Comprehensive Review of Tinea Capitis in Adults: Epidemiology, Risk Factors, Clinical Presentations, and Management.

Tinea capitis is a fungal infection of the scalp and hair caused by dermatophyte molds, that most often affects children and may also affect adults. Previous estimates suggest that between 3% and 11% of all tinea capitis cases worldwide occur in adults, although updated epidemiological studies are needed to reassess the prevalence of tinea capitis in adult populations specifically. Postmenopausal adult women are most often affected by tinea capitis, with African American or Black women particularly at risk. Adults who experience crowded living conditions, who live in close proximity to animals, who are immunosuppressed, and/or who live in households with affected children are at greatest risk of infection. Tinea capitis can be non-inflammatory or inflammatory in nature, and the subtype affects the extent and severity of clinical symptoms. Fungal culture and potassium hydroxide preparations are the most commonly used diagnostic tools. Trichoscopy, defined as dermoscopic imaging of the scalp and hair, is a useful adjunct to the physical examination. The mainstay of therapy is oral antifungal therapy, and topical therapy alone is not recommended. Since tinea capitis infection is uncommon in adults, there are no widely accepted treatment guidelines. Rather, the same medications used for tinea capitis infection among children are recommended for adults at varying doses, including griseofulvin, and terbinafine, and, less commonly, itraconazole and fluconazole. The prognosis for tinea capitis in adults is typically excellent when prompt and adequate treatment is administered; however, delayed diagnosis or inadequate treatment can result in scarring alopecia. Over the past decade, dermatophyte infections resistant to treatment with topical and oral antifungal agents have emerged. While tinea capitis infections resistant to antifungal therapy have been rarely reported to date, antifungal resistance is rising among superficial fungal infections in general, and antifungal stewardship is necessary to ensure that resistance to treatment does not develop among dermatophytes that cause tinea capitis.

Tinea Capitis at Ibn Sina Hospital in Rabat, Morocco: Epidemiological and Etiological Study Over 25 Years (From 1997 to 2021).

Introduction/Objective In Morocco, tinea capitis is a common reason for consultation, especially in children. Our study aimed to determine the epidemiology of tinea capitis in the Central Laboratory of Parasitology and Mycology at the Ibn Sina University Hospital Center (UHC) in Rabat. Materials and methods This is a retrospective study conducted over 25 years (from 1997 to 2021). It included 247 patients with lesions suggestive of tinea capitis, who underwent a mycological examination. Results Among 594 requests for the diagnosis of tinea capitis, 247 cases were positive. A clear predominance of children (86.23%; n=213) as compared to adults (13.77%; n=34) was observed. The sex ratio (M/F) was 1.77. Hair parasitism was mainly dominated by the pure endothrix type 54.47% (n=122). The two most frequently isolated species were Trichophyton violaceum (51.24%; n=125) and Microsporum canis (36.06%; n=88). In children, these two species represented 47.42% (n=101) and 41.31% (n=88), respectively. In adults, Trichophyton violaceum was the predominant species, accounting for 77.42% (n=24); in females, it was 76.41% (n=68); and Microsporum canis was predominant in males (50.32%; n=78). Conclusion The epidemiology of this condition is in a constant state of flux, influenced by various lifestyle factors. Our research unveiled a notable upward trend in zoophilic species over the 25-year study period, while conversely, anthropophilic species demonstrated a discernible decline.

Understanding Kerion Celsi in Children: Diagnosis and Therapeutic Guidelines Through an Algorithm.

Kerion celsi (KC), known as scalp ringworm, is the most common dermatophytosis in children. In Mexico, it ranks fourth among dermatophytoses, with a frequency of 4%-10%. KC is the inflammatory variety of tinea capitis (TC), with the most common causative agents being Microsporum canis and Trichophyton mentagrophytes. We present the clinical case of a six-year-old male diagnosed with KC. Direct examination stained with chlorazol black and cultures were performed, yielding negative results. Histopathological study revealed spores and short hyphae within and surrounding the hair shaft. Treatment with itraconazole was initiated based on suspicion of Microsporum spp. from the trichoscopy findings. We propose a diagnostic and therapeutic algorithm for kerion celsi.

Tinea capitis caused by Trichophyton tonsurans: An emerging disease in Argentina. / Tinea capitis por Trichophyton tonsurans: una enfermedad emergente en Argentina.

