Tinea Capitis Research Articles

The role of ingrown hairs in persistent kerion of children: A clinical study.

Tinea capitis, a common public health problem in developing countries, has severe forms such as kerion. However, the underlying mechanisms and standard treatments for persistent cases of tinea capitis or kerion remain controversial. In this work, we investigate the ingrown hairs and corresponding treatment in persistent kerion of children. Children with persistent kerion were enrolled among 312 cases of tinea capitis at the Department of Dermatology, Hangzhou Third People's Hospital from January 2020 to June 2024. The presence of fungal infection was ascertained by direct microscopic examination under calcofluor white staining and routine culture. The structure of the ingrown hairs was observed directly by a dermatoscope, which was subsequently extracted using sterile tools. A total of six cases of persistent kerion among 312 cases of tinea capitis were enrolled. Ingrown hairs were ascertained under dermatoscopy and extracted by minor operation. Except for one patient who continued oral terbinafine, the other five cases were cured by removal alone. Ingrown hairs, induced by fungal infection, may be an aggravating factor of persistent course of tinea capitis. Our study demonstrated that the presence of ingrown hairs could be confirmed through direct dermatoscopy, and patients experienced significant improvement following removal treatment under dermatoscopy.

Epidemiology, clinical features, and outcome of the hospitalized patients with Kerion in Fars Province, Iran: an eleven-year retrospective study

BackgroundKerion, a severe inflammatory type of tinea capitis, presents with purulent, boggy swelling and alopecia. Few articles in the literature provide information on this uncommon manifestation of tinea capitis (TC). This study aimed to determine the epidemiological and clinical characteristics of patients with Kerion over an 11-year period in an inpatient setting.MethodsIn this retrospective cross-sectional study, we enrolled all the admitted patients with inflammatory TC in the dermatology department of Shahid Faghihi referral hospital during 2011–2022. The data included demographic factors, animal contact, treatment, outcome, and past medical profiles. We used STATA 14.2 to analyze the data.ResultsOne hundred and thirty-two patients with Kerion were enrolled in to the study. the mean age of patients was 7.6 ± 5.8 years. Boys (82.5%, n = 109) significantly outnumbered girls (17.5%, n = 23), and 82.2% of patients were under 11 years of age. Eight patients were one to two years old, two were infants under one year old, and five were adults. More than half (52.2%) of the patients were from rural areas. Most of the cases had heavily utilized systemic antifungal therapy, antibiotics, and corticosteroids. In addition, 43 patients reported positive animal contact. Over the course of an eleven-year period, there was a downward trend in the number of hospitalized patients.ConclusionWe report one of the largest studies on Kerion patients over an eleven-year period. We have expanded the information on Kerion patients’ epidemiology, transmission mode, and clinical outcomes. To develop preventative strategies for Kerion, future studies should focus on additional risk factors and individual susceptibilities.

Fungal disease incidence and prevalence in Iraq – Preliminary estimates

BackgroundThe surveillance of serious and superficial skin fungal infections in Iraq has not been conducted. Limited information exists on their incidence and prevalence. ObjectivesThis study aimed to analyze, compute and estimate the prevalence and burden of fungal infections, as no previous data is available and no studies has been attempted in Iraq. MethodsIn the present study the data were collected and reviewed from published data on epidemiology of fungal infections nationally, internationally, from unpublished postgraduate master and PhD theses, hospital records and private clinic records. External sources of data from other countries were used for diseases which lacked sufficient local data. ResultsWe estimated 985,628 annual serious infections comprising of 2.26 % of the total population. When including superficial fungal infections group of the skin, this rises to 2,075,113 infections at 4.76 % of the total population. The most common serious and skin infections were recurrent Candida vaginitis, fungal rhinosinusitis and tinea capitis comprising 61.5 %, 21.8 %, and 22.4 % of all infections although the total incidence of superficial fungal infections was also high at 1,071,485. Respiratory fungal disease is also common comprising 14.0 % of infections. We predicted the following annual burden per 100,000; oral candidiasis at 247.9, esophageal candidiasis at 6.04, candidemia at 5.0, Candida peritonitis at 0.75, recurrent Candida vaginitis at 5461, allergic bronchopulmonary aspergillosis at 35, severe asthma with fungal sensitisation at 46, invasive aspergillosis at 7.9, chronic pulmonary aspergillosis at 11.7, chronic fungal rhinosinusitis at 496, mucormycosis at 0.99, fungal keratitis at 14.0, and total dermatophytosis at 1631, the most severe being tinea capitis at 366. Many of these estimates were made with data sourced from other nations, so additional data from Iraq is required to validate or modify these estimates. ConclusionRecurrent Candida vaginitis, fungal rhinosinusitis, and tinea capitis are considered to be the most frequent fungal diseases present in Iraq.

