Guidelines for the management of tinea capitis. British Association of Dermatologists

These guidelines for the management of tinea capitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.     

不同方案国产特比萘芬治疗头癣随机双盲比较研究

目的：评价国产特比萘芬治疗头癣的疗效及安全性,探索最佳给药方案。方法：头癣患者随机分成三组,Ａ组连服２周,Ｂ组连服４周,Ｃ组连服１周后间隔２周再连服１周,４周治疗中不口服特比萘芬时给安慰剂,按体重给药,于第８周末评价疗效及安全性。结果：７６例可评价患者分离的病原菌主要包括犬小孢子菌４８株（６２．３％）、须癣毛癣菌２４株（３１．２％）。于８周末评价时,治愈率分别为６４％、８８．９％和８３．３％。只见轻微副作用。结论：口服国产特比萘芬治疗头癣疗效高、安全性好、患者耐受性好,连服药１周间隔２周再连续服药１周,为我们的推荐方案。     

伊曲康唑4周疗法治疗儿童头癣128例临床疗效观察

目的：了解伊曲康唑治疗儿童头癣的疗效与安全性。方法：采用伊曲康唑治疗128例头癣患儿，4岁以上的剂量为100mg／d，4岁以下剂量为50mg／d，晚餐后服用，连续服用4周。结果：128例患儿在疗程结束后4周的痊愈率为80．47％。所有患儿服药期间均未出现不良反应。结论：伊曲康唑4周疗法治疗儿童头癣疗效确切，安全性好。     

特比萘芬超声透入治疗头癣的临床研究

目的 :　评价特比萘芬超声透入治疗头癣的疗效和安全性 ,探索头癣治疗新方法。方法 :　按标准选取头癣患者 4 5例。皮损处及其周围 1cm范围剃发 ,用 1%特比萘芬霜均匀涂抹 ,用超声治疗仪透入治疗 ,超声频率 80 0kHz,声强 0 .75W cm2 ,移动法 ,15分钟 ,每周两次 ,共 4周。于 0、2、4、8周末进行临床评分和真菌学检查 ,于 8周末评价疗效和安全性、并与我们 1999年做的口服特比萘芬 4周治疗头癣的试验结果进行比较。结果 :　 36例患者按要求完成试验 ,病原菌包括犬小孢子菌 2 9株 (80 .6 % ) ,须癣毛癣菌 7株 (19.4 % )。 4周末超声组与口服组治愈率分别为 33.3%和 5 1.9% ,χ2 =2 .18,P >0 .0 5 ;8周末超声组与口服组治愈率分别为 6 3.9%和 88.9% ,χ2 =5 .0 8,P <0 .0 5。超声透入治疗未见副作用发生 ,而口服组 2例发生轻度副作用。结论 :　特比萘芬超声透入疗法治疗头癣有较好的疗效和很好的安全性 ,但比口服特比萘芬的疗效稍差 ,超声透入疗法的最适条件、疗程和操作方法尚需进一步研究     

上海地区600例头癣病原菌分析

目的：了解近10年间上海地区头癣的发病情况及病原菌的分布情况。方法：采用回顾性分析方法对1993年1月-2002年12月在华山医院皮肤科门诊诊治的居住在上海的头癣患者进行分析。结果：600例头癣患者男268例，女332例；年龄20d～84岁；498例真菌培养阳性患者中，白癣325例(65．26％)、黑癣132例(26．5l％)、脓癣40例(8．03％、)、黄癣1例(0．20％)。主要病原菌为羊毛状小孢子菌，322株(64．66％)、紫色毛癣菌89株(17．87％)、断发毛癣菌45株(9．04％)。结论：上海地区头癣中白癣发病率占首位，羊毛状小孢子菌为主要致病菌。     

188例头癣病原菌分析

目的:分析188例头癣患者病原菌菌种的分布。方法:回顾性分析2013年1月至2016年7月188例头癣患者的临床及真菌学资料。结果:188例头癣患者中,男133例,女55例,年龄1个月~81岁,7岁以下患者120例(63.8%)。共分离出菌株117株,其中须癣毛癣菌47株(40.2%),犬小孢子菌43株(36.8%),石膏小孢子菌14株(11.9%),红色毛癣菌复合体11株(9.4%),紫色毛癣菌1株(0.85%),苏丹毛癣菌1株(0.85%)。结论:188例头癣主要致病菌为须癣毛癣菌和犬小孢子菌,主要感染人群为学龄前儿童。     

Humoral immunity in patients with tinea versicolor

Thirty patients with tinea versicolor (TV) and 30 age/sex-matched healthy individuals were used to evaluate the anti-Pityrosporum orbiculare antibodies (anti-PO) using indirect immunofluorescence. Both serum IgG and IgM type anti-P. orbiculare existed in both patients and controls. The antibody titers were significantly higher in patients, especially in those with erythematous lesions. Further analysis was performed and discussed in 120 controls at various ages. This investigation supports again that P. orbiculare, either as a pathogen or as a saprophyte, has enough antigenicity to produce specific humoral response in humans. The anti-P. orbiculare antibodies may perhaps help explain the nonexistence of dermal invasion of this organism in the immunity-intact host.     

