Tinea capitis: dermoscopy and calcium fluorescent microscopy as highly efficient and precise diagnostic tools

Tinea capitis comprising of tinea favosa and kerion is mostly seen in school-aged children. Some tinea capitis often presented with insignificant findings under the naked eyes are easily overlooked. The authors describe an unusual case of tinea capitis caused by Trichophyton violaceum. The patient was an 8-year-old girl, with a history of pruritus on the scalp for more than one year. A diagnosis of tinea capitis was confirmed by clinical examination aided by dermoscopy, calcium fluorescent microscopy and culture. Comma and corkscrew hairs are two specific dermoscopic patterns of tinea capitis. The patient was treated with systemic itraconazole, topical application with 1% naftifine 0.25% ketoconazole cream followed after daily hair wash with 2% ketoconazole shampoo for 8 weeks.     

Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil

BACKGROUND: Pediculosis capitis and scabies are common parasitic skin diseases, especially in resource-poor communities, but data on epidemiology and morbidity are scanty. OBJECTIVES: To assess the prevalence, seasonal variation and morbidity of pediculosis capitis and scabies in poor neighbourhoods in north-east Brazil. METHODS: The study comprised cross-sectional surveys of a representative population of an urban slum (n = 1460) in Fortaleza, the capital of Ceará State (Brazil) and a fishing community 60 km south of the city (n = 605). Study participants were examined for the presence of scabies and pediculosis capitis. In a longitudinal study in the slum, variation of prevalence in different seasons of the year was assessed. RESULTS: Prevalence of pediculosis capitis was 43.4% in the slum and 28.1% in the fishing community. Children aged 10-14 years and females were most frequently affected. Scabies was present in 8.8% of the population in the slum and in 3.8% of the population in the fishing community. There was no consistent pattern of age distribution. Superinfection was common in patients with scabies, and cervical lymphadenopathy in patients with pediculosis capitis. Multivariate analysis showed that age < or = 15 years, being of female sex and living in the urban slum were independent factors contributing to the simultaneous coinfestation with pediculosis capitis and scabies. The longitudinal data from the urban slum showed a characteristic seasonal variation of pediculosis capitis, but no fluctuation of scabies. CONCLUSIONS: Pediculosis capitis and scabies are hyperendemic in the study areas and are associated with considerable morbidity. There is an urgent need to develop control measures for these parasitic skin diseases in resource-poor communities. This is the first community-based study describing in detail the epidemiology and morbidity of scabies and head lice infestation in Brazil.     

采乐治疗头皮糠疹200例疗效观察

目的:探讨采乐洗剂治疗头皮糠疹的疗效。方法:对头皮糠疹200例应用采乐洗剂洗头,每周2次～3次,连用4w。结果:2w治愈率为45%,3w治愈率为51%,4w治愈率为60%。结论:本组观察显示采乐洗剂治疗头皮糠疹疗效高,具有副作用小、安全性高、病人依从性好等优点。     

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.     

Tinea Capitis in Adults

Tinea capitis is regarded as rare in healthy adults. A study of 46 adults presenting with scalp problems with no other identifiable cause and 26 asymptomatic adult contacts of children with tinea capitis was undertaken. The confirmation of tinea capitis in 9 of 46 patients and 5 carriers among 26 adult contacts suggests that tinea capitis may affect healthy adults more often than was supposed. Further epidemiologic studies may be of interest.     

Tinea capitis due to Trichophyton rubrum in a neonate

Tinea capitis is a common infection of school-aged children, but there have been only a few reports of tinea capitis in newborns. Furthermore, Trichophyton rubrum as a causative organism of tinea capitis is documented very rarely. We report herein a neonate in whom T. rubrum was the causative agent. This boy was successfully treated with three pulses of oral itraconazole solution.     

An open study of tinea capitis in 50 children treated with a 2-week course of oral terbinafine.

BACKGROUND: Terbinafine is used in the treatment of dermatophyte infections. There have been several studies suggesting a good response to terbinafine in treating tinea capitis, specifically with dermatophytes of the Trichophyton species. METHODS: We enrolled 50 consecutive children with a clinical diagnosis of tinea capitis into an open study using terbinafine for 2 weeks. RESULTS: Clinical and mycologic cure occurred in more than 86% of patients with no side effects and good compliance. CONCLUSION: In this study terbinafine was a safe and effective treatment of tinea capitis in children, particularly when caused by the Trichophyton species.     

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.     

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.     

Microsporum canis tinea capitis in an 8-month-old infant successfully treated with 2 weekly pulses of oral itraconazole

We report an 8-month-old girl with tinea capitis caused by Microsporum canis which was successfully treated with two pulses of oral itraconazole 50 mg/day, each of 1 week duration with an interval of 2 weeks. M. canis tinea capitis can be a difficult therapeutic problem in an infant, as the treatment is usually long, lasting up to 4-6 weeks with griseofulvin and 6-12 weeks with terbinafine, and the desire to provide a safe systemic therapy is particularly important. With an intermittent regimen the duration of treatment with active drug can be much shorter compared to continuous therapy. We found that itraconazole pulse therapy for M. canis tinea capitis was a safe and effective treatment in an infant.     

