Progressão infantil de tinea capitis, kerion celsi e infecção secundária bacteriana cutânea com hemocultura positiva para s. Aureus ­ relato de caso / Infant progression of tinea capitis, kerion celsi and secondary bacterial skin infection with positive blood culture s. Aureus - case report

Introdução: A Tinea Capitis (TC) é uma dermatofitose que tem como evolução grave a forma Kerion Celsi (KC). Clinicamente, é caracterizada por manifestações tonsurantes e inflamatórias; diagnosticada por achados clínicos e laboratoriais, como micológico direto com KOH, tricoscopia e cultura fúngica. É utilizado no tratamento de TC antifúngicos sistêmicos por seis a oito semanas. Nesse caso houve associação de infecção secundária por Staphylococcus aureus, caracterizando um quadro atípico, raro. Objetivo: Relatar o caso, pouco descrito na literatura, de criança com Tinea Capitis (TC) com Kerion Celsi (KC) e bacteremia por contaminação secundária local e sistêmica de Staphylococcus aureus. Relato do caso: Paciente feminino, 5 anos, com manchas hiperemiadas, descamativas e pruriginosas de crescimento centrífugo em face, com surgimento de lesões circulares e pelos tonsurados em couro cabeludo que, após uso de antifúngico oral, houve inflamação aguda e saída de secreção. Apesar do tratamento independente domiciliar, com Betametasona e Cetoconazol creme e Cetoconazol 2% xampu, houve involução da lesão de face e ampliação da área de alopecia. Com a procura médica, iniciou tratamento sistêmico com Griseofulvina, seguido de antibioticoterapia oral por quadro bacteriano secundário em couro cabeludo. Houve linfonodomegalia cervical e intensificação do prurido e secreção. Foi internada para análise clínica e laboratorial, com antibioticoterapia endovenosa de amplo espectro: Ceftriaxona e Clindamicina. Colhida cultura da lesão e hemocultura, definiu-se, em ambas, S. aureus. Devido à resistência bacteriana, ocorreu troca para Cefazolina endovenosa. Na alta, a paciente seguiu com apoio dermatológico semanal e Griseofulvina, havendo a troca do antifúngico por Terbinafina. Conclusão: Quadro atípico e raro com progressão para bacteremia. O alerta para o diagnóstico precoce possibilita tratamento oral adequado e menor impacto da doença na qualidade de vida, evitando-se a contaminação secundária bacteriana

Introduction: Tinea Capitis (TC) is a dermatophytosis that has as severe evolution the form Kerion Celsi (KC). Clinically, it is characterized by tonsuring and inflammatory manifestations; diagnosed by clinical and laboratory findings, such as direct mycological with KOH, trichoscopy and fungal culture. It is used in the treatment of systemic antifungal CT for six to eight weeks. In this case there was an association of secondary infection by Staphylococcus aureus, characterizing an atypical, rare condition. Objective: To report the case, little described in the literature, of a child with Tinea Capitis (TC) with Kerion Celsi (KC) and bacteremia due to local and systemic secondary contamination of Staphylococcus aureus. Case report: Female patient, 5 years old, with hyperaemic, scaling and pruritic spots of centrifugal growth on the face, with the appearance of circular lesions and tonsure on the scalp that, after use of oral antifungal, there was acute inflammation and discharge of secretion. Despite the independent home treatment, with Betamethasone and Ketoconazole cream and Ketoconazole 2% shampoo, there was involution of the face injury and enlargement of the area of alopecia. With medical demand, he started systemic treatment with Griseofulvin, followed by oral antibiotic therapy for secondary bacterial condition in the scalp. There was cervical lymph node enlargement and intensification of pruritus and secretion. She was hospitalized for clinical and laboratory analysis, with broad spectrum intravenous antibiotic therapy: Ceftriaxone and Clindamycin. Culture of the lesion and blood culture, was defined in both S. aureus. Due to bacterial resistance, there was exchange for intravenous Cefazolin. At discharge, the patient followed with weekly dermatological support and Griseofulvin, with the exchange of antifungal by Terbinafine. Conclusion: Atypical and rare condition with progression to bacteremia. Early diagnosis provides adequate oral treatment and less impact of the disease on quality of life, avoiding secondary bacterial contamination