Molecular Identification of Microsporum canis Isolated from Infected Children with Tinea corporis and Tinea capitis in Baghdad

Microsporum canis is considered one of the filamentous fungi that cause surface fungal contagion in the humans and animals. The present study aimed to diagnose M. canis via the molecular method and differentiating its local Iraqi isolates from global isolates. Microscopic examination showed 55 specimens with M. canis from 130 specimens collected from children aged between 4-10 years suspected of dermatophytes who attended Medical City Laboratories and Baghdad Hospital in Baghdad city from 1/12/2022 to 1/3/2023. The results showed that the frequency of M. canis infections was 55/130 (42.31%). The results demonstrated significant differences in the animals' contact (p <0.0001), lesions (0.03) and habitation area (p =0.002). Whilst the ages appeared with non-significant differences (p =0.6). In order to confirm the microscopic examination and compare the Iraqi isolates with other global ones, the 55 positive results with M. canis were further diagnosed by using internal transcribed spacer (ITS) 1 and 4 universal primers with a size of 550 bp for PCR amplicons. PCR amplicons sequencing showed only one isolate of M. Canis that differed from global isolates registered in the database of NCBI. The Iraqi local isolate of M. canis was registered with accession number: OM185328. In conclusion, the PCR technique using ITS rDNA aided in confirming the detection of dermatophytes.

Trichoscopic Evaluation of Focal Non-Cicatricial Alopecia in Egyptian Children

Introduction: Dermoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible to the naked eye. Trichoscopy is useful for the diagnosis and follow-up of hair and scalp disorders. Objective: The aim of the present study is to evaluate the causes of focal non-cicatricial alopecia in Egyptian children and to assess the importance of the trichoscope in the diagnosis of each disease. Methods: This study was done with 200 Egyptian children patients aged from 2 to 18 years who suffered from focal non-cicatricial alopecia. Clinical and dermoscopic evaluations were performed for all patients, and informed consent was obtained from their parents. Results: The most prevalent diagnoses were alopecia areata (42%) and tinea capitis (40.5%), followed by trichotillomania (8%) and tractional alopecia (7%). Congenital triangular alopecia (1.5%) and patchy androgenetic alopecia (1%) were less common. Trichoscopy revealed distinct features in alopecia areata cases, such as short vellus hair, exclamation mark hair, black dots, broken hair, pigtail hair and upright regrowing hair. The most common trichoscopic features of tinea capitis were comma hair, corkscrew hair, broken hair, bent hair, zigzag hair, morse code hair, perifollicular scaling, and diffuse scaling. These findings contribute to understanding the etiology and clinical presentation of childhood alopecia, facilitating accurate diagnosis and appropriate management. Conclusion: The routine use of dermoscopy in the clinical evaluation of scalp and hair disorders enhances diagnostic capabilities beyond simple clinical inspection. Dermoscopy reveals disease features that contribute to accurate diagnosis and improved management.

Systematic review of the evidence for treatment and management of common skin conditions in resource-limited settings: An update.