Tinea capitis is a dermatophytosis, which is more common in children. It is caused by dermatophytes that vary according to the region; the most frequently isolated dermatophyte in our setting is Microsporum canis. Given its anthropophilic nature, its dissemination via interpersonal transmission and through the use of hair care tools is very common. In the course of the past year, an increase has been reported in the incidence of a pathogen that was very rare in our setting: Trichophyton tonsurans. Here we describe a retrospective study of cases of tinea capitis caused by Trichophyton tonsurans identified between September 2021 and March 2023 in the Department of Pediatric Dermatology at a general hospital of the City of Buenos Aires.

La tinea capitis es una dermatofitosis, más frecuente en niños. Está causada por hongos dermatofitos que varían según la región; el más frecuentemente aislado en nuestro medio es el Microsporum canis. Dado su carácter antropofílico, la transmisión por vía interpersonal y mediante el uso de instrumentos de cuidado capilar es muy habitual. En el transcurso del último año, se ha reportado un incremento en la incidencia de un patógeno que era muy poco habitual en nuestro medio: el Trichophyton tonsurans. Presentamos un estudio retrospectivo de los casos de tinea capitis por Trichophyton tonsurans identificados en el período comprendido entre septiembre de 2021 y marzo de 2023 en la Sección de Dermatología Infantil de un hospital general de la Ciudad Autónoma de Buenos Aires.

Epidemiology and management of tinea capitis in France: a 6-year nationwide retrospective survey.

Tinea capitis (TC) is still a frequent dermatophytosis in France, both autochthonous and imported. A nationwide retrospective survey was performed and a total of 4,395 TC cases were recorded within 36 French mycology laboratories during a 6-year period. TC is a disease that occurs in childhood with 85% of the cases occurring before 10 years old and 94% before the age of 15. Anthropophilic origin was predominant with 779 cases of Trichophyton tonsurans (32.6%), 738 cases of Trichophyton soudanense/T. violaceum (31%), and 445 cases of Microsporum audouinii (19.2%). Of note, T. tonsurans represents more than 80% of the cases in the French West Indies (Martinique and Guadeloupe). By contrast, zoophilic species were less prevalent with mainly M. canis (10.3%) confirming the shift from zoophilic to anthropophilic species observed in many centers during the last decades. During this survey, diagnosis methods were also collected. Most labs had a classical process for the diagnosis: microscopic direct examination associated to cultures on Sabouraud and Sabouraud-cycloheximide media (incubated between 25±5°C for 2 to 3 weeks) in all laboratories. Identification of the causal dermatophyte was performed by microscopic and macroscopic examination of the cultures in 100% of the labs, with various specific culture media available when fructification was insufficient (mainly malt or potato-dextrose agar, or Borelli medium). New techniques were also implemented with the introduction of MALDI-TOF mass spectrometry identification in more than two third of the labs, and molecular identification available if necessary in half of the labs.

A total of 4,395 tinea capitis cases were recorded within 36 French mycology laboratories during a 6-year period. An anthropophilic origin was predominant with 33%, 31% and 18.8% of cases due to Trichophyton tonsurans, T. soudanense/T. violaceum and Microsporum audouinii, respectively.

Microsporum canis-Induced Tinea Capitis: A Rapid Screening Algorithm.

Tinea capitis is a common fungal infection of the scalp, primarily affecting children, and caused by fungi like Trichophyton and Microsporum. Its pathogenesis is influenced by both host-specific and environmental factors, resulting in various clinical presentations including hair loss and scaling of the scalp. We present the case of an eight-year-old male with tinea capitis, characterized by itching and hair loss in the occipital area. Examination revealed characteristic findings on trichoscopy, and direct examination of hair confirmed parasitization. Treatment with terbinafine was initiated, leading to the resolution of symptoms. Epidemiological variations in the etiology of tinea capitis exist globally, with Trichophyton predominating in some regions and Microsporum in others. Trichoscopy is a valuable diagnostic tool for differentiating fungal infections, guiding treatment decisions. Despite the efficiency of direct skin and hair examination, the common occurrence of tinea and the lack of mycological centers in many clinics pose challenges. To address this, we propose integrating trichoscopy and epidemiological and clinical data for a quick in-office decision tool.

Dermoscopic image of the hairs in a very early lesion of tinea capitis caused by Trichophyton rubrum.

While the initial lesions of tinea capitis are often overlooked due to their small size and numerous hairs emerging from the follicle, it is crucial not to dismiss the partial presence of comma or harpin hairs and black spots.