犬小孢子菌毛发穿孔试验及扫描电镜观察

目的　光镜和电镜下观察犬小孢子菌对毛发破坏的程度 ,比较犬小孢子菌头癣株和体癣株对不同年龄组毛发感染时间的差异。方法　临床采集不同年龄组的健康人毛发 ,分别进行头癣株和体癣株的毛发穿孔试验及扫描电镜观察。结果　犬小孢子菌头癣株和体癣株均可致毛发破坏 ;在各个年龄组中 ,头癣株导致毛发感染的时间明显短于体癣株 (P <0 .0 1) ;无论是头癣株还是体癣株 ,感染毛发的感染时间均随着年龄的增长而延长 (P <0 .0 1)。结论　犬小孢子菌头癣株较体癣株对毛发的破坏早且严重 ;年龄越小 ,毛发越易受破坏。     

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.     

广州地区241例头癣及病原菌分布情况分析

目的 了解广州地区头癣及其病原菌分布情况。方法 对1997年2月至2010年8月在本院皮肤科诊治的241例头癣患者资料进行回顾性分析。结果 241例头癣患者中白癣179例占74.27%,脓癣34例占14.11%,黑点癣28例占11.62%,未发现黄癣。病原菌中犬小孢子菌182株占80.89%,紫色毛癣菌25株占11.11%,须毛癣菌10株占4.44%,断发毛癣菌3株占1.33%,红色毛癣菌2株占0.89%,石膏样小孢子菌2株占0.89%,疣状毛癣菌1株占0.44%。患者年龄段分层分析结果显示,主要感染人群为学龄前儿童占39.00%。结论 广州地区头癣中白癣所占比例最高;犬小孢子菌为头癣患者的主要致病菌;主要感染人群为学龄前儿童。     

Administration of Oral Itraconazole Capsule with Whole Milk Shows Enhanced Efficacy As Supported by Scanning Electron Microscopy in a Child with Tinea Capitis Due to Microsporum canis

Although diagnosis and treatment of tinea capitis in children are not difficult, treatment failures are still somewhat common. We report a case of pediatric tinea capitis cured using oral itraconazole administered with whole milk, after prior treatment failure when oral itraconazole was administered with water. This apparent enhanced efficacy in one individual was demonstrated using scanning electron microscopy.     

Itraconazole oral solution for the treatment of tinea capitis

Twenty-seven children (12 boys, 15 girls, age range 3–11 years, weight range 10–40 kg) were treated with itraconazole oral solution 10 mg/mL given as pulse therapy for tinea capitis. The dosage regimen was 3 mg/kg per day given once daily in a fasting state with each pulse lasting 1 week. The first two pulses were separated by a 2-week off-drug period, and the second and third pulses had a 3-week period without drug between them. For each patient a second and third pulse were administered if there was clinical evidence of tinea capitis at the time-point when the next pulse was due. The overall severity of tinea capitis at pretherapy was classified as mild, moderate or severe with the aetiology being: Trichophyton tonsurans , 24 patients; T. violaceum , two patients and Microsporum canis , one patient. In 19 evaluable patients, 12 weeks after starting therapy, the numbers of pulses of itraconazole oral solution required to produce complete cure were, according to the severity of disease, mild tinea capitis (one pulse: four patients; two pulses: five), moderate disease (one pulse: two patients; two pulses: two; three pulses: two), and severe disease (three pulses: three patients). One patient with moderate severity tinea capitis was clinically clear after three pulses of therapy but mycological examination was positive. Seven patients were lost to follow-up and one discontinued therapy because of nausea. Itraconazole oral solution 3 mg/kg per day was generally well tolerated. Three children developed gastrointestinal adverse effects which were considered to be minor or 'nuisance' effects. The data from this preliminary report need to be confirmed in a larger group of patients. It remains to be seen whether itraconazole oral solution will become a practical alternative to the antifungal agents available in a liquid preparation for the treatment of tinea capitis.     

