脓癣的临床和实验室观察

脓癣(Kerion)为皮肤癣菌引起的局部过敏反应。可发生在头皮或光滑的皮肤上。发生在头颅披发部位的脓癣(Kerion Celsi)系头癣的一种少见类型,或认为是头癣的一种并发症,我科自1979年1月～1981年10月门诊共见头癣27例,其中脓癣9例。现将脓癣的资料总结如下:     

特比萘芬治疗头癣28例

目的 :观察特比萘芬治疗头癣的疗效。方法 :选用 2 8例病人 ,男性 19例 ,女性 9例 ,年龄 9a±s 3a ,病程 5mo± 2mo ,其中白癣 12例 ,黑癣 2例 ,脓癣 14例。口服特比萘芬片 ,病人体重 <2 0kg ,6 2 .5mg ,qd ;2 0～ 4 0kg ,12 5mg ,qd ;>4 0kg ,2 50mg ,qd。同时外用特比萘芬软膏涂抹患处 ,bid。6例脓癣病人加服罗红霉素 (病人体重 2 4～ 4 0kg者10 0mg ,bid ;12～ 2 3kg者 50mgbid)及外用莫匹罗星软膏 ,bid。疗程均为 4wk ,2wk复查 1次。结果 :2 8例头癣病人均在 8wk内痊愈 ,未见不良反应。结论 :特比萘芬治疗头癣 ,疗效确切 ,不良反应少。     

国产伊曲康唑(美扶)治疗儿童头癣40例

本院从2004年10月—2006年12月采用国产伊曲康唑胶囊(商品名:美扶)治疗儿童头癣获得满意疗效,现报告如下。1资料与方法1·1临床资料所有患儿均来自本院皮肤科门诊,随机分为治疗组和对照组。治疗组40例,男26例,女14例,年龄平均7.2岁(3~12岁),病程平均6.3周(2~8周),其中白癣26例,黑点癣12例,脓癣2例;对照组30例,男18例,女12例,年龄平均7.5岁(3~13岁),病程平均6.1周(2~7周),其中白癣20例,黑点癣8例,脓癣2例。两组患儿2个月内均未外用或口服抗真菌药物和皮质类固醇激素,患处未伴发其他皮肤病,患儿无肝、肾功能障碍。1·2真菌学检查取皮损处病发…     

头癣的防治

头癣是浅部真菌在头皮和毛发上的感染,在我国流行较广。由于各级卫生部门采取一系列的防治措施,此病已得到有效的控制,但是目前在农村仍可见到散在的头癣病人。 头癣由直接和间接接触患者而传染。如理发工具、梳子、家庭中同床共枕、互戴帽子、头巾等。有时也可由接触患癣病的猫、狗而感染。根据病原菌及临床特点,头癣可分3型,即黄癣、白癣和黑癣。     

怎样治疗头癣

许多人患了头癣病后,精神负担很沉重,下面介绍一种治疗头癣的小方法,患者不妨试试:去掉患处头发,再涂抹2%碘酒或癣药膏等。已糜烂,可用高锰酸钾热水洗涤或湿敷。化脓时需服用消炎药,同时做浸泡或湿敷。可涂用碘酒、癣药膏。用刀或锉刀刮去病,涂上癣药水,每天2～3次,直到痊愈为止。     

贵阳医学院附院近十年头癣收治情况及病原菌分析

为更好地了解贵阳地区近十年来头癣的发病状况、头癣类型以及发现引起头癣的病原菌种类，我们将1980年10月至1990年2月间共检查的105例头癣患者及其病原菌的分离结果总结如下。1一股资料105例头癣系我科10年来门诊患者。在105例头癣中，男56例（53．33％）；女49例（4666％）。发病年龄最小7月，最大42岁，其中3～10岁儿童最多，共72例（68．57％）；11～15岁儿童欢之，为14例（13．33％）。105例头癣患者中，白癣73例（69．52％）；黑点癣27例（25．71％）；黄癣5例（4．77％）。105例头癣中，明确猫狗接触史（以描为主）有32例（3047％）…     

