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 mimicking dissecting cellulitis in three children

Tinea capitis mimicking dissecting cellulitis is a rare presentation, and there is a paucity of information regarding this presentation in the literature. Three children 10‐14 years of age who presented with an unusual clinical manifestation of tinea capitis that clinically resembled dissecting cellulitis are reported. The patients were treated with systemic antifungals for 3‐4 months. Treatment success was measured according to repeat fungal cultures and clinical assessment of hair regrowth at follow‐up visits. All three patients had resolution of infection, with negative repeat fungal cultures and complete hair regrowth without scarring. These cases highlight a rare inflammatory subtype of tinea capitis that can be easily misdiagnosed and therefore improperly treated, prolonging the duration of infection.     

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 dermoscopic comma,zigzag, and bar code-like hairs: Markers of fungal infection of the hair follicles

Comma hair has been described as a specific dermoscopic feature of tinea capitis, however, it is not always present. Recognition of the additional dermoscopic features is therefore important. Furthermore, comma hair has never been shown to be applicable in fungal infection of the hair follicles on other parts of the body such as the eyebrows, axillary, or pubic areas. We encountered 13 Taiwanese patients who had been diagnosed with tinea capitis and evaluated their dermoscopic features using a nonpolarized, contact-type dermoscopic instrument with alcohol as the interface medium. Herein, we describe a woman with fungal infection of the eyebrow and present the under-recognized zigzag hair and bar code-like hairs for the first time.     

Influence of hair oil on scalp fungal cultures

It has been clinically speculated that the use of oil for hair grooming may change detection of fungus on culture; however, the effect of hair oil on fungal cultures remains poorly studied. In this prospective case-controlled study, scalp cultures were collected from twenty-eight pediatric patients with clinically suspected tinea capitis before and after cosmetic hair oil was rubbed into the scalp. Following hair oil application, fifteen of the sixteen originally positive patients tested positive, while one patient that had tested negative prior to hair oil had a positive culture. Our study suggests that recent hair oil application has minimal effect on the sensitivity of fungal culture for tinea capitis and we can rely on our standard fungal cultures with or without hair oil.     

3例头癣患者毛发和头皮的皮肤镜观察

我们对3例头癣患儿的毛发及头皮进行了皮肤镜观察,并与15例斑秃、15例盘状红斑狼疮以及15名正常对照者进行比较。结果发现逗号发和螺旋状发在头癣患儿具有特异性。逗号发和螺旋状发在抗真菌治疗后3周消失,早于查菌结果转阴。     

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.     

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。     

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...     

Single typical trichoscopic feature predictive of tinea capitis

This study which was carried out in four university hospitals in France was designed to assess the usefulness of the technique, trichoscopy, in the diagnosis of tinea capitis, also known as scalp ringworm. Tinea capitis is an infection of the scalp hair and the surrounding skin with a fungus. Fungi are microscopic organisms that can live on the hair, nails, and outer skin layer. It is common in children and the main treatment is a course of antifungal drugs taken by mouth. Currently tinea capitis is diagnosed by culture (taking samples and growing the fungi in a lab) or genetic analysis of the hair. Trichoscopy is a form of microscopic examination using a hand-held magnifier called a dermatoscope, which allows someone trained in its use to see minute differences in the growth and shape of hairs. The study was carried out by dermatology trainees with an expert assessor who also examined the patients. The results found that trichoscopy showed a number of visible changes in infected hairs, each named for a specific identifiable feature e.g. corkscrew hairs or morse code hairs. The presence of just one of these changes was found to be an accurate predictor of infection, which was subsequently confirmed by the laboratory. These results suggest that this simple observational technique can be used to diagnose tinea capitis with accuracy. Furthermore, some of the visible changes are specific to particular fungi. This helps the dermatologist in selecting the correct treatment with antifungal medicines, which is different for different organisms.     