Introducción: La Tinea Capitis (TC) es una dermatofitosis cuya evolución severa es la forma Kerion Celsi (KC). Clínicamente se caracteriza por manifestaciones amigdalizantes e inflamatorias; se diagnostica por hallazgos clínicos y de laboratorio, como micología directa con KOH, tricoscopia y cultivo fúngico. Se utiliza en el tratamiento de la TC antifúngica sistémica durante seis a ocho semanas. En este caso se asoció infección secundaria por Staphylococcus aureus, caracterizando una condición atípica y rara. Objetivo: Reportar el caso, poco descrito en la literatura, de un niño con Tinea Capitis (TC) con Kerion Celsi (KC) y bacteriemia por contaminación secundaria local y sistémica de Staphylococcus aureus. Caso clínico: Paciente femenino, de 5 años de edad, con placas hiperémicas, descamativas y pruriginosas de crecimiento centrífugo en la cara, con aparición de lesiones circulares y pelo tonsurado en el cuero cabelludo que, luego de utilizar un antifúngico oral, presentó inflamación aguda y salida de secreciones. A pesar del tratamiento independiente domiciliario, con crema de Betametasona y Ketoconazol y shampoo de Ketoconazol al 2%, se presentó involución de la lesión facial y agrandamiento del área de alopecia. Con la búsqueda médica se inició tratamiento sistémico con Griseofulvina, seguido de antibioticoterapia oral por una afección bacteriana secundaria en el cuero cabelludo. Había agrandamiento de los ganglios linfáticos cervicales y aumento del prurito y la secreción. Ingresa para análisis clínicos y de laboratorio, con antibioticoterapia endovenosa de amplio espectro: Ceftriaxona y Clindamicina. Tras la recogida de cultivo de la lesión y hemocultivo, se definió S. aureus en ambos. Debido a la resistencia bacteriana, hubo un cambio a cefazolina intravenosa. Al alta, la paciente continuó con soporte dermatológico semanal y Griseofulvina, reemplazándose el antifúngico por Terbinafina. Conclusión: Condición atípica y rara con progresión a bacteriemia. La alerta para el diagnóstico precoz permite un adecuado tratamiento oral y menor impacto de la enfermedad en la calidad de vida, evitando contaminaciones bacterianas secundarias

Retrospective two-centre study on prepubertal children with Tinea capitis in Korea.

Tinea capitis is an infectious dermatological disorder caused by dermatophytes that occur primarily in children. It has recently been brought under effective control in Korea since the introduction of oral antifungal medications and the implementation of concerted public health initiatives. Therefore, its incidence rate has decreased considerably. We investigated changes in the epidemiological and mycological characteristics of tinea capitis patients under the age of 10 in Korea. Using medical records from Kyungpook National University Hospital and the Catholic Skin Disease Clinic from 1989 to 2018, we retrospectively investigated the characteristics of 786 patients with tinea capitis. Of the 786 patients, 744 were KOH-positive. The annual incidence of tinea capitis was decreased from 120 to less than 10 between 1989 and 2018. Overall, 446 (56.74%) were male and 340 (43.26%) were female, representing a ratio of 1:0.8. In terms of the seasonality of it, 276 (35.11%) visited hospital in winter, 193 (24.55%) in spring, 177 (22.52%) in fall and 140 (17.81%) in summer. Dermatophytes were cultured from 628 patients. Microsporum canis was the most common dermatophyte (73.16%), followed by Trichophyton verrucosum and Trichophyton rubum. Of the 786 patients, 577 (73.41%) lived in urban areas and 209 (26.59%) in rural areas. Changes in the epidemiological and mycological characteristics of children with tinea capitis were shown in incidence, sex distribution, seasonality and causative dermatophytes. The incidence of tinea capitis has fallen significantly in prepubertal children. Nevertheless, continuous surveillance is needed to prevent tinea capitis in Korea.