皖北地区头癣病原菌的培养报告

在我国头癣病原菌菌种的分布各地略有不同,我省合肥地区亦有分离的研究报告,为探明我省皖北地区头癣病原菌的种类,我院皮肤科自1961年12月～1985年12月,对皖北地区455例头癣患者进行了真菌的分离研究,共获得阳性培养385例,分离出5种真菌,阳性率为84.6％,现简报其结果。一、分离方法 1.取材:所有455例头癣患者均经临床症状确诊及镜检真菌阳性者,其中黄癣125例,白癣260例,黑癣70例。 2.培养基:采用普通培养基两种,即加氯霉素(0.1mg/ml)的葡萄糖蛋白胨琼脂     

伊曲康唑治疗脓癣36例疗效观察

目的 寻找治疗脓癣有效、安全的方法。方法 应用伊曲康唑治疗脓癣,成人患者口服伊曲康唑200mg/d,儿童按5mg/(kg·d),连服6周,并作临床疗效及真菌清除率观察。结果 36例脓癣患者于治疗4周时临床痊愈率、有效率和真菌学清除率分别为55.6％、61.1％和66.7％;治疗6周后分别为83.3％、86.1％和88.9％;停药后4周时则分别为91.7％、94.4％和97.7％。结论 口服伊曲康唑治疗脓癣疗效高、耐受性好、副作用小。     

对于灰黄霉素黄癣耐药菌株的出现与其防治措施

黄癣对于灰黄霉素耐药已有发现,然而国内的报导不多,应引起重视。我县自一九七七年以来,用灰黄霉素加综合措施治疗头癣17330例(黄癣17141例,黑点癣189例),除三例黄癣未愈外,余均治愈。实践证明,灰黄霉素治疗头癣疗效满意。惟有三例黄癣病人经用灰黄霉素9—12个疗程而未愈,并且通过真菌培养和药敏试验均被证明为菌株耐药。现将耐药的三例黄癣治疗效果报告如下:     

1622例黑癣的调查报告

头癬在平潭县的流行较为严重,全县共普查101,223人,发现头癣患者1768例,发病率为1.75%。其中黄癖占0.54%,白癣占2.91%,黑癣占96.55%。一、方法与材料: (1)对全县14岁以下儿童头部进行详细检查,如发现头癣者再追踪其家庭成员,藉以发现家庭患者。     

Safety and efficacy of terbinafine in a pediatric Iranian cohort of patients with Tinea capitis

Background and objectives

Tinea capitis is a common infection of the scalp and hair shaft caused by dermatophyte fungi that mainly affects prepubescent children. Systemic therapy is required for treatment and to prevent spread. The aim of present study was to assess the effect of terbinafine for Tinea capitis treatment in children.

Methods

Thirty Iranian pediatric patients with a clinical diagnosis of Tinea capitis were enrolled in the study. The Study was conducted in a general and referral teaching hospital (Imam Medical Centre – Tehran, Iran) from 2006 to 2007. Eligible patients with less than 20 kg of body weight were given 62.5 mg terbinafine, and for patients between 20 and 40 kg the dose was 125 mg, on the first visit. All patients had the second clinical visit and second samples for microscopic study were taken. For each patient, direct mycology test (KOH test) and mycological culture were carried out before the study was started and after second, fourth, fifth, sixth and eighth weeks. Probable drug’s adverse effects were also recorded.

Results

Based on the results of mycological culture of patients’ lesions, Microsporum canis and Trichophyton sheonlini were considered as major causes of Tinea capitis in these children. Out of 30 study patients, KOH test of 93% in the 5th week and 100% in the 6th week was negative. All patients healed completely from signs of infection, after six weeks. Also, no severe side effects were seen in any patients.

