Basal cell carcinomas of the scalp after radiotherapy for tinea capitis: Clinicopathological study in a case series of 96 patients with analysis of 427 tumours.

BACKGROUND/OBJECTIVES: Low-dose X-ray radiotherapy to treat tinea capitis during childhood is a well-known risk factor for scalp basal cell carcinomas (BCCs). Post-radiotherapy BCCs are often multiple, and it has been suggested that they display more aggressive features. Our main objective was to study the clinicopathological aspects of post-radiotherapy BCCs to evaluate their biological behaviour and identify features that may differ from other BCCs. METHODS: We performed an observational, retrospective study assessing multiple clinical and pathological characteristics of patients with post-radiotherapy BCCs. RESULTS: We studied 96 patients with 427 post-radiotherapy scalp BCCs. Post-radiotherapy BCCs were often multiple (median of 4 lesions/patient, ranging from 1 to 54). Significant comorbidities included a high incidence of thyroid disease and meningiomas. Recurrences were observed in 23% of patients, but there may be confounding factors, such as referral bias, heterogenous treatment modalities and occurrence of new tumours due to field effect. We found a high incidence of infundibulocystic BCCs (in 14.6% of patients and corresponding to 5.4% of the total number of tumours), trichoblastomas (5.2%) and neurofibromas of the scalp (10%). CONCLUSIONS: This study is consistent with the occurrence of multiple lesions (sometimes numerous) and a relatively high tendency for recurrence in post-radiotherapy BCCs, as suggested by previous studies. We also found a high incidence of the infundibulocystic variant and a higher risk of follicular tumours and neurofibromas, which suggests that radiotherapy may influence the type of differentiation of BCCs and contribute to induce neoplasms of different cell lines.

Alopecia as a systemic disease.

Alopecia is a skin condition of great social and psychologic impact. Primary alopecia originates from the hair follicles and usually does not have systemic manifestations; however, secondary alopecia can affect the hair follicles in the setting of systemic diseases, medications, and external trauma. Connective tissue diseases, granulomatous diseases, bullous diseases, infections, and tumors are some of the systemic diseases that will be covered in this review. Trichoscopy is a useful noninvasive tool that can help with the diagnosis in the office and can guide the selection of the optimal site for the scalp biopsy. Histopathology is the ultimate tool for the diagnosis in most cases of secondary alopecia and can be performed on vertical and horizontal sections. In most cases, treating the underlying condition is the single most important strategy, but topical treatments for the alopecia are also applied.

Kerion of the pubis and vulva with bacterial superinfection: a rare occurrence.

Kerion is a severe hypersensitivity reaction to fungal infection that is rarely seen in the groin. Frequent shaving of pubic hair and religious conservatism surrounding genital hygiene are common among Bedouin women in the Negev Desert, and may predispose to kerion. This case highlights the clinical course of a 20-year-old Bedouin woman who presented with severe kerion celsi of the pubis and vulva with secondary bacterial infection. The patient was successfully treated with intravenous antibiotics, oral antifungal medication and wet topical dressings. The case outlines the risk factors and treatment for severe kerion celsi of the groin, as well as possible preventive measures that may reduce its incidence.

A case report of tinea capitis in infant in first year of life.

BACKGROUND: Tinea capitis is a cutaneous fungal infection common among 3 to 7 year old children but it is rare in the first year of life. CASE PRESENTATION: We present a case of a 12-month-old infant with erythematous scalp lesions combined with hair loss. He was suspected of dermatophytosis and mycological analysis of all suspected lesions was performed. Clinical features and culture results confirmed tinea capitis caused by Microsporum canis. The infant patient was treated with griseofulvin for 2 months. However, 15 days later at the end of treatment he presented with a single vesicle positive for M. canis. Griseofulvin therapy continued for another month. After 3 months of follow-up, no recurrence was observed. CONCLUSIONS: In infant, sometimes tinea capitis is misdiagnosed and underreported because it is similar to other scalp pathologies. Therefore, if erythematous scalp lesions are present, they must be examined from a mycological point of view to inform the differential diagnosis. Once diagnosed, treatment of tinea capitis can pose a dilemma because different factors may influence the choice between equally effective therapies (i.e. safety, age, formulation, cost). This case report suggests that it is important to establish an accurate diagnosis and  treatment for this dermatophytosis to avoid recurrences or therapeutic failures, especially in infants.