One-Step Triple-Layer Reconstruction of an Exposed Calvarium in a Patient With Radiated Tinea Capitis.

Full-thickness large scalp defects with underlying exposed calvarium pose a significant reconstructive challenge. Traditional reconstructive techniques are usually not an option in patients with irradiated scalp with thin skin and reduced laxity.Dermal substitutes-based reconstruction techniques have been described in recent years. A common approach is the staged methodology, with the initial application of skin substitute followed by a split-thickness skin graft few weeks later; however, this method involves a prolonged period of local wound management prior to skin grafting and is often associated with complications that interfere with wound healing.This report describes a single-stage triple-layer technique for the reconstruction of a large scalp defect with exposed bone in a patient with a history of radiation treatment, using 3 turnover pericranial flaps in conjunction with a Matriderm dermal substitute and split-thickness skin graft. This immediate multilayered reconstruction provides a long-lasting structural and aesthetic outcome, with minimal donor site morbidity and reduced complications.

Etiologia e epidemiologia da tinea capitis: relato de série de casos e revisão da literatura / Etiology and epidemiology of tinea capitis: case-serie report and literature review

Dermatofitose é uma micose superficial, causada por fungos filamentosos denominados dermatófitos, que são capazes de degradar estruturas queratinizadas. Os agentes dessas infecções em humanos pertencem a três gêneros: Microsporum, Trichophyton e Epidermophyton. O objetivo deste trabalho é revisar os estudos epidemiológicos e relatos de casos de tinea capitis, a partir de artigos publicados entre 2000 e 2018. Com base nos dados analisados, o gênero masculino foi o mais afetado pela tinea capitis e a faixa etária mais relatada foi a de indivíduos menores de 10 anos. As principais espécies isoladas foram: T. tonsurans e M. canis, sendo o primeiro mais encontrado nas regiões norte, nordeste e centro-oeste, e o segundo, nas regiões sudeste e sul do Brasil. Nos relatos de casos foram reportadas lesões com diferentes características, sendo algumas mais inflamatórias, eritematosas, com pústulas, placas de alopécia ou descamativas do que outras. Dor e prurido foram sintomas observados em alguns casos. A griseofulvina e os derivados azólicos foram os principais fármacos empregados na terapia, ainda que em associação em alguns casos. As avaliações dos tratamentos empregados nos casos de tinea capitis devem ser minuciosamente realizadas, visto que há relatos de casos em que a reposta terapêutica não é eficiente, agravando as lesões e prolongando o tempo de tratamento.

Dermatophytosis is a superficial mycosis, caused by filamentous fungi called dermatophytes, which are capable of degrading keratinized structures. The agents of these infections in humans belong to three genera: Microsporum, Trichophyton and Epidermophyton. The objective of this study is to review the epidemiological studies and reports of tinea capitis cases in Brazil, based on articles published between 2000 and 2018. Based on the data analyzed, the male gender was the most affected by Tinea capitis and the most reported age group was of individuals with less than 10 years. The main species isolated from the samples were: T. tonsurans and M. canis, being the first one most found in the north, northeast and center-west regions and the second one found in the southeastern and southern regions of Brazil. In the case reports, lesions with different characteristics were reported, being some more inflammatory, erythematous, with pustules, others with plaques of alopecia or desquamative than others. Pain and itching were symptoms observed in some cases. Griseofulvin and azole derivatives were the main drugs used in therapy, although in association in some cases. The evaluations of the treatment employed in the cases of Tinea capitis should be thoroughly done since there are reports of cases in which the therapeutic response is not efficient, aggravating the lesions and prolonging the treatment time

Tinea capitis: a retrospective epidemiological comparative study.

