Excretion of technetium in human milk

Abstract

fore, physicians are most familiar with the clinical manifestations of this infectioni round patches of scaling alopecia which fluoresce blue-green with Wood light, kerion formation, or both. Since the 1950s, however, reports have indicated an increase in the incidence of Trichophyton tonsurans induced tinea capitis:-' Zais et aP reported this organism as the etiologic agent in 45% of 324 cases of tinea capitis they reviewed. Infection of the scalp with T. tonsurans causes partial alopecia which is not always oval or rounded but often irregular in outline, with indistinct margins. Normal hairs may be seen growing within the patch. A characteristic feature is the breakage of infected hairs at the scalp surface, producing the appearance of dots. ''5 The hairs are non-fluorescent. A manifestation of tinea capitis caused by T. tonsurans that physicians, other than dermatologists, are not familiar with is diffuse scaling (dandruff') with minimal or no hair loss. Current pediatric literature 6-8 and textbooks 9. 10 fail to emphasize these findings in discussions of tinea capitis. The diagnosis of tinea capitis can be elusive. Wood light examination is not a suitable procedure when T. tonsurans infection of the scalp is present. A potassium hydroxide preparation of infected hairs is a meticulous and timeconsuming effort which is often difficult to interpret by the inexperienced observer. However, with a properly interpreted potassium hydroxide examination treatment can be started immediately. Our greatest success has been with toothbrush scrapings of the scalp inoculated onto Mycosel media. Scalpel scrapings may also be used for culture. Tinea capitis should be included in the differential diagnosis of diffuse scaling of the scalp, as well as seborrheic dermatitis, atopic dermatitis, and impetigo. Clinical clues which may indicate the presence of tinea capitis are (1) nonresponsive seborrheic or atopic dermatitis of the scalp (i.e., diffuse or patchy scaling), (2) scattered broken hairs giving the appearance of black dots, and (3) increased scaling of the scalp after topical application of steroid solutions. Any of these manifestations should prompt a request for fungal cultures of the scalp. REFERENCES