Common causes of paediatric alopecia

BACKGROUND: Hair loss in children aged 12 years and younger is most often due to a benign or self-limiting condition. This article presents a review of the assessment of common causes of paediatric alopecia and outlines the implications for general practice. OBJECTIVE: The objective of this article is to help readers systematically assess a child presenting with alopecia, manage the most common diseases of paediatric alopecia and identify patients requiring referral to a dermatologist. DISCUSSION: The most common causes of paediatric alopecia are largely non-scarring. These include tinea capitis, alopecia areata, trauma due to traction alopecia or trichotillomania, and telogen effluvium. Scarring alopecia can also occur in childhood and requires scalp biopsy and further investigation by a dermatologist. General practitioners should treat clear cases of tinea capitis. Referral to a dermatologist is necessary in cases when the diagnosis is uncertain, treatment is failing or there is evidence of scarring alopecia.

Hair Loss: Common Causes and Treatment.

Hair loss is often distressing and can have a significant effect on the patient's quality of life. Patients may present to their family physician first with diffuse or patchy hair loss. Scarring alopecia is best evaluated by a dermatologist. Nonscarring alopecias can be readily diagnosed and treated in the family physician's office. Androgenetic alopecia can be diagnosed clinically and treated with minoxidil. Alopecia areata is diagnosed by typical patches of hair loss and is self-limited. Tinea capitis causes patches of alopecia that may be erythematous and scaly and must be treated systemically. Telogen effluvium is a nonscarring, noninflammatory alopecia of relatively sudden onset caused by physiologic or emotional stress. Once the precipitating cause is removed, the hair typically will regrow. Trichotillomania is an impulse-control disorder; treatment is aimed at controlling the underlying psychiatric condition. Trichorrhexis nodosa occurs when hairs break secondary to trauma and is often a result of hair styling or overuse of hair products. Anagen effluvium is the abnormal diffuse loss of hair during the growth phase caused by an event that impairs the mitotic activity of the hair follicle, most commonly chemotherapy. Physician support is especially important for patients in this situation.

[Erythema nodosum due to tinea]. / L'érythème noueux, une complication des teignes à Trichophyton mentagrophytes.

UNLABELLED: Erythema nodosum (EN) is the most common clinical and pathological variant of panniculitis. A Celsus kerion is an inflammatory and suppurative tinea of the scalp. We report on a rare case of EN secondary to a kerion of the scalp. OBSERVATION: A 9-year-old child without a notable medical history, had a squamous plaque of the vertex for 15 days, which became painful and purulent. Five days after the plaque appeared, he presented with painful, hot, erythematous lesions symmetrically on the extensor surfaces of the legs and forearms. A medical examination found a fever of 38.5°C, a squamous purulent and crusty plate of the vertex (6/5cm) with pustules and a few hairs cut short, and symmetrical painful erythematous hot nodules on the anterior surfaces of the two legs and forearms. A mycological sample of the crusts of the scalp lesion confirmed the presence of Trichophyton mentagrophytes. A bacteriological sample was not taken, and a skin biopsy confirmed the diagnosis of EN. The results of other paraclinical investigations were normal. The diagnosis of EN secondary to an inflammatory scalp tinea was established, and our patient was prescribed an orally and locally administered antimycotic, rest, and elevation of the limbs. DISCUSSION: EN is an acute nodular hypodermitis considered a nonspecific hypersensitive reaction to various allergens. Rarely, it can occur secondary to a fungal infection of the scalp such as a kerion or even secondary to the antifungal treatment of this tinea. EN secondary to a kerion of the scalp before the beginning of antifungal treatment has been reported in the literature, with a spontaneous improvement of the EN after treatment of the tinea.