BACKGROUND: Currently, a wide spectrum of retrospective studies regarding the incidence of TC among children and adults are available in the world literature, but none of them are comparative, aiming to distinguish etiological diversity depending on the different geographic areas. OBJECTIVE: This study aimed to investigate the epidemiology of TC in Plovdiv, Bulgaria and Thessaloniki, and Greece, and to compare the results and predominant etiological agents using retrospective comparative analysis for an 11-year time period. MATERIALS AND METHODS: The subjects included were selected from archives of the Mycological Laboratory of the University Dermatologic Clinic, University Hospital "St. George" Plovdiv, Bulgaria, and the Mycological Laboratory of the First Dermatology Department of Aristotle University Thessaloniki, Greece, by retrospective analysis of data from an 11-year time period (2004-2014). A total count of 374 children aged 0-18, with confirmed diagnosis of TC via direct mycological examination and culture were included (128 children from Plovdiv, Bulgaria, and 246 children from Thessaloniki, Greece). Samples were plated on Sabouraud agar, followed by species identification of the isolated colonies. RESULTS: Our results demonstrate that the incidence of TC in the region of Bulgaria and Thessaloniki for the investigated period was lower than for the previously reported period. In Plovdiv, Bulgaria, it was 1.20 ± 0.09 % (n = 172 from a total count of 14,278 cases of mycoses), as the disease accounts for 23.10 ± 1.79 % of all mycological infections among the pediatric population and 0.36 ± 0.05 % (n = 49 from a total count of 13,724) among the adults patients in Plovdiv, Bulgaria. The incidence of the disease during the period 2004-2014 in Thessaloniki was 2.49 ± 0.15 % (n = 253 cases of TC from a total count of 10,168 mycoses), as it accounts for approximately 27.06 ± 1.47 % of mycological infections among the pediatric population in Thessaloniki, Greece, and 0.08 ± 0.03 % (n = 7 from a total count of 9259) of the population of adult patients with mycoses. Our study confirmed the presumption that M. canis is the leader among the causative agents in TC in children in both of the included countries, but its presence in the etiology of disease in adult patients was very low and nonsignificant. We categorically identified dominance of the female gender among the children with TC in Plovdiv, Bulgaria; while in Thessaloniki, Greece, the gender distribution had an almost equal ratio of males to females. CONCLUSION: Our results suggest that the gender predisposition depends also on the investigated geographic region and the time of the study, rather than only on the causative pathogen and age.

Clinical specificities of Tinea capitis in Georgia population.

The aim of the study was to reveal peculiarities of the clinical symptoms and forms of Tinea capitis caused by etiological agents that are common in our country. The study was conducted on 176 ambulatory patients who approached the National Centre in 2009-2013. Inclusion criterion was simultaneous presence of clinical symptoms and positive result of microscopic study. For cultural examination was used Sabouraud's dextrose agar with the antibiotic chloramphenicol. Clinical manifestations were divided into inflammatory and non-inflammatory (i.e. slightly manifested inflammatory signs) lesions. 85(48,3%) inflammatory and 91(51,7%) non-inflammatory cases of Tinea capitis were revealed. Clinical forms were distributed in following way: kerion 73 (41,5%), grey patch with single lesions 71 (40,3%), seborrheic dermatitis-like form 14 (8%), agminate folliculites 12 (6,8%) and black-dot dermatophytosis 6 (3,4%). In 41(89,1%) of the cases etiological agent of the kerion was Trichophyton mentagrophytes; in 41(85,4%) of the cases etiological agent for the grey patch with single lesions was Microsporum canis. Important clinical and etiological relationship was revealed between kerion and Trichophyton mentagrophytes, as well as between grey patch with single lesions and Microsporum canis. In case of inflammatory forms (predominantly kerion) caused by Trichophyton verrucosum and Trichophyton mentagrophytes ID reaction was manifested by disseminated follicular papules.

