Management of tinea capitis in infants and children in the United States: A national survey of pediatric dermatologists.

This study aimed to evaluate the current management of tinea capitis in the United States, specifically focusing on patients aged 0-2 months, 2 months to 2 years, and 2 years to 18 years. An online survey, distributed through the Pediatric Dermatology Research Alliance and the Society of Pediatric Dermatology, revealed the following preferences: fluconazole for those under 2 months, griseofulvin for those aged 2 months to 2 years, and terbinafine for those aged 2 years and older. There exists inter-provider variation in tinea capitis treatment regimens within the pediatric dermatology community.

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.

Evaluation of curcumin for dermatologic conditions: a systematic review.

There is increasing demand for natural and sustainable products for the treatment of dermatologic conditions. This systematic review aims to critically analyze published randomized controlled trials (RCTs) and provide evidence-based recommendations on the therapeutic use of curcumin for a variety of dermatological diseases. A systematic search of published literature was performed on July 18, 2023 using PRISMA guidelines for turmeric or curcumin for the treatment of skin diseases. Clinical recommendations were made based on the Oxford Centre for Evidence-Based Medicine guidelines. We identified 18 original randomized controlled trials for use of turmeric or curcumin for psoriasis, radiation dermatitis, oral lichen planus, pruritis, vitiligo, tinea capitis, facial erythema, and scarring. Psoriasis, cesarean section scar, and pruritus received grade of recommendation B. Radiation dermatitis, oral lichen planus, vitiligo, tinea capitis, and facial redness received grade of recommendation C or D. Curcumin was demonstrated to have an excellent safety profile in all clinical trials analyzed. Further research is required to determine optimal dosing and treatment parameters of turmeric. Additional, larger, RCTs and non-RCTs should be conducted to further investigate the safety and efficacy of curcumin as a treatment option for dermatological diseases.

[Prevention and control of pediatric tinea capitis].

Tinea capitis is a superficial fungal infection of the scalp and hair caused by Dermatophytes. It represents the most prevalent superficial fungal infection among preadolescent children worldwide, including in developing countries such as China. The highly contagious nature of tinea capitis can result in outbreaks within communal settings for children. Furthermore, pustular lesions associated with this condition can lead to permanent scarring and hair loss, imposing a significant psychological burden on affected children and their parents. This article aims to provide a comprehensive literature review encompassing the susceptible person, epidemiological characteristics, trends, etiology, modes of transmission, clinical manifestations, treatment, and prevention strategies of tinea capitis. The ultimate objective is to raise awareness, implement effective prevention and control measures, interrupt the transmission cycle, and ultimately reduce the incidence of tinea capitis in the pediatric population.

5-aminolevulinic acid-photodynamic therapy for a refractory severe kerion: A case report.

Kerion is a subtype of tinea capitis with a severe inflammatory response, requiring early diagnosis to prevent secondary bacterial infection, folliculitis and permanent alopecia. Oral antifungal drugs are considered the first-line treatment for tinea capitis; however, drugs therapy is challenged by the long treatment duration, side effects, and drug resistance. Photodynamic therapy (PDT) has been widely used to treat dermatomycosis and has shown significant efficacy in recent years. We report the case of a girl who presented with refractory severe kerion following unregulated treatment and insensitivity to itraconazole; however,she was cured with 5-aminolevulinic acid-PDT. The case showed that PDT is a potentially promising alternative treatment for cutaneous fungal infections.

A Multicenter Retrospective Database Evaluation of Pediatric Patients Diagnosed With Tinea Capitis.

