Analysis of trichoscopic signs observed in 24 patients presenting tinea capitis: Hypotheses based on physiopathology and proposed new classification.

INTRODUCTION: Trichoscopy (hair dermoscopy) is a non-invasive and very useful technique for the diagnosis and follow-up of hair and scalp disorders. In tinea capitis, specific aspects of the hair shaft have been described, with the main ones being: comma hair, corkscrew hair, bar code-like hair (BCH) and zigzag hair (ZZH). METHOD: Herein we report on a retrospective study of 24 patients with tinea capitis (TC). All patients underwent trichoscopic examination and mycological culture. RESULTS: Trichoscopy was abnormal in all 24 patients showing hair-shaft abnormalities. We observed three types of images depending on the nature and the mechanism of infection and discuss the different trichoscopic aspects of the hair shaft (comma hair, corkscrew hair, bar code-like hair, zigzag hair, broken hair and black dots) resulting from 3 mechanisms of penetration of the fungus in the hair shaft (endothrix, ectothrix and ectothrix-endothrix). All patients had positive mycological cultures: 15 with trichophytic TC (8 with Trichophyton tonsurans, 5 with T. soudanense and 2 with T. verrucosum) and 9 microsporic TC (7 with Microsporum audouini, and 2 with M. canis). DISCUSSION: We propose for the first time, to our knowledge, a classification of trichoscopic signs of TC. This classification will enable rapid diagnosis and prediction of the nature of the fungus before mycological culture. CONCLUSION: Our study shows the importance of trichoscopy in the diagnosis and monitoring of TC as well as its very good correlation with mycological culture. We propose a new classification of trichoscopic signs dependent on the nature of the mycological agent and the mechanism of infection. Further prospective studies with more patients are needed to confirm this classification.

Clinical types of tinea capitis and species identification in children: an experience from tertiary care centres of Karachi, Pakistan.

OBJECTIVE: To study the clinical types of Tinea Capitis and identify species in children reporting to two tertiary care centres of Karachi, Pakistan. METHODS: The descriptive, cross-sectional study was conducted at the Dermatology Outpatients' Department, PNS Shifa Hospital and the Institute of Skin Diseases, Karachi, from January 1, 2008 to December 31, 2009. It comprised 202 children with clinical diagnosis of tinea capitis, confirmed by skin scrapings, showing fungal hyphae and spores in 10% potassium hydroxide on direct microscopy. Wood's lamp examination was carried out and the scrapings were cultured on Sabouraud's agar. A detailed dermatological examination was performed for evidence of fungal infection elsewhere in the body. SPSS 19 was used for data analysis. RESULTS: Male-to-female ratio was 1.1:1 and age ranged from 1 to 14 years.The commonest clinical type gray patch was observed in 71 (35.1%) of the patients, black dot in 63 (31.2%), kerion in 50 (24.8%), favus in 10 (5.0%), diffuse pustular in 6 (3.0%), and diffuse scale in 2 (1.0%) patients. The most frequent species grown on culture was Trichophyton (T). Soudanense, followed by T. Tonsurans, T. Schoenleinii, and T. Mentagrophytes respectively. CONCLUSION: Most of the patients of Tinea capitis presented with gray patch and black dot variety. The most common species identified by culture was Trichophyton Soudanense. Disease was equal in both gender and predominantly affected the population belonging to low and middle socioeconomic class.

A prospective study of tinea capitis in children: making the diagnosis easier with a dermoscope.

INTRODUCTION: Tinea capitis is a scalp infection caused by different fungi. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. The association of clinical and dermatoscopic findings in suspected cases of tinea capitis may help the identification of the etiological agent, facilitating precocious, specific treatment. MATERIALS AND METHOD: We report a prospective descriptive analytical study of 34 children with tinea capitis. We performed a trichoscopic examination of all patients; only six children were able to have the mycological culture. RESULTS: Trichoscopy was abnormal in all 34 patients; it showed hair shaft abnormalities and, in some cases, scalp disorders too. We found that the comma and corkscrew appearance was found in microsporic tinea capitis, V-shaped hair was mainly seen in inflammatory tinea capitis, scales and follicular keratosis in non-inflammatory tinea capitis, and crusts and follicular pustules in inflammatory tinea capitis. Finally, erythema was seen in trichophytic and inflammatory tinea capitis. CONCLUSION: We propose a classification of trichoscopic signs of tinea capitis. This classification will enable rapid diagnosis and prediction of the type of fungus before mycological culture, thus a faster and more adapted management. Our study shows the importance of trichoscopy in the diagnosis and monitoring of tinea capitis. We suggest further prospective studies with a larger number of patients with tinea capitis, having performed mycological culture, to confirm this classification.

[Summarization of tinea capitis cases encountered at a clinic in the past 5 years].

Twelve cases of tinea capitis were encountered at a clinic in Kumamoto prefecture between April 2004 and December 2008. Patients were boys aged between 2 and 18 in 11 cases, and a woman aged 50 years in 1 case. The pathogen was Microsporum canis in 6 cases, and Trichophyton tonsurans in 6 cases. In the cases with M. canis , patients were boys aged 2 to 8 years in 5 cases, and the type of disease was non-inflammatory in 5 cases and inflammatory in 1 case. The patients with T. tonsurans were boys aged 12 to 18 years (judo athletes in 5 cases) and the type of disease was inflammatory in 2 cases and black dot in 4 cases. Three of the M. canis cases were treated with oral administration of itraconazole (ITCZ) at doses of 2.4-4.0 mg/kg/day, and the other 3 with terbinafine hydrochloride (TBF) at doses of 2.6-4.6 mg/kg/day. The duration of treatment was 8-14 weeks with ITCZ, and 4-8 weeks with TBF. In the T. tonsurans cases, TBF was orally administered at doses of 1.4-2.4 mg/kg/day for a period of 8-12 weeks. In one case of non-inflammatory M. canis infection (Case 6) and one case of inflammatory T. tonsurans infection (Case 10), treatment was initiated with the dose recommended in Japan, but symptoms did not improve; therefore the dose was doubled according to European and American guidelines and the patients recovered. As tinea capitis frequently resists treatment, establishment of treatment guidelines is necessary.

Tinea capitis in Benghazi, Libya.

BACKGROUND: Tinea capitis is a worldwide problem. It affects mainly school age children. Late detection and improper treatment of the inflammatory type of this disease may result in disfigurement and permanent alopecia. The objectives of this study were to determine the prevalence, clinical types, and causative species of tinea capitis in Benghazi, Libya. METHODS: One hundred and ninety six patients with tinea capitis were enrolled in this study. Hair stumps and scales were collected from every case and exposed to direct microscopic examination using 10% potassium hydroxide solution, and cultivation on modified Sabouraud's dextrose agar with cyclohexamide and chloramphenicol. RESULTS: Tinea capitis accounts for 45% of all superficial fungal infection and 92% occurred in children below the age of 10 years. The gray patch type was the most common clinical variety (53.6%), followed by black dots, seborrhoid type, and kerion (25.5%, 10.2%, and 8.2%), respectively. Four patients with a clinical picture of alopecia areata-like lesion and one patient with a favus-type lesion were seen. Species identification revealed that Trichophyton violaceum was the most common causative agent, responsible for 49.4% of infection, followed by Microsporum canis (38.6%) and T. verrucosum (7.8%). From seven patients the isolate was a mixture of both T. violaceum and M. canis. CONCLUSIONS: There has been a dramatic decrease in the incidence of favus with complete disappearance of T. schoenleinii. T. verrucosum as a causative agent of tinea capitis in this area has been reported for the first time in this study.