septate hyphae in the outer part of the hair cortex. With the upward development of the hair layers, some hyphae invaded the keratinized hair cuticle and keratinized inner root sheath and were transformed into arthrospores. Some hyphae remaining in the hair cortex were also transformed into arthrospores, while other hyphae in the hair cortex did not survive, but degenerated. In T. rubrum hair infection, there is a distinct relationship between the morphological changes of the fungi and the hair cell differentiation as seen in T. violaceum and M. canis infections. However, T. rubrum displays unique morphological changes, which are different from those of T. violaceum and M. canis, in hair apparatuses.
Adult↗
Study of 73 cases of tinea capitis and tinea favosa in adults and adolescents.
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Adolescent↗
Guidelines of care for superficial mycotic infections of the skin: tinea capitis and tinea barbae. Guidelines/Outcomes Committee. American Academy of Dermatology.
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Antifungal Agents↗
An outbreak of tinea capitis and tinea corporis due to Microsporum lanosum.
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Dermatitis↗
A clinico-etiologic correlation in tinea capitis.
BACKGROUND: Tinea capitis is a dermatophytosis with diverse clinical manifestations. The causative fungi of tinea capitis vary with geography and time. This study aimed to identify the etiologic agents and to determine the clinico-etiologic correlation of tinea capitis in Lahore, Pakistan. METHODS: From clinically suspected cases of tinea capitis, skin scrapings and hair samples were taken and subjected to microscopy and culture. RESULTS: Of 100 evaluable patients, 95% were children below 12 years of age with almost equal sex incidence. Noninflammatory and inflammatory lesions were seen in 56.4% and 43.6%, respectively. Trichophyton violaceum was the most common etiologic agent, responsible for 82% of infection, followed by T. tonsurans (8%), T. verrucosum (5%), and T. mentagrophytes (5%). CONCLUSIONS: T. violaceum is the predominant pathogen causing tinea capitis in this part of the world, and gives rise to a varied clinical picture.
Adolescent↗
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↗
Efficacy of itraconazole in children with Trichophyton tonsurans tinea capitis.
BACKGROUND: Tinea capitis is prevalent in children. Although widely used as the drug of choice, the response to griseofulvin may be incomplete and an extended duration of therapy is often required. The response to newer antifungals has not been methodically evaluated in children with Trichophyton tonsurans infection. OBJECTIVE: Our purpose was to determine the efficacy of itraconazole in children with tinea capitis caused by T. tonsurans. METHODS: Pediatric patients with culture proven tinea capitis were enrolled from a hospital-based primary care clinic between January and December of 1996. Patients were treated with itraconazole 100 mg/day and a selenium sulfide-containing shampoo for 4 weeks. Children were evaluated mycologically and clinically every 2 weeks for 2 months. Patients were considered successfully treated if they were culture negative and clinically improved at the end of the study period. Children who remained culture positive or who were clinically not improved at 2 months were classified as treatment failures and retreated. RESULTS: Twenty-five patients completed the study, and 10 (40%) were successfully treated. Fifteen children required re-treatment: 14 remained culture positive at week 8, and one was mycologically negative but clinically worse. CONCLUSION: Itraconazole at a dose of 100 mg/day for 4 weeks may be effective in less than half of children with T. tonsurans tinea capitis.
Antifungal Agents↗
A randomized comparison of 4 weeks of terbinafine vs. 8 weeks of griseofulvin for the treatment of tinea capitis.
BACKGROUND: Tinea capitis is a common childhood infection that has recently become more frequent in urban areas in Europe and the U.S.A. The current licensed treatment in children is griseofulvin 10 mg kg(-1) daily, which is usually given for 6--8 weeks. OBJECTIVES: To compare this treatment with a 4-week course of oral terbinafine. METHODS: Terbinafine was given at the following doses: in children weighing < 20 kg, 62.5 mg daily; 20--40 kg, 125 mg daily; > 40 kg, 250 mg daily. Two hundred and ten children aged 2--16 years, with mycologically confirmed tinea capitis, were randomized to 4 weeks treatment with terbinafine or 8 weeks with griseofulvin, and followed for a total of 24 weeks to determine the difference between treatments with respect to short- and long-term efficacy and tolerability. RESULTS: One hundred and forty-seven patients were evaluable (terbinafine 77, griseofulvin 70). Although the 4-week course of terbinafine resulted in a trend to more rapid clearance of tinea capitis, there were no statistically significant differences between the two drugs in terms of overall outcome or tolerability, apart from in a subgroup of patients with Trichophyton infections, and weighing > 20 kg, who responded better to terbinafine than to griseofulvin at 4 weeks. By contrast, there was a better response to griseofulvin than to terbinafine in patients with Microsporum audouinii infections. CONCLUSIONS: Overall, the study showed that 4 weeks of treatment with oral terbinafine has similar efficacy to 8 weeks of treatment with griseofulvin for the management of tinea capitis in children.
Adolescent↗