The skin is the largest and most visible organ of the human body. As such, skin infections can have a significant impact on overall health, social wellbeing and self-image. In 2019, we published a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource-limited settings where skin infections are endemic. This current review serves as an update to assess the evidence for treatment of these conditions as well as atopic dermatitis, molluscum contagiosum and head lice in endemic settings. The data from this systematic review have supported an update to the Australian National Healthy Skin guidelines. A systematic review was conducted using two separate searches in MEDLINE, PubMed, Embase, CINAHL, Cochrane and Web of Science. The first search was an update of the 2018 systematic review using the same search strategy for the same skin conditions to identify emerging literature from 2018 to 2022. The second search strategy used the same key terms but with the addition of atopic dermatitis, head lice and molluscum contagiosum from 1960 to 2022. Eligible studies included Indigenous peoples and populations in resource-limited settings with a diagnosis of impetigo, scabies, crusted scabies, tinea capitis, atopic dermatitis, molluscum contagiosum or who presented with head lice. Studies conducted in high-income countries were excluded. Articles were screened for inclusion independently by one author with a second group of reviewers independently double screening. Data extraction and an in-depth quality assessment conducted by one author and checked by two others. Of 1466 original articles identified, 68 studies were included and key findings outlined for impetigo, scabies, crusted scabies, atopic dermatitis, head lice and molluscum contagiosum. Recommendations for each condition based on the available evidence are provided. The importance of assessing literature relevant to the populations with heavy burden of skin infections is outlined in this systematic review. We have summarised updates to this literature, which may benefit in developing guidelines for skin infection management similar to the National Healthy Skin Guidelines for Australia.

Microsporum audouinii: Emergence of an etiological agent of tinea capitis in Rio de Janeiro, Brazil (2012-2019).

The etiology of tinea capitis changes over time, mainly due to trends in migration. We report 19 cases of tinea capitis caused by Microsporum audouinii, an uncommon agent in South America, all of them confirmed by molecular methods. All patients were male. The average age was 6.1 years. Fifteen patients were residents of Rio de Janeiro city and four were from neighboring cities. Among the patients submitted to follow-up, griseofulvin was prescribed for eight of them. Due to medication shortages, terbinafine was prescribed for five patients, needing to be switched in three cases, with a bigger total average time until clinical improvement. The study reaffirms the emergence of a new etiological agent in Rio de Janeiro, Brazil.

Trichophyton soudanense, Trichophyton violaceum, and Trichophyton tonsurans in Munich: Travel- and Migration-Related Cutaneous Fungal Infections

Introduction: Trichophyton soudanense, Trichophyton violaceum, and Trichophyton tonsurans are considered rare pathogens in Germany. They are presumed to infect people from Germany when they are traveling to tropical and subtropical areas. The incidence and the mode of infection with these three fungal pathogens in Munich were investigated to assess their significance for clinical practice. Methods: This monocentric study was conducted at a large European academic dermatology department in Munich from January 1, 2011, till August 30, 2020. We performed a retrospective analysis of medical data of all out- and inpatients presenting at our hospital with a suspected cutaneous fungal infection. Results: A total of 87,229 swabs were collected from 48,916 patients; 11,513 (13.2%) cultures confirmed a fungal infection. One of the three aforementioned dermatophytes was detected in 247 (2.1%) samples. The average patient age was 15.5 years (0–84 years, SD: 15.6) at the time of infection. T. tonsurans was the confirmed pathogen in 137 (55.5%) samples with increasing frequency over time. T. tonsurans spread in 11 cases through close contact with humans (kindergarten, martial arts, accommodation for asylum seekers). T. violaceum was detected in 88 (35.6%) samples with a peak in 2016 and 2017. T. soudanense was detected in 22 (8.9%) samples. A total of 46.7% of all tinea capitis cases were caused by one of these pathogens. Conclusion: In case of tinea capitis, a travel history should be performed and rare fungal infections should be considered in the differential diagnosis.

Prevalence and Risk Factors of Tinea Capitis Among Primary School Children in the Grand Lomé Region (Togo), 2021: A Cross-Sectional and Case-Control Study Approach.