Unravelling Childhood Tinea Capitis: A Multi-Dimensional Investigation Using Dermoscopy, Scanning Electron Microscopy and Mass Spectrometry.

Tinea capitis, a common cutaneous fungal infection, shows an increasing prevalence with the increasing number of pets. We present tinea capitis in a 4-year-old girl presenting without typical symptoms such as alopecia or hair breakage. After a comprehensive evaluation including dermoscopy, Wood's light, direct KOH fluorescent staining, scanning electron microscopy, fungal culture and mass spectrometry analysis, a diagnosis of tinea capitis infected Microsporum canis carried by domestic cats was made. We preliminarily explored the two modes of hair erosion by tinea capitis fungi and analyzed the possibility of the feature in this case. This case highlights the importance of accurate diagnosis and appropriate therapeutic intervention in cases of paediatric tinea capitis, particularly in households with resident pets.

A Current Diagnostic and Therapeutic Challenge: Tinea Capitis.

Tinea capitis is a dermatophyte scalp infection with a marked prevalence among the pediatric population. However, in the last few years, its epidemiology has changed due to increasing population migration worldwide. Host-specific and environmental factors contribute to the pathogenesis of tinea capitis. Clinically, tinea capitis may present as a subtle hair loss accompanied by scalp scaling, alopecia with scaly patches, or alopecia with black dots. A more severe form of tinea capitis is represented by kerion celsi, which clinically presents as a tender plaque covered by pustules and crusts. If left untreated, this dermatophytic infection may resolve with permanent scarring and alopecia. The pathological changes found in tinea capitis are reflected by a spectrum of clinical changes. Zoophilic infections typically prompt an extensive inflammatory reaction, while anthropophilic dermatophytoses often lack inflammation and result in more persistent lesions. Tinea capitis typically requires systemic antifungal therapy. Griseofulvin, terbinafine, itraconazole, and fluconazole are the main antifungal agents used. Currently, the duration of antifungal therapy varies based on the clinical presentation and type of dermatophyte involved. Through the reported cases and literature review, we aim to emphasize the importance of the early recognition of atypical variants of tinea capitis in immunocompetent children for the prompt initiation of systemic antifungal therapy, minimizing the need for prolonged treatment. Additionally, we emphasize the importance of regular laboratory testing during systemic antifungal therapy, particularly liver enzyme tests, to prevent adverse events, especially in cases requiring long-term treatment.

Dermoscopic findings in Tinea Capitis among under 18 children in dermatology polyclinic patients: a hospital-based cross-sectional study.

Background: Tinea capitis is a fungal infection that affects the scalp. It is caused by a group of fungi known as dermatophytes, which thrive in warm and moist environments. In Somalia, there is a data shortage regarding dermatological conditions, especially in Mogadishu, the most populous city in the country. Tinea capitis has gone unreported despite its high prevalence in Somali dermatology clinics and the Somali diaspora in Western countries. The absence of up-to-date information hampers the capability to diagnose, treat, and prevent Tinea capitis. Therefore, the study aims to evaluate dermoscopic signs about isolated organisms and potassium hydroxide (KOH) examination. Method: A hospital-based cross-sectional study was implemented between January and April 2023 in Mogadishu, Somalia. All eligible Tinea capitis-infected children were included in the study. Microscopically, analysis was conducted by adding 10% of KOH in fungal elements. Data were analyzed using descriptive statistics and the χ2 test at P value less than 0.05. Results: A total of 76 tinea capitis-infected children participated in the study; 56% were age group between 5-9 years old, 68.4% were male, and 92.1% showed KOH positivity. Trichophyton violaceum (65.8%) and Trichophyton sudanense (14.5%) were the most common fungal organisms detected in the culture. comma hairs (93.10%), scales (40.80%), and corkscrews (32.90%) were the most common dermoscopic signs of tinea capitis. The demographical characteristics and dermoscopic signs of tinea capitis significantly associated with the positivity of KOH examination were age, sex, comma hairs, corkscrew hairs, broken hair, Scales, and Zigzag hair. Conclusion: Children in Mogadishu, Somalia, bear a significant burden of Tinea Capitis infections. Trichophyton violaceum and Trichophyton sudanense were the predominant causative agents identified in the cultures. The most common dermoscopic signs of tinea capitis observed in this study were comma hairs, scales, and corkscrew patterns. Hence, early diagnosis of Tinea Capitis infections and timely, effective treatments with contact tracing are highly needed.