196例儿童头癣病原菌分析

目的了解湖北仙桃地区近16年来儿童头癣的发病及病原菌分布状况。方法对拟诊为头癣的患儿、取病发及鳞屑作真菌直接镜检及真菌培养。结果共分离出病原菌13种,致病菌株196株,主要病原菌为堇色毛癣菌、石膏样毛癣菌、红色毛癣菌、羊毛状小孢子菌、断发毛癣菌等。病原菌主要分布于5-12岁。     

Intermittent short duration therapy with fluconazole is effective for tinea capitis

We have demonstrated in an open multicentre investigation that oral fluconazole 6 mg/kg daily for 2 weeks, followed, if clinically indicated four weeks from the start of therapy, by an extra week of treatment at the same dosage, may be effective and safe in the treatment of tinea capitis. Of a total of 48 patients, there were 42 evaluable children < 18 years old (19 boys, 23 girls; mean age 6.2 years, range 1.5-16). The causative organisms were Trichophyton tonsurans (38 subjects) and T. violaceum (four). In the 42 evaluable patients, a 2-week course of fluconazole was administered in 21, with the remainder requiring 1 additional week of therapy. At follow-up 12 weeks from the start of therapy, mycological and clinical cure was recorded in 37 of the 42 evaluable patients (88.1%, 95% confidence interval 83.1-93.1%). The treatment was well tolerated, with no clinical adverse effects. This regimen appears to be effective and safe, and is associated with high compliance. The preliminary results of the investigation need to be evaluated in a larger sample of patients, and in tinea capitis caused by zoophilic species.     

Optimizing the therapeutic approach in tinea capitis of childhood with itraconazole

BACKGROUND: Tinea capitis is the most common dermatophytosis of childhood with increasing incidence. Whereas griseofulvin is considered by many as the mainstay of treatment, newer oral antifungal agents, including fluconazole, itraconazole and terbinafine have demonstrated higher efficacy, resulting in shorter treatment durations. OBJECTIVES: We aimed to determine the optimum regimen for the treatment of childhood tinea capitis with itraconazole. METHODS: A mycological culture outcome-dependent combination of a 28-day continuous and facultative additional 14-day courses with itraconazole was used in 42 children (20 girls; 22 boys) aged 12-140 months (mean 66) with tinea capitis due to Microsporum canis (n = 26) and Trichophyton violaceum (n = 16). The drug was given orally according to the patients' body weight (50 mg daily for < 20 kg; 100 mg daily for > or = 20 kg) over 4 weeks. Direct microscopy and fungal culture as a parameter for efficacy were repeated 2 weeks after termination of treatment. Assessment of efficacy was based on the evaluation of results from light microscopy and culture at 8 weeks after initiation of treatment, and in the case of a further positive mycological culture at 14 and 20 weeks, respectively. A positive fungal culture at these times resulted in an additional course for 2 weeks with the initially chosen itraconazole dosage. RESULTS: In 34 of 42 patients a single 4-week course of itraconazole resulted in a complete mycological cure of lesions as demonstrated by light microscopy and mycological culture. Four of 42 patients had to be treated by a second itraconazole course for 2 weeks, and four children received a third course of itraconazole for 2 weeks until all lesions showed negative direct microscopy and mycological culture. No abnormal haematological or biochemical results occurred. Apart from transient, completely reversible indigestion in two children, no side-effects were observed. CONCLUSIONS: A culture-based 28-day continuous therapeutic regimen plus facultative cultural outcome-dependent additional 14-day courses of a body weight-adapted dosage of itraconazole in tinea capitis due to M. canis and T. violaceum is discussed; this offers the advantage of an effective therapy with complete negative direct microscopy as well as negative cultural results, within a shorter active treatment period (cf. previous studies with continuous administration of itraconazole).     

11例头癣患者皮肤镜特点回顾性分析

目的 探讨皮肤镜下逗号发、螺旋状发、营养不良发头癣特征性表现规律,找出皮肤镜初步鉴别犬小孢子菌和断发毛癣菌方法.方法 选取2019-2021年广西医科大学第一附属医院皮肤科首诊真菌涂片为阳性的11例头癣患者,对其皮肤镜特点进行回顾性分析.结果 在犬小孢子菌感染的白癣患者中逗号发100％,营养不良发80％,无螺旋状发;在...     

伊曲康唑与特比萘芬治疗儿童头癣疗效观察

目的:寻找治疗儿童头癣有效、安全的方法。方法:应用伊曲康唑治疗儿童头癣27例,特比萘芬治疗儿童头癣25例,并作疗效与真菌清除率观察。结果两种药物在用药8周以上的总有效率无明显差异,但伊曲康唑于用药第4周与第6周时疗效存在显著性差异,而特比萘芬在用药第6周与第8周时疗效存在显著性差异。结论:伊曲康唑与特比萘芬对治疗儿童头癣都是有效安全的,但伊曲康唑疗程需达6周,而特比萘芬疗程需达8周;伊曲康唑6周时达到真菌清除;而特比萘芬需达8周。     