Tinea capitis is an infectious dermatosis frequent in children, causative fungi variable over time and space. The risk factors associated with this disease are still poorly understood. The objective of this study was to estimate the prevalence of tinea capitis among schoolchildren in Lomé (Togo), identify the fungal species involved and assess the associated risk factors. It was a cross-sectional and case-control study conducted in primary schools in Lomé from November 2020 to April 2021. All pupils presenting tinea capitis suspected lesions have been sampled, and the scraping and hair were examined by direct microscopy in KOH solution and cultured in Sabouraud dextrose agar with chloramphenicol and cycloheximide. Positive children were matched by age and sex with those without symptoms for case-control study. Out of the 15,087 pupils enrolled, 465 had positive cultures for dermatophytes, corresponding to the tinea capitis prevalence of 3.08% (95% CI [2.59-3.57]). Trichophyton mentagrophytes (81.86%) and Trichophyton soudanense (13.12%) were the majors isolated dermatophytes. The risk factors were mostly living in households with domestic animals, showering less than twice a day, having a history of ringworm, having similar lesions in the same household and sharing personal hygiene items. This study highlights the low prevalence of tinea capitis in schoolchildren in Lomé (Togo), the causative species dominated by T. mentagrophytes and emphasises the importance of environmental and behavioural factors in the mycosis transmission. Implementing preventive measures addressing the identified factors could help to reduce the prevalence of this disease.

Clinical Profile and Mycological Profile of Dermatophytosis: A Cross-sectional Study at a Tertiary Care Hospital in Southern India

Abstract Background: This cross-sectional observational study aimed to analyze the clinical and mycological characteristics of dermatophytosis in patients visiting the outpatient clinic of the department of dermatology at a tertiary care hospital in Telangana. Methodology: The study was conducted from November 2017 to July 2019, involving patients clinically diagnosed with dermatophytosis. Data collection included detailed demographic and clinical information and laboratory investigations such as direct microscopy, fungal culture, and hematological examinations. Specimens were collected from skin lesions, nails, and hair, processed using appropriate methods, and subjected to culture and microscopic examination. Descriptive statistics was performed to present the findings. Results: A total of 100 participants were recruited, with a median age of 24 years. The majority were male (n = 75, 75%) and students (n = 47, 47%). Most participants (n = 71, 71%) presented with extensive tinea followed by tinea corporis and tinea capitis. Trichophyton mentagrophytes was the most isolated variant (n = 42, 97.7%) among positive cultures. Conclusion: Young male populations are the most common victims in this region. The significant number of tinea cases and the high prevalence of T. mentagrophytes underscore the necessity for precise diagnosis and effective management strategies in treating dermatophytosis.

Molecular Detection of Microsporum Canis Infection in Cats in Baghdad Governorate

Microsporum canis is a keratinized skin fungus that causes diseases in all animals, especially in cats. It is able to infected human causes Tinea corporis and Tinea capitis. In this study,the aim was toward detection and confirmation of Microsporum canis infection in cats in Baghdad governorate using polymerase chain reaction (PCR).The diagnosis depend on sequencing of the PCR products obtained by using a universal primer to amplification of the primer DppV which was 895 bp.A total of two hundred and eighty three hair and skin scraping samples were collected from infected cats with and without skin lesions. Preliminarily examined of samples with 10% KOH preparation, and cultured for fungal identification . For the culture; Saboruad dextrose agar was used . Culture results showed that four isolates were positive for M. canis , the best growth of these isolates was confirmed by PCR and DPPV gene then sequencing of this gene. PCR technique showed that one isolate from the total of 283 isolates were assured for the DPPV gene and yielded a band at 895 bp, this finding is regarded as distinctive for the genus Microsporum canis ,which was dumped in the GenBank nucleotide sequence database under accession number OR126262. Results sequencing of this gene in Iraq revealed compatibility with global results in USA and Belgium.