Epidemia de tiña por Trichophyton tonsurans en un área sanitaria de la Comunidad de Madrid (España) / Outbreak of Trichophyton tonsurans ringworm in a health area of the Community of Madrid (Spain)

Antecedentes. Trichophyton tonsurans es un hongo dermatofito que puede dar lugar a epidemias de tiña. En septiembre de 2013 fueron diagnosticados en nuestra área sanitaria dos casos de tiña por T. tonsurans en niños que convivían en un centro infantil. Objetivos. Conocer el origen y la extensión del brote. Métodos. Se realizaron cultivos micológicos de muestras de cuero cabelludo y piel de los contactos de los casos detectados, y de muestras ambientales del centro infantil. Se inició el tratamiento de los pacientes y la desinfección ambiental del centro. Resultados. Se identificaron doce casos de tiña y tres portadores asintomáticos de T. tonsurans en el cuero cabelludo entre los 20 menores residentes del centro infantil. El caso índice fue un residente del centro en cuya familia, que acababa de regresar de su país de origen, Nigeria, se detectaron tres casos de tiña. Desde noviembre de 2013 a febrero de 2014 se diagnosticaron otros cinco casos de tiña en compañeros de colegio de tres casos del centro infantil. Conclusiones. El tratamiento resolvió clínica y micológicamente los casos, y entre marzo y noviembre de 2014 no se diagnosticó ningún otro caso de tiña por T. tonsurans en la misma área sanitaria (AU)

Background. Trichophyton tonsurans is a dermatophyte fungus that can cause ringworm outbreaks. In our health area in September 2013, two cases of T. tonsurans ringworm were diagnosed in children who lived in a Children's Centre. Aims. To determine the origin and extent of the outbreak. Methods. Mycological cultures of scalp and skin samples from the contacts of the diagnosed cases were performed, as well as environmental samples from the Children's Centre. The patients started with a treatment for their ringworm, and an environmental disinfection of the centre was performed. Results. Twelve cases of ringworm were detected, along with three asymptomatic scalp carriers of T. tonsurans among 20 children in the Centre. The index case was a resident in whose family, that had just returned from their country of origin, Nigeria, three cases of ringworm were diagnosed. From November 2013 to February 2014 another five cases of ringworm were diagnosed among schoolmates of three cases from the Children's Centre. Conclusions. The antifungal treatment of the children resulted in the mycological and clinical resolution, and from February to November 2014 no other cases of ringworm by T. tonsurans in the same health area were diagnosed (AU)

Successful treatment of severe kerion Celsi in an immunocompromised girl with evacuation of pus, terbinafine and short course glucocorticosteroids.

A 6-year-old girl with a 2-year history of idiopathic thrombocytopenic purpura complained of a 4-week history of scalp desquamation together with small pustules. During the recent 10 days, she complained of high fever with multiple abscesses formation with no response to intravenous antibiotics. She received varied doses of oral prednisone therapy for 2 years. Microscopy showed endothrix infection. We prescribed terbinafine 125 mg/d and prednisone 10 mg/d. After 1 week, she returned to our office with severe ache and persistent high fever. She refused any topical drugs because of pain. Manual pressure to remove pus from sinuses and infected scale under general anesthesia was done and about 100 ml pus was discharged from kerion lesions. Prednisone (1 mg/kg/d) was started and fever disappeared on the same day. Prednisone was tapered to withdraw in 10 days. A total of a 3-month course of oral terbinafine (125 mg/d) resulted in mycological clearance. Hair regrowth was satisfactory 8 months later.

Administration of Oral Itraconazole Capsule with Whole Milk Shows Enhanced Efficacy As Supported by Scanning Electron Microscopy in a Child with Tinea Capitis Due to Microsporum canis.

Although diagnosis and treatment of tinea capitis in children are not difficult, treatment failures are still somewhat common. We report a case of pediatric tinea capitis cured using oral itraconazole administered with whole milk, after prior treatment failure when oral itraconazole was administered with water. This apparent enhanced efficacy in one individual was demonstrated using scanning electron microscopy.