Analysis of Adult Patients with Tinea Capitis in Southeastern Korea

BackgroundTinea capitis is a cutaneous infection of dermatophytes and predominant in children. Although tinea capitis in Korea is controlled by oral antifungal medications and concerted public health initiatives, it''s still a health issue.ObjectiveTo investigate changes in the epidemiological and mycological characteristics of adult patients with tinea capitis in southeastern Korea.MethodsUsing medical records from Kyungpook National University Hospital and Catholic Skin Clinic from 1989 to 2018, we retrospectively investigated the epidemiological and mycological characteristics of 266 adult patients (aged over 20) with tinea capitis.Results Among total 266 patients, 239 were KOH-positive. The annual incidence of tinea capitis ranged from 3 to 18 between 1989 and 2018. Of the total, 54 (20.30%) were male and 212 (79.70%) were female. Eighty patients (30.08%) were in their seventies, the most commonly affected age group. Of the remaining, 58 (21.80%) were in their sixties, and 41 (15.41%) in eighties. Among all, 77 (28.95%) visited the hospital in summer, 72 (27.07%) in spring, 64 (24.06%) in winter, and 53 (19.92%) in fall. Dermatophytes were cultured from 171 patients. Microsporum canis was the most common dermatophyte (42.48%), while Trichophyton rubrum was the second (15.79%). Of the 266 patients, 186 (69.92%) lived in urban areas and 80 (30.08%) in rural areas.ConclusionThe epidemiological and mycological characteristics of adult patients with tinea capitis were different from those of children in terms of annual incidence, sex distribution, and isolated dermatophytes. These results provide useful information for the treatment and prevention of tinea capitis.     

Treatment of pediculosis capitis with topical albendazole

Pediculosis capitis, or head lice infestation, caused by Pediculus humanus capitis, is a common and ubiquitous health concern. Increasing resistance and treatment failures are reported with available topical pediculicides and may prove challenging to manage. Recent data indicate that the oral anti-helmintic agents thiabendazole and albendazole could represent new therapeutic options against pediculosis capitis. We report a novel treatment modality in four patients with head lice who were successfully treated with a topical application of albendazole.     

Spatial and kinetic factors for the transfer of head lice (Pediculus capitis) between hairs

Although the global increase in pediculosis is well known, little is known about the exact nature of head lice (Pediculus capitis) transmission. Several mechanisms have been proposed such as head-to-head and fomite transmission, but some contention remains concerning the primary transmission route. This study investigated spatial and kinetic factors influencing the dynamics of hair-to-hair transfer to clarify further how head lice transmit from head to head. Forty-eight factorial experimental trials, with 10 replicates each, were conducted using 480 freshly caught P. capitis from primary school children. In the trials, each louse was placed on a stationary suspended hair or a mobile hair and was presented with mobile or stationary hairs for transmission. All hair passes involved contact between the uninhabited hair and the lice. Hairs without a louse were presented dorsally, laterally, and ventrally to the louse. They were also passed from head to tail or from tail to head and were moved at speeds of 8 m and 4 m per min. The proportion of P. capitis transmission was highly dependent on the specific setting. The tail-to-head direction, slow movement, and a parallel direction all proved favorable for transmission. The highest transfer proportion of P. capitis (85%) was observed in the setting where the presented hair was laterally slow moving in a parallel way from tail to head. No transmission at all was observed under an angle of 90 degrees. Hair-to-hair P. capitis transmission occurred more frequently when hairs were in particular physical and kinetic relationships. This suggests that head lice are less likely to take advantage of many proposed fomite transmission scenarios and are most likely to rely on head-to-head contact for transmission.     

Itraconazole oral solution for the treatment of tinea capitis using the pulse regimen.

A 7-year-old boy with Trichophyton tonsurans tinea capitis was cured following the administration of itraconazole oral solution. He had difficulty swallowing tablets or capsules, so the availability of the oral solution was particularly advantageous. The itraconazole was given once daily in a fasting state at a dosage of 3 mg/kg/day as a pulse lasting 1 week. The first two pulses were separated by 2 weeks and the second and third pulse by 3 weeks. The decision whether or not to administer the third pulse was guided by the presence of clinical symptoms and signs of tinea capitis just prior to the scheduled administration. The availability of the oral solution will enable more young children to be considered for treatment of tinea capitis with itraconazole than was possible when only tablets or capsules were available.     

An experience from an outbreak of tinea capitis gladiatorum due to Trichophyton tonsurans

'Tinea corporis gladiatorum' describes a dermatophytosis transmitted mainly from close skin contact among wrestlers. Although tinea corporis is well recognized, no data are available for tinea capitis infections in wrestlers. After finding tinea capitis infection in a student wrestler, we aimed to search for possible ringworm infections among wrestlers in a wrestling boarding-school. Of the 32 wrestlers, 29, aged 12-18 years, were affected, of whom 22 had scalp involvement. Trichophyton tonsurans was isolated from 20 of the patients, and T. mentagrophytes from the remaining two. Isolated strains of dermatophytes were susceptible to terbinafine and itraconazole. The patients with tinea capitis received oral terbinafine for 4 weeks, and patients with more than two lesions but without scalp involvement received oral terbinafine for 2 weeks. Overall clinical and mycological cure rate was 72.4% and 70%, respectively, at assessment at week 6. The asymptomatic dermatophyte carrier rate was negative 1 year after control of the epidemic. Terbinafine seems to be an alternative drug for the treatment of tinea capitis caused by T. tonsurans; however, control of an outbreak may be very difficult and effective preventive measures should be considered.