Photodynamic therapy of tinea capitis in children using curcumin loaded in nanospanlastics: A randomized controlled comparative clinical study

Abstract

Tinea capitis is a common scalp dermatophyte infection in children. Treatment necessitates oral antifungal therapy which represents a therapeutic challenge. Photodynamic therapy (PDT) has emerged as a new antifungal therapeutic approach. The efficacy of PDT depends on the proper choice of the photosensitizer and its delivery system. Curcumin, a natural polyphenol, is well studied as a photosensitizer, however, its hydrophobicity hinders its clinical use. This study aims to improve the use of curcumin in PDT by loading it to a novel vesicular nano spanlastics (NVS) and examine their efficacy in PDT of tinea capitis.A prospective, randomized, controlled comparative study was conducted. Fifty-two children with Tinea Capitis were randomly divided into four groups; Cur-PDT group, oral griseofulvin group, topical curcumin group, and blue light group. Clinical and dermoscopic assessments were done, at baseline, every two weeks and after 6 months for follow-up. The results were confirmed by potassium hydroxide (KOH) 10% and fungal culture before and after the treatment. Complete cure was based on clinical, dermoscopic, and mycological cures.Cur-PDT group showed complete clearance in 46% of children with variable response among fungal species, compared to 100% in the griseofulvin group. No effects were observed in curcumin or light groups. Cur-PDT group showed very mild tolerable burning pain. Griseofulvin group experienced systemic side effects in some cases. Cur-PDT can be a promising well-tolerated alternative treatment of tinea capitis, but with variable responses among fungal species.