Conclusion

According to the results of this study, the use of terbinafine is an effective therapy in Iranian cases of Tinea capitis in children without severe side effects.     

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.     

Tinea capitis: epidemiology,diagnosis and management strategies

Tinea capitis is a common superficial fungal infection of the scalp in children, particularly in those of African descent. Trichophyton tonsuran, an anthropophilic dermatophyte, is responsible for the majority of cases in North America. The clinical presentations are variable and include: (i) a "seborrheic" form that is scaling, often without noticeable hair loss; (ii) a pustular, crusted pattern, either localized or more diffuse; (iii) a "black dot" variety characterized by small black dots within areas of alopecia; (iv) a kerion, which is an inflammatory mass; and (v) a scaly, annular patch. Most experts still consider griseofulvin to be the drug of choice, but recommend a higher dosage of 20-25 mg/kg/day for 8 weeks because of the increase in treatment failures. Despite a history of having an excellent tolerability profile, the long treatment course and higher doses required for griseofulvin have led to consideration of new antifungal agents for this infection. Terbinafine, itraconazole, and fluconazole compartmentalize in skin, hair, and nails, thereby allowing shorter treatment courses of < or =4 weeks. All have generally been shown to be effective in the treatment of tinea capitis and appear relatively well tolerated, with gastrointestinal symptoms being the most common adverse effect. Monitoring for liver enzyme elevations is generally unnecessary if therapy is limited to 相似文献   

Clinical and mycological evaluation of therapeutic effectiveness of Solanum chrysotrichum standardized extract on patients with Pityriasis capitis (dandruff). A double blind and randomized clinical trial controlled with ketoconazole

Dandruff (also called Pityriasis capitis) is a seborrhoeic dermatitis of the scalp. It has been correlated with the pathological colonization of the scalp with yeast from the genus Malassezia; this illness has a worldwide distribution and represents 25% of all scalp dermatosis cases. It has been demonstrated that the extract obtained from leaves of the plant Solanum chrysotrichum possesses biological activity against dermatophytes and yeast. Different steroidal saponins with antimycotic activity have been isolated from the active extract. Clinical trials with standardized extracts prepared with this vegetal species report high rates of clinical and mycological effectiveness in the treatment of Tinea pedis,without producing secondary effects. The aim of this randomized, double blind and controlled clinical study, was to compare the therapeutic effectiveness and tolerability of a shampoo containing a standardized extract of S. chrysotrichum (applied every third day, for 4 weeks), against 2% ketoconazole in the topical treatment of Pityriasis capitis. From a total of 120 patients with the clinical diagnosis of Pityriasis capitis, 14 subjects were eliminated because the presence of Malassezia was not proved, an-other two patients withdrew from the study due to non-medical causes and one more withdrew because Tinea capitis was diagnosed. Therefore, the final analysis included 51 subjects in the experimental group and 52 in the control; in 45.6% of the cases M. furfur was identified as the pathogenic agent, in 44.66% M. globosa was isolated, and 9.71 % of the patients had a mixed infestation. At the end of the treatment period, the prepared phytopharmaceutical with the standardized extract from S. chrysotrichum achieved a clinical effectiveness (total absence of signs and symptoms produced by Pityriasis capitis) of 92.16%;the mycological effectiveness (absence of Malassezia spp. in the direct examination and culture) was 68.63 %; whilst the tolerability (absence of side effects that prompt subjects to abandon the treatment) was 100%. The therapeutic success (clinical and mycological effectiveness plus tolerability) was 64.71%. The comparison of these results with that obtained from the group treated with 2% ketoconazole, showed no significant differences (Z2, p >0.23). These results show the therapeutic effectiveness and tolerability of the standardized extract from S. chrysotrichum on the local treatment of Pityriasis capitis associated with the yeast of the genus Malassezia.     