Tinea capitis inflamatoria por Trichophyton tonsurans var. sulfureum / Inflammatory tinea capitis by Trichophyton tonsurans var. sulfureum

Los dermatofitos constituyen un grupo de hongos queratinofílicos y queratinolíticos que pueden producir lesiones en piel y sus anexos en animales y el hombre. Las lesiones pueden variar de intensidad desde leves a severas, algunas de las cuales son altamente inflamatorias. Trichophyton tonsurans es un dermatofito antropofílico agente de tiñas no inflamatorias, de piel y raramente de uñas. Es altamente contagioso, que se adquiere por contacto interhumano y de escasa presentación en nuestro medio. Raramente y asociado a estados de inmunocompromiso ocasiona tiña inflamatoria de cuero cabelludo (Kerion Celsi o Querión de Celso). Kerion Celsi es una lesión altamente inflamatoria y supurativa, generalmente causada por dermatofitos zoofílicos que se transmiten de animales al hombre, la cual representa una respuesta inmune exagerada del huésped a la presencia del hongo. Se documenta un caso de Kerion Celsi a T. tonsurans presentado por un niño de 4 años de edad, sin inmunocompromiso, residente en el interior de la provincia. Se trata del primer caso local de tinea capitis altamente inflamatoria a T. tonsurans. El propósito es demostrar que el hongo, a pesar de ser antropofílico, puede ocasionar esta forma clínica en paciente sin inmunocompromiso. Su existencia en el medio requiere de diagnóstico rápido, de extremar medidas higiénicas y posterior control para evitar su propagación.

The dermatophytes are keratinophilic and keratinolytic fungi that cause skin and its annexes lesions in animals and man. T. tonsurans is an anthropophilic fungi, highly contagious, of rare presentation in our environment. Infection is acquired by interpersonal. Noninflammatory ringworm occurs in children and adults. Very rarely it causes highly inflammatory and suppurative ringworm of the scalp (Celsi kerion) associated with immunocompromised states. The kerion is caused by zoophilic dermatophytes. It represents an exaggerated host immune response to the presence of the fungus. This paper presents a case of T. tonsurans Kerion in a 4-year-old non-immunocompromised patient, who lives in rural area in the province. This is the first local case of severe inflammatory tinea capitis to T. tonsurans. The purpose of the study is to demonstrate that T. tonsurans can cause Kerion not associated to immunocompromised. Furthermore, it shows its existence in the medium, which requires immediate diagnosis of the diseases and increase hygiene and disease control to prevent the spread of the fungus.

Analysis of Trichophyton antigen-induced contact hypersensitivity in mouse.

BACKGROUND: Trichophyton-induced superficial skin mycosis is a common infectious human disease, but the immunological mechanism against Trichophyton infection is unclear with regard to many points. Since Trichophyton cannot colonize mice, guinea pigs were used in previous experiments on Trichophyton infection. However, it is difficult to perform immunological and genetic analyses in guinea pigs. OBJECTIVE: The objective of this study was to establish a mouse Trichophytin-associated inflammation model of superficial skin mycosis in which immunological and genetic analyses can be performed. METHODS: We established a mouse Trichophyton-induced contact hypersensitivity model by applying Trichophytin, the Trichophyton antigen, extracted from Trichophyton mentagrophytes, to mice. Using a Th1-dominant strain, C57BL/6, and a Th2-dominant strain, BALB/c, we investigated the expression of inflammatory cytokines and receptors of the innate immune system for fungi, TLR4, TLR2, and dectin-1, and their influences on responses of the acquired immune system. RESULTS: In C57BL/6 mice, expressions of IFN-γ and IL-17 A in regional lymph nodes and IL-1ß, IFN-γ, IL-6, and IL-23 in the inflammatory auricular skin were enhanced by Trichophytin challenge, suggesting that not only Th1 cells but also Th17 cells were induced. In BALB/c mice, expressions of IL-4 in regional lymph nodes, and TSLP and IL-4 in the auricular skin were enhanced by Trichophytin challenge. Interestingly, dectin-1-neutralizing antibody inhibited the promotion of IFN-γ production in C57BL/6 mice, and dectin-1-expressing immune cells had crucial actions in Trichophyton-induced IFN-γ production. CONCLUSION: These results suggest that inflammatory mediators differently regulate Trichophytin-induced contact hypersensitivity on the basis of the status of host immunity.