兰州地区105例头癣的发病情况及其病原菌种分析

目的:了解兰州地区头癣的发病情况及其病原菌的分布特点。方法:对临床拟诊为头癣的患者进行真菌镜检、培养及分离鉴定。设计统一的调查表,登记镜检阳性患者的相关临床资料,分析头癣的发病特点。结果:105例真菌镜检阳性的头癣患者男72例,女33例,男女之比为2.18:1;白癣92例(87.62%),脓癣13例(12.38%);年龄1~34岁,平均(6.13±2.92)岁;72例有宠物接触史,41例有头癣患者接触史;培养菌株93株(阳性率88.57%),其中犬小孢子菌90株(占培养菌株的96.77%),红色毛癣菌、石膏样小孢子菌、白念珠菌各1株(各占1.08%)。结论:兰州地区头癣的临床类型以白癣为主,脓癣次之;传染方式主要为动物到人、人到人;致病菌以亲动物性的犬小孢子菌为主。     

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.     

A 30‐year survey of paediatric tinea capitis in southern Spain

Background Tinea capitis (TC) is the most common mycological infection in childhood. The epidemiology of TC varies depending on the geographical area and the time of study, and although it is an important public health problem in our area, only a few long‐term studies have focused on children. Objectives The aim of this study was to analyse the main epidemiological, clinical and microbiological features of TC in children over 30 years and compare these features with those of other tineas. Methods We undertook a retrospective study of 818 tineas in children at a referral hospital in southern Spain diagnosed between 1977 and 2006, concentrating on TC. Results Of the 444 TC diagnosed, 61.5% were in boys. Most children (66.9%) were aged 4–9 years. Twelve patients were immigrants. Inflammatory clinical forms were present in 18.2% of cases. At the time of diagnosis, 10.4% of the cases had been treated with antifungal agents. The most frequently isolated dermatophyte was Microsporum canis (63.5%). Conclusions We report the largest study of TC in Spain. Our results were very similar to those in other national studies, noting a predominance of non‐inflammatory cases of TC caused by zoophilic dermatophytes. Although the species of the causal dermatophytes have not varied substantially in this period, the increasing number of immigrants may lead to a change in the aetiology of TC in the future. The number of cases referred to the dermatology department who have already been treated shows a lack of communication between primary care and dermatology.     

海南地区35例头癣临床和病原菌分析

目的: 了解我院确诊头癣的临床特征和病原菌。方法: 对我院门诊2014年6月到2017年5月收治的头癣病例进行回顾性分析。结果: 共有35例头癣患者,其中脓癣25例 (71.4%),白癣和黑点癣各5例(14.3%)。28例患者真菌培养阳性,其中须癣毛癣菌复合体10例,断发毛癣菌7例,石膏样小孢子菌4例,犬小孢子菌3例,红色毛癣菌和紫色毛癣菌各2例。结论: 我院确诊的头癣以脓癣为主,多见于0～10岁的儿童,最常见病原菌是须癣毛癣菌复合体。     

五例成年女性头癣临床表现及病原菌分析

成人头癣感染因症状轻微,临床表现不典型,易造成误诊误治,本文回顾性分析5例成人头癣患者的临床表现、病原菌检查及治疗。5例患者均为女性,年龄26～75岁,平均年龄54.4岁,其中4例绝经,1例有使用免疫抑制剂史。3例患者为紫色毛癣菌感染,并有使用同一理发器具史,临床表现为脂溢性皮炎样及脓疱损害,轻微脱发。2例患者为犬小孢子菌感染,表现为局限性脱发、红斑、脓疱等。5例患者均给予伊曲康唑胶囊联合外用硝酸舍他康唑乳膏,3例患者已痊愈,随访半年,未见复发。2例患者用药不规律,治疗效果欠佳,后失访。     

Terbinafine: efficacy and tolerability in young children with tinea capitis due to Microsporum canis

AIMS: We carried out an open, prospective, uncontrolled study to evaluate the efficacy and tolerability of terbinafine in the treatment of young children with tinea capitis due to Microsporum canis. METHODS: A total of 83 healthy, immunocompetent children (age range 2-13 years) were enrolled in eight centres in Estonia, Latvia and Lithuania. Patients received oral terbinafine in dosages based on weight, 62.5 mg for those weighing 10-20 kg, 125 mg for 20-40 kg, plus application of topical 1% terbinafine cream twice daily to affected areas. Treatment lasted for 4 weeks, followed by an 8-week observation (treatment-free) period. All the subjects were assessed for efficacy and tolerability at 12 weeks. RESULTS: Eighty-one subjects were available for assessment at 12 weeks: 32 had completely recovered, with no evidence of relapse during the observation period, and 21 showed mycological cure, but presented residual physical signs of infection. Thus the effective cure rate was 65.4% in an infection known to be more difficult to cure than other causes of tinea capitis. Terbinafine was well tolerated by these children. CONCLUSIONS: This study showed effective cure of two-thirds of 81 cases of tinea capitis caused by M. canis with a 4-week course of treatment. As one-third of the cases did not respond to treatment, we suggest using combined oral and topical treatment with terbinafine in children with tinea capitis caused by M. canis.