Treatment of pediculosis capitis infested children with 1% permethrin shampoo in Turkey

Pediculosis capitis (head lice) is an infestation that affects many children. Although, there are a number of different treatment modalities, at the present study, we investigated the efficacy of permethrin in the treatment of pediculosis capitis in children. This study was carried out in 3 village primary schools in the Kayseri region involving 185 of 712 school children infested with Pediculus humanus capitis during a survey conducted in March 2001. It was found that 173 (97.29%) of the 178 students who applied the prescribed medications were cured, indicating that interestingly 1% permethrin shampoo (Kwellada) is an effective and safe treatment choice for pediculosis capitis.     

Ketoconazole: therapeutic results obtained in the district of Cagliari

The therapeutic results of ketoconazole treatment in 61 patients affected by mycoses at various locations are reported. The mycotic conditions in these patients were: pityriasis versicolor (26), tinea cruris (14), tinea corporis (8), tinea pedis (6), kerion celsi (6) and monilial granuloma (1). Clinical and mycological cure was obtained in 56 cases (91.8%) over a mean treatment period from a minimum of 29 days (pityriasis versicolor) to a maximum of 39 days (tinea pedis) and 150 days (monilial granuloma), with a mean daily dosage of 200 mg in adults and 100 mg in children. The authors stress the high level of tolerability of the drug and its high therapeutic activity. They indicate the conditions for its use in superficial epidermomycoses and kerion celsi and note its unparalleled effect in chronic mucocutaneous candidosis.     

Fluconazole in the treatment of pediatric tinea capitis caused by Microsporum canis

Fluconazole has been shown to be effective in the treatment of fungal scalp infections in children; however, there is limited experience of its use in Microsporum scalp infections. We studied 11 children with tinea capitis caused by Microsporum canis who received oral fluconazole at a dose of 5-7.5 mg/kg/day for 6 weeks. Mycological cure was observed in two of the 11 patients at week 4 from the start of therapy, in four patients at week 8 and in three patients at week 16. One of the remaining patients had positive mycology at week 8, but was unavailable for further evaluation. Fluconazole was effective in treating pediatric tinea capitis caused by Microsporum canis and was well tolerated. Clinical and mycological response was achieved in some patients weeks after the cessation of the administration of fluconazole.     

A study in industry of clotrimazole cream in Tinea pedis and Tinea cruris

Summary

A double-blind trial was carried out in 30 industrial workers presenting either with Tinea pedis or Tinea cruris. Patients were treated at random with either 1 % clotrimazole or 1% tolnaftate creams, applied twice daily, for up to 4 weeks. Patients were assessed clinically and skin scrapings were taken for mycological examination. The results showed that Tinea cruris responded better to treatment with both agents than did Tinea pedis. Clotrimazole appeared to act faster than tolnaftate since many patients were clinically clear at 2 weeks.     

Superficial fungal infections of the skin. Diagnosis and current treatment recommendations.

Superficial fungal infections are common. Most diagnoses of fungal infections of the skin can be made by physical examination, assisted by the use of a Wood's lamp, skin scrapings for microscopic examination, and fungal cultures. Dermatophyte infections are common at all ages, in both sexes, and they have a worldwide distribution. These infections include tinea capitis, tinea cruris, tinea pedis, tinea corporis, tinea manuum and tinea barbae. Tinea versicolor, caused by Malassezia furfur, and candidal infections are also common. Treatment modalities include oral and topical agents. Good personal hygiene is an important adjunct to antifungal therapy. Decisions regarding the appropriateness of therapy in a given patient must take into account the extent and location of the infection, the benefits and risks of each of the treatments, and cost. Oral therapies include griseofulvin, ketoconazole, and itraconazole. There are a large variety of topical treatments, including nystatin, selenium sulfide, tolnaftate, haloprogin, miconazole, clotrimazole, and sodium thiosulfate. Important to successful treatment is compliance with what is sometimes a long course of treatment, and good personal hygiene.