PURPOSE: Tinea capitis is a common pediatric superficial dermatophyte infection associated with lower socioeconomic status, overcrowded environments, and poor hygiene internationally. Nevertheless, to the authors' knowledge, no studies in the United States have reported an association between tinea capitis diagnoses and diagnostic codes for social determinants of health (SDOH). The objectives of the present study were to analyze the diagnostic and treatment approach and frequency of SDOH diagnostic codes in order to assess the presence of racial disparities in the treatment of pediatric patients aged 0 to 18 years diagnosed with tinea capitis. METHODS: This study comprised a retrospective analysis using the TriNetX electronic health record database of de-identified pediatric tinea capitis data in ambulatory and emergency settings. The data evaluated demographics, SDOH diagnostic codes, medication codes, and procedure codes. RESULTS: Analysis of 19,677 patients (17,471 [88.8%] ambulatory and 2206 [11.2%] emergency encounters) demonstrated that a low frequency of patients had a confirmatory test for tinea capitis (ie, potassium hydroxide prep or fungal culture; 5.5%), prescription for dual therapy (25.2%), or SDOH diagnostic codes (5.5%). Patients with races classified as Black (odds ratio = 0.48, 95% confidence interval = 0.41-0.57, p < 0.001) and "other" (odds ratio = 0.52, 95% confidence interval = 0.33-0.81, p = 0.004) had a lower likelihood of having an ambulatory encounter, but a higher likelihood of receiving dual therapy. CONCLUSIONS: This study found that diagnostic testing, dual therapy, and SDOH diagnostic codes were underutilized for pediatric patients diagnosed with tinea capitis. In addition, patients of races classified as Black and "other" were more likely to be diagnosed in emergency encounters, but had a higher likelihood of receiving dual therapy regardless of encounter type. Further research is needed to determine how to improve the management of tinea capitis and better understand its relationship with SDOH.

[Trichophyton tonsurans Infection].

Trichophyton tonsurans infection has been prevalent among individuals involved in contact sports in Japan since about 2000. The present review focuses on its diagnosis, molecular epidemiology, drug susceptibility, and infection control. The most commonly observed lesions of T. tonsurans, an anthropogenic dermatophyte, are tinea corporis and tinea capitis. However, the presence of asymptomatic carriers must be considered for infection control. Genotypic epidemiology using restriction fragment length polymorphisms (RFLP) in the non-transcribed spacer (NTS) region of the ribosomal RNA gene showed a lack of diversity of genotypes, and only the NTS I genotype is detected at present. In regard to drug susceptibility, terbinafine drug resistance has not been found to be associated with the RFLP genotypes, and it is assumed that there are no terbinafine-resistant strains in Japan. T. tonsurans coexisted with other fungi and bacteria in the scalp of asymptomatic carriers without affecting species diversity. T. tonsurans is an anthropogenic dermatophyte and may be difficult for the human immune system to eliminate. During an infection outbreak, screening of infection and treatment including asymptomatic carriers are essential to eradicate the infection.

A Case of Kerion Celsi due to Trichophyton tonsurans.

The patient was a 13-year-old boy who was a member of the judo club at his junior high school. Approximately 1 week prior to his presentation, he developed multiple erythematous pilaris papules on his occipital area and was treated by a local doctor. The erythematous lesions expanded to 10 × 10 cm, showing granulation with drainage and strong spontaneous pain. At this point, he visited our hospital. He was diagnosed with kerion celsi due to Trichophyton tonsurans by fungal examination. The patient was treated with terbinafine (125 mg/day) for 6 weeks, and a brush test at 6 weeks was negative. All 18 members of the judo club, including this patient, were investigated; brush tests were positive in 4 cases, and one was positive for tinea corporis alone. The patient's family members parents were both negative. When an athlete is diagnosed with ringworm, T. tonsurans infection should be considered, and testing and treatment of family members and fellow athletes should be carried out to prevent the spread of infection.

Comparative analysis of whole genomes and transcriptomes of Microsporum canis from invasive dermatophytosis and tinea capitis.

ABSTRACTGenomes of strains of the zoophilic dermatophyte Microsporum canis from invasive (disseminated and subcutaneous) and noninvasive (tinea capitis) infections were compared. Especially the disseminated strain showed significant syntenic rearrangements, including multiple translocations and inversions, and numerous SNPs and Indels in comparison to the noninvasive strain. In transcriptome analysis, both invasive strains were enriched for GO pathways related to components of the membrane, iron binding and heme binding, which possibly enables them to invade deeper into dermis and blood vessels. At 37 °C, invasive strains showed gene expression enriched for DNA replication, mismatch repair, N-glycan biosynthesis and ribosome biogenesis. The invasive strains were slightly less susceptible to multiple antifungal agents suggesting that acquired elevated drug resistance might be involved in the refractory disease courses. Patient with disseminated infection failed to respond to a combined antifungal treatment with itraconazole, terbinafine, fluconazole and posaconazole.

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

Neglected Adult Tinea Capitis in South China: A Retrospective Study in Nanchang, Jiangxi Province, from 2007 to 2021.