Kerion Celsi in infants and children-A narrative review 2010-2023.

Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections.

Tinea capitis in newborns: Report of a case and review of the literature with a focus on treatment modalities.

Tinea capitis is a common disease in children but rare in newborns younger than 1 month of age. Only 29 cases of tinea capitis in newborns have been described in indexed literature from 1990 until now. While antifungal agents can be used topically and systemically, systemic antifungal therapy is generally accepted as the treatment of choice for tinea capitis due to limited penetration of topical agents into the hair follicle. However, there is a lack of data on the use of systemic antifungal agents in newborns, and there are reports of successful treatment of tinea capitis in newborns using only topical therapy. In this paper, we present a case of tinea capitis in a 29-day-old female baby and review the previous 29 reported cases.

Combination oral antifungal therapy for paediatric fungal infection: An option to improve efficacy and overcome clinical resistance.

There is increasing evidence of clinically resistant cutaneous fungal infections. The use of combination oral antifungals is described in adults but not in paediatric patients. We present seven paediatric cases of clinically resistant fungal infections treated successfully with combination oral antifungal therapy after inadequate response to a single agent.

Three Cases of Recalcitrant Pediatric Tinea Capitis Successfully Treated with Griseofulvin.

Tinea capitis is an infection of the scalp hair follicles and surrounding skin that primarily occurs in prepubertal children. Microsporum canis remains the most common pathogen causing tinea capitis in Asian countries, including South Korea, although the causative organism of this condition varies across geographical regions and time periods. Systemic antifungal agents are the mainstay treatments for tinea capitis; however, the therapeutic responses to antifungal drugs may vary depending on the causative species, and treatment failure may occur owing to drug resistance. Although dermatophytosis resistant to clinical treatment have been increasingly encountered, recalcitrant tinea capitis cases have rarely been reported. Herein, we report three cases of tinea capitis caused by M. canis in children. All three patients showed unsatisfactory clinical responses to prolonged courses of oral terbinafine or itraconazole without achieving mycological cure; however, they were successfully treated with oral griseofulvin. Although griseofulvin is not currently available or licensed for use in many countries, including South Korea, it is one of the most effective agents against Microsporum species and remains the most widely used first-line treatment for tinea capitis in children, based on dermatology textbooks and reliable treatment guidelines.

Low utilization of confirmatory testing for tinea capitis by pediatricians at an academic center in New York, United States, 2005-2021.

We retrospectively reviewed physician diagnostic and treatment practices for pediatric tinea capitis at an academic institution over 16 years, in assessing adherence with published guidelines. We demonstrate the need to increase utilization of confirmatory testing and systemic therapy, and call for directed pediatrician education towards these goals.

Inflammatory Tinea Capitis Mimicking Dissecting Cellulitis in a Healthy Woman.

Introduction: Inflammatory tinea capitis (TC) is uncommon in adults. Case Presentation: A 29-year-old healthy woman presented with a 2-year history of scalp alopecia with purulent discharge. Clinical, trichoscopic, and histological features and the negativity of a first fungal sampling were consistent with the diagnosis of dissecting cellulitis of the scalp. A second mycological examination guided by trichoscopy was carried out, showing tinea endothrix. Fungal culture isolated trichophyton violaceum. The patient was treated with terbinafine with complete healing. Conclusion: The diagnosis of adult TC is challenging, mainly the inflammatory form. An exhaustive trichoscopic examination of all alopecic plaques may help make a rapid diagnosis and provide a guide to the mycological examination.

Tinea capitis caused by Trichophyton violaceum in an immunocompetent elderly patient: A case report and review of literature.

Tinea capitis is a common dermatophyte infection of the scalp in children. It is an uncommon infection in adults and usually affects postmenopausal women and immunocompromised patients. We report an immunocompetent elderly female with inflammatory tinea capitis caused by Trichophyton violaceum and review the literature for the past 5 years to describe the disease, its epidemiologic characteristics, dermatophyte species involved and treatment options used. The total number of cases was 11, including 8 women and 3 men, with an average age of 48.36. The most commonly isolated dermatophyte was Trichophyton tonsurans, and most cases were treated successfully with oral terbinafine with no side effects. In our case, the diagnosis was established by direct examination, culture and histological examination. Remedy with itraconazole and prednisolone was very successful. Early diagnosis of tinea capitis in adults is necessary to provide early treatment and minimize sequelae of the disease.