Dermoscopy findings in tinea capitis: case report and literature review

Dermoscopy is a method of increasing importance in the diagnoses of cutaneous diseases. On the scalp, dermoscopic aspects have been described in psoriasis, lichen planus, seborrheic dermatitis and discoid lupus. We describe the "comma" and "corkscrew hair" dermoscopic aspects found in a child of skin type 4, with tinea capitis.     

Tinea capitis: current concepts in clinical practice

Tinea capitis is a common infection, particularly among young children in urban regions. The infection often is seen in a form with mild scaling and little hair loss, a result of the prominence of Trichophyton tonsurans (the most frequent cause of tinea capitis in the United States). T. tonsurans does not fluoresce under Wood light, unlike the common tinea capitis-causing fungal organisms seen in Europe and many other countries, which emit a green fluorescence. However, T. tonsurans, like other fungi, also may less often produce an intense inflammatory reaction, which is suggestive of an acute bacterial infection.     

A retrospective study of the management of pediatric kerion in Trichophyton tonsurans infection

Kerion celsi is the inflammatory extreme of tinea capitis, representing a delayed hypersensitivity reaction to the causative dermatophyte. Some authors have advocated the use of oral corticosteroids in patients with kerion formation to inhibit the host inflammatory response and minimize the risk of scarring. This retrospective study analyzed the management and outcome of all children younger than 10 years old presenting to our pediatric dermatology service with tinea capitis resulting in kerion formation between 2003 and 2009. We propose that kerion treatment be directed toward the underlying dermatophyte. Oral and intralesional corticosteroids are an unnecessary adjunct to oral antifungal therapy for children with tinea capitis presenting with kerion in urban areas.     

Scalp ringworm in south-east London and an analysis of a cohort of patients from a paediatric dermatology department

BACKGROUND: Scalp ringworm or tinea capitis has become an increasingly important public health issue in the past decade in Great Britain. Recently, certain dermatology departments in London have seen a large increase in tinea capitis in all its forms. OBJECTIVES: The aim of this paper is to present the detailed analysis of a cohort of 277 patients with tinea capitis seen during a 2-year period together with the latest local figures of tinea capitis cases from an inner city paediatric dermatology service. Methods Demographic, clinical and laboratory data were collected prospectively over 2 years from all cases of ringworm in patients seen in a paediatric clinic specially set up for scalp problems. RESULTS: Sixty-two per cent of 277 cases of scalp ringworm were caused by Trichophyton tonsurans, occurring mainly (91%) in patients with Afro-Caribbean hair type, more often in boys (68%), and in the 3-8 year olds (70%). Only 7% of the patients had received appropriate treatment with oral griseofulvin. An additional 156 cases from the general paediatric dermatology clinic showed 91%T. tonsurans infections. CONCLUSIONS: The prevalence of scalp ringworm appears to be reaching epidemic proportions in certain areas that include south-east London. The clinical problem is not yet well recognized by local general practitioners.     

Versorgung von Hauterkrankungen

Treating eczema with fungal and/or bacterial superinfections or superficial mycoses are a common problem in daily practice. A fungal superinfection as a consequence of a diminished skin barrier might complicate the course of eczema. In addition, in an inflammatory superficial mycotic infection a delayed-type hypersensitivity reaction may result in healing of the lesion, but might also be responsible for irreversible damage of epidermal structures. An example is permanent hair loss by scarring alopecia in the context of inflammatory tinea capitis. In both cases, combination of an antifungal and a glucocorticoid is appropriate in therapy, preferentially in topical application. The use of azole antimycotics is especially helpful, as they are also effective against gram-positive bacteria.     

Trichophyton rubrum tinea capitis in an 85-year-old woman

BACKGROUND: Tinea capitis is a worldwide problem and occurs most commonly in young children. Certain common fungal types are most often recognized as the responsible infecting organism. OBJECTIVE: This article presents the case of an elderly woman with tinea capitis caused by a fungal organism that rarely infects hair. A review of the world literature provides evidence of only a few other similar cases. CONCLUSIONS: Trichophyton rubrum causing tinea capitis in adults is a rare but now increasingly recognized entity. This possibility should be kept in mind when caring for adults with nonhealing scalp conditions.     