Two unusual pediatric cases of fungal infections in farming families.

It is not known whether farming families have more cases of uncommon fungal infections than the general population because of their interdependence on farming environments, including farm animals and other pets. The authors describe here two cases of fungal infections with interesting epidemiology that suggest associations that have been insufficiently described and explored in the literature. The first is a case of otomycosis in a 17-year-old female and is suspected to be linked to hay baling. The second is a case of tinea capitis in a 25-month-old female toddler living on a farm and illustrates that rural farming families with closer association with animals are infected with different species of fungi than are seen in urban areas.

Trichophyton Spp. fungal keratitis in 22 years old female contact lenses wearer.

Fungal keratitis represents one of the most difficult forms of microbial keratitis to diagnose and treat successfully. It is difficult to obtain correct diagnosis and topical antifungal preparations. Fungi can cause severe stromal necrosis and enter the anterior chamber by penetrating an intact Descemet membrane. The most common pathogens are filamentous fungi (Aspergillus and Fusarium spp.) and Candida albicans. The incidence of Trichophyton spp. keratitis is 5%. A 22 years old female contact lenses wearer after keratitis developed corneal melting syndrome, spontaneous perforation of the cornea and complicated cataract of the left eye. Conjunctival swab was sterile as well as first sample of corneal tissue and sample from the anterior chamber. Urgent therapeutic perforating keratoplasty (PK), was performed together with extracapsular cataract extraction and the implantation of the intraocular lens in the posterior chamber. The patient was treated with ciprofloxacin and diflucan (systemic therapy); with dexamethason and atropin (subconjunctivaly) and chlorhexidine, brolene, levofloxacin, polimyxin B, and dexamethason/neomycin (topically). Microbiology evaluation was performed once again following excisional biopsy of the intracameral portion of the lesion. The presence of Trichophyton spp. was finally confirmed. Itraconazole and garamycin were included in the systemic therapy. Corneal graft was clear for 17 days but decompensated 28 days after the PK. After two weeks microorganisms invaded the vitreous and caused endophthalmitis. Despite urgent pars plana vitrectomy patient developed endophthalmitis, lost light sensation and developed phthysis. Evisceration and the implantation of silicon prosthesis was done. Perforating keratoplasty is a method of choice in treating severe infectious keratitis unresponsive to conservative treatment but without the eradication of microorganisms it cannot restore the vision or save the eye. Trichophyton spp. may cause a severe disease of the anterior and posterior part of the eye which may finish with the lost of vision/eye. Prompt diagnosis and treatment of Trichophyton spp. keratitis are essential for a good visual outcome.

Infectious alopecia in a dog breeder after renal transplantation.

Tinea capitis rarely occurs in renal transplant recipients. We report this living-related renal transplant patient receiving cyclosporine-based therapy who initially presented with severe exfoliation of the scalp with yellowish-white scales and marked hair loss. The lesions extended to the frontal area and both cheeks, resulting in several skin ulcers with perifocal erythematous inflammatory changes, and palpable cervical lymph nodes. A biopsy of a skin lesion revealed fungal infection and culture yielded Microsporum canis. The patient mentioned an outbreak of ringworm in her breeding dogs during this period. After adequate treatment of the patient and her infected animals with griseofulvin and disinfection of the environment, her skin lesions resolved dramatically, with regrowth of hair.

A novel congenital ichthyosiform syndrome with associated panhypopituitarism, corneal opacities and mental retardation.

A 15-year-old male presented with ichthyosis since infancy with panhypopituitarism, short stature and knock-knees, delayed puberty, high scrotal retractile testes, mental retardation and corneal opacities. He developed recurrent tinea capitis and tinea corporis. The clinical symptomatology indicates that this case cannot be considered as a subtype of inherited ichthyosis group, but suggests a new syndrome as a separate nosologic entity. Two previously reported cases with possibly the same syndrome also had ichthyosis associated with variable endocrinopathy. Thorough endocrinological evaluation and appropriate intervention in patients of ichthyosis with short stature may reduce the morbidity associated with retarded skeletal growth and gonadal maturation.