Tinea capitis (TC) in adults is much less frequently diagnosed in comparison to TC in children. In this study, we explored retrospectively adult TC in a specialized dermatology hospital, located in South China, during the years 2007-2021. Among 1037 TC cases, 168 (16.2%) patients were older than 18 years. The majority of adults with TC, 77.38% (130/168), were older than 40, with a peak in the age of 51-60 years (40/168, 23.81%). Before presenting at our hospital, many of patients did not got proper treatment due to misdiagnosis or simply did not consulted an appropriate clinic. 60.71% (102/168) of the patients reported symptoms lasting for more than 1 year and 29.76% (50/168) reported chronic scalp problems of at least 10 years. And 27.38% (46/168) of the patients had an immunocompromised status, including long-term use of corticosteroids shampoo, type 2 diabetes mellitus (DM), psoriasis vulgaris, rheumatoid arthritis, systemic lupus erythematosus or bullous pemphigoid. As for clinical presentation, 87.5% (147/168) of the cases presented as black dot type of TC and anthropophilic dermatophytes were the predominant etiology, with Trichophyton violaceum (126), T. tonsurans (15), T. rubrum (8) and T. shoenleinii (6). Grey patch type of TC (3.57%, 6/168) was seldom in Jiangxi Province and zoophilic/geophilic dermatophytes were rare. Our study indicates that anthropophilic Trichophyton species can cause long-lasting TC in adults. Not in all cases, the manifestation had symptom clearly indicating a dermatophyte-related TC. Thus, patients with long-lasting scalp inflammation, also older ones, should be examined for the presence of dermatophyte-related TC.

Kerion Celsi due to Microsporum canis in an Adult Woman, Treated Successfully with Fosravuconazole.

A 64-year-old woman presented with a fist-sized, severely painful lesion with scales, crusts, pustules, erythema with subcutaneous abscess, and hair loss on the left temporal region. Direct microscopic examination revealed a large number of spores around the hair, which indicated ectothrix hair invasion, and some hyphae were also found. Histopathological examination showed significant inflammatory cell infiltration from the dermis to the subcutaneous tissues and into the hair follicles, destruction of the hair follicles with granulomatous reactions, and fungal masses along the hair within the hair follicles. Microsporum canis was identified based on morphological features via culture method and molecular biological analysis of the internal transcribed spacer region DNA sequence. The patient was diagnosed with kerion celsi caused by M. canis. For treatment of kerion celsi, we chose an oral antifungal agent, fosravuconazole (FRVCZ), which has been available since 2018 only in Japan. Clinical symptoms were cured in 12 weeks without scarring. No side effects were observed during oral administration of FRVCZ. The results of our case and several previous reports suggest that FRVCZ is effective in treating various types of dermatomycoses.

Scalp Infection, Inflammation, and Infestation.

Tinea capitis, folliculitis, seborrheic dermatitis, and pediculosis capitis are four common scalp conditions. Although tinea capitis and seborrheic dermatitis are found more commonly in patients with skin of color and highly textured hair, all of these conditions have special diagnostic or management considerations in these populations. This article reviews the diagnosis and management of these common scalp conditions.

Pediatric tinea capitis in Jilin Province: analyzing previous results from a new perspective.

OBJECTIVES: To investigate the current etiological, diagnostic, and therapeutic characteristics of tinea capitis in children in Jilin Province. METHODS: Sixty pediatric patients with tinea capitis were enrolled between August 2020 and December 2021. Data on calcofluor white (CFW) fluorescence microscopy, fungal culture, Wood's lamp examination, dermoscopy, treatment, and follow-up were collected and analyzed. RESULTS: 1. Of all the enrolled patients, 48 had a history of animal contact, mostly with cats and dogs. Fifty-one strains were isolated, of which 46 were Microsporum canis (M. canis). 2. All enrolled patients were examined using fluorescence microscopy, and 59 were positive. Forty-one cases of tinea alba were examined using Wood's lamp, and 38 were positive. Forty-two cases of tinea alba were examined using dermoscopy, and 39 demonstrated specific signs. Effective treatment manifested as a fading bright green fluorescence, decreased mycelial/spore load, reduced specific dermoscopic signs, and hair regrowth. 3. Treatment was terminated in 23 and 37 cases based on mycological and clinical cures, respectively. No recurrence occurred during follow-up. CONCLUSION: 1. M. canis is the predominant pathogen causing tinea capitis in children in Jilin Province. Animal contact is considered the main risk factor. 2. CFW fluorescence microscopy, Wood's lamp, and dermoscopy can be used to diagnose ringworms and follow-up patients. 3. Both mycological and clinical cures can be the endpoint of adequate treatment for tinea capitis.