Tinea capitis in the form of concentric rings in an HIV positive adult on antiretroviral treatment

Dermatophyte infection may present in the form of concentric rings caused by Trichophyton concentricum, known as Tinea Imbricata. In immunosuppressed patients, there are reports of lesions in the form of concentric rings caused by dermatophytes other than Trichophyton concentricum too, mostly by Trichophyton tonsurans, known as Tinea indesiciva or Tinea pseudoimbricata. We report a case of tinea capitis in a HIV-positive adult woman on antiretroviral therapy, who presented with concentric rings of papules and pustules with slight scaling on the scalp along with diffuse thinning of hair. Both Potassium hydroxide mount and culture showed the presence of Dermatophytes. Tinea capitis is considered rare in adults, but new cases are being reported in immunocompromised as well as in immunocompetent patients. The pertinent features of this case are: HIV-positive adult female on antiretroviral therapy, presenting with tinea capitis in the form of concentric rings; culture from the lesion grew Microsporum audouinii; responding to oral Terbinafine.     

Kerion — a case report

We describe a 6-year-old girl with severe tinea capitis, who required several months of systemic treatment with griseofulvin, before her condition started to improve with eventual partial hair regrowrh. Kerion refers to the severe inflammatory reaction that occurs in some cases of fungal infection of the hair or hair follicles. The word is derived from the Greek, meaning honeycomb. There is usually a painful, inflamed area studded with pustules, which eventually forms nodules and sinuses. The condition is self-limiting, but even with treatment permanent scarring may ensue.     

Clinical diagnosis of common scalp disorders

Scalp skin is unique on the body due to the density of hair follicles and high rate of sebum production. These features make it susceptible to superficial mycotic conditions (dandruff, seborrheic dermatitis, and tinea capitis), parasitic infestation (pediculosis capitis), and inflammatory conditions (psoriasis). Because these scalp conditions share similar clinical manifestations of scaling, inflammation, hair loss, and pruritus, differential diagnosis is critically important. Diagnostic techniques and effective treatment strategies for each of the above conditions will be discussed.     

Successful treatment of tinea capitis with 2% ketoconazole shampoo

BACKGROUND: Oral antifungal drugs are required for effective treatment of tinea capitis. Topical antifungal shampoo's, namely ketoconazole 2% shampoo or products with selenium sulfide or salicylic acid are recommended as adjunctive therapy. Topical antifungal monotherapy has not been successful in the treated of tinea capitis. The purpose of this open study was to evaluate ketoconazole 2% shampoo as a monotherapy for the treatment of tinea capitis. METHOD: A total of 16 black children, aged 3-6, all with proven tinea capitis caused by Trichophyton tonsurans, were treated daily for 8 weeks with 2% ketoconazole shampoo for a total of 56 treatments. Clinical and mycologic examinations were performed every 2 weeks and again at 4 weeks following treatment. The number of colonies were counted on each plate after each visit. Patients with positive cultures after 8 weeks were placed on oral griseofulvin; those with negative cultures were followed monthly by culture for an additional 12 months. RESULTS: Marked clinical improvement occurred in all patients within 2 weeks and absence of pruritus was noted by the patients as early as 2-6 days. After 8 weeks of shampoo, 14 of the 15 (93%) children were clinically healed. Mycologically, the cultures dropped from a confluent growth of T. tonsurans to less than 100 colonies within 2 weeks; fewer than 50 at week 4 and 20 colonies or fewer after week 6. At 8 weeks of treatment the number of colonies remained at 20 or fewer. Six of the 15 children (40%) had negative cultures after 2, 4, and 6 weeks. One child relapsed at the first 4-week follow-up visit. Five of 15 (33%) of the children remained culturally negative for 12 months post-treatment. CONCLUSIONS: Ketoconazole 2% shampoo alone reduces the number of viable arthroconidia in children with tinea capitis thus reducing the transmissibility and contagious nature of the disease. Unexpectedly, complete cure was obtained in 5/15 (33%) of the children. The children remained clinically and mycologically clear as long as one year after treatment.