Tinea Capilatis causada por Trichophyton rubrum en un adulto portador de artritis reumatoidea / Tinea capilatis caused by T. rubrum in adult patient with rheumatoid arthritis

Presentamos un caso de tinea capilatis causada por Trichophyton rubrum en una mujer de 47 años de edad con artritis reumatoidea. Creemos que esta enfermedad crónica la volvió susceptible a esta dermatofitosis poco común

Tiña de la cabeza: Comunicación de 54 casos / Tinea capitis: Communication of 54 cases

La tiña de la cabeza (o tínea capitis) es una dermatofitosis producida por hongos de los géneros Trichophyton o Mentagrophytes. Presenta varias formas clínicas y es casi exclusiva de los niños. Objetivo: Conocer las características de los casos de tiña de la cabeza observados en el Servicio de Dermatología del Hospital Nacional en los periodos: 1990û1992 y 1999û2001. Material y Método: Estudio retrospectivo, descriptivo y observacional. Se determinan porcentajes y se comparan con otras series. Todos los casos tienen estudios micológicos directos y varios de ellos cultivos. Resultados: Se observan 54 casos siendo 19 del periodo 1990-1992 y 35 del periodo 1999-2001. Hay ligero predominio del sexo femenino y la edad promedio de presentación es de 5,6 años. En los casos en que se determinó la especie del hongo predomina el Trichophyton mentagrophytes (10 casos, principal agente en el primer periodo), el Trichophyton rubrum (9 casos, observado exclusivamente en el segundo periodo) y el Microsporum canis (8 casos). En el periodo 1999-2001 el 7,5 por ciento de las primeras consultas son por dermatofitosis, siendo el 37 por ciento niños y de éstos 50 por ciento tiña de la cabeza. Conclusiones: La tiña de la cabeza es la principal dermatofitosis de la niñez en nuestro servicio y muestra una tendencia al aumento de la prevalencia. Además hay aumento de las formas inflamatorias (20 por ciento del total) y surgimiento del Trichophyton rubrum como agente etiológico.

[A case of tinea capitis with a couple of nodular lesions possibly resulting from topical application of tacrolimus].

We herein report a case of tinea capitis initially showing a couple of nodular lesions. The patient was a 66-year-old woman who had seen a nearby dermatologist for itching on her head and had been treated with a topical steroid followed by tacrolimus application for one month. Because pseudolymphoma-like erythematous nodules developed at two sites, she visited us. Two weeks after stopping all medication, some slight scaling was found around these nodules. On KOH direct microscopic examination, many filamentous elements around hair shafts were observed. Biopsy of the nodules confirmed the destruction of hair follicles surrounded by granulomatous inflammation histologically. Grocott staining of the same specimen revealed a few short fungal hyphae as well as spores. She was also diagnosed as tinea pedis by direct microscopic examination of her feet. Trichophyton rubrum was isolated from scales of both her head and feet on Sabouraud's dextrose agar at 25 degrees C. Kerion celsi (KC) is usually clinically preceded by a gray patch or black dots. Such a typical course of KC, however, was not observed in our patient. Tacrolimus was thought to have possibly played an important role in modifying tinea capitis.

Etiology of tinea capitis in Athens, Greece -- a 6-year (1996-2001) retrospective study.

A total of 577 patients with tinea capitis have been diagnosed at the Mycology laboratory of 'A. Sygros' Hospital of Skin and Venereal Diseases, Athens, Greece between 1996 and 2001. From these patients, 100 were immigrants from Balkan, Near East and African countries. The vast majority of the patients (95%) were children, mainly at preschool and school age and only 5% were adults. Zoophilic dermatophytes accounted for 86.5% followed by anthropophilic (12.4%) and geophilic (1.2%) dermatophytes. The majority of anthropophilic infections (59.5%) were recorded in the sub-population of immigrants. Microsporum canis (84.5%) was the main etiologic agent.

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.