Isolation and Identification of Microsporum Canis from cats in Baghdad governorate

Microsporum canis is a keratinized skin fungus that causes diseases in animals, especially cats. It is able to infect human causes Tinea corporis and Tinea capitis . The aim of this study is to isolate and identify the dermatophyte fungi Microsporum canis from cats in Baghdad / Iraq .This research focused on the epidemiology of M. canis found in cats.A total of two hundred and eighty three hair and skin scraping samples were collected from infected cats .preliminarily examined with 10% KOH preparation, and cultured for fungal identification . For the culture; Saboruad dextrose agar was used . The results of this study showed that four samples were positive for M.canis . The pathogen was found both at the site of the lesion and at other sites in the body. The pathogen can be found in the hair of cats with and without skin lesions.

Tinea capitis with kerion complicated by keloid formation in a 34-year-old man: A case report

A kerion, also known as a dermatophyte, is a type of inflammatory tinea capitis caused by an exaggerated immune response to a fungal ringworm infection primarily affecting the scalp. A keloid is an abnormal scar tissue proliferation occurring at the site of tissue injury or spontaneously. It occurs more commonly in darker-skinned individuals. The coexistence of kerion and keloid is rare. This case involves a 34-year-old man who presented with a four-year history of scalp swelling, itching, and occasional fluid discharge. There is a history of keloids in multiple parts of the body. Examination revealed multiple keloids on the scalp alongside a purulent, oozing rash with satellite nodules. Skin scraping for KOH microscopy was positive for fungal spores and hyphae. This case highlights the rare complication of keloid formation in kerion which can hinder effective treatment of the underlying fungal infection.

Tinea capitis, caused by Microsporum canis (felineum) : literature review and clinical cases

According to statistics, tinea capitis remains the main mycological problem in childhood. The spectrum of causative agents of tinea capitis varies depending on the continent. In epidemiological terms, the pathogenic fungus Microsporum canis (felineum)absolutely predominates on the Eurasian continent. A significant problem in the diagnosis and, in particular, in the treatment of microsporia are cases of the disease in very young children: we estimate this most problematic age from 1 to 18 months. Microsporia in children under the age of 1 year is the most relevant in pediatric clinical mycology due to the limited arsenal of topical and systemic medications approved at this age. The clinical case presented in this article demonstrates an example of successful treatment of scalp microsporia in a 7-month-old child who had contraindications to systemic therapy. It should be noted that the duration of treatment in this case was almost 4 months, while the most effective therapy regimens, including systemic drugs, lead to the elimination of pathogenic fungus from the foci on the scalp within 30–45 days.

A study on the Prescription Pattern of Antifungal Drugs in Aden-Yemen

Background: Fungal infections are more common in tropical zones; they can be simple, complicated, or even fatal. Studying the prescribing pattern can help physicians provide rational medical care and appropriate patient compliance. The current study aimed to determine the prescription patterns of antifungals in three departments and the distribution of fungal disease to help in developing policies and stewardship in using antifungal medications. Method: This cross-sectional study was conducted over 6 months from March to October 2023. Potential participants were approached in Governorate and private pharmacies, and dermatologic, gynecologic, and dental clinics. Results: The total number of collected prescriptions was 250. The analysis of the demographic characteristics of the involved patients showed that about 166 (66.4%) of the patients were females and 84 (33.65%) were males. Most of the patients are in the age group (19-35 years). Most of the fungal infection was vulvovaginal candidiasis 64(25.6%), Tinea versicolor 38(15.2), Tinea cruris 30(12%), oral candidiasis 21 (8.4 %), Tinea corporis (8.4%) then Tinea pedis and skin candidiasis had equal number 19 (7.6%), followed by tinea capitis 12 (4.8%) and onychomycosis 12 (4.8%). The most prescribed oral medicines were Itraconazole 66 (26.4%), followed by Fluconazole 56 (22.4%), Terbinafine 28 (11.2%), Ketoconazole 29 (11.6%) and Griseofulvin 13 (5.2%). The topical medicines prescribed were as follows: Ketoconazole 98 (39.28%), Clotrimazole 46 (18.4 %), Terbinafine 36 (14.4%), and Miconazole 33 (16.4%). The majority of patients (75%) received a combination of topical and systemic oral therapy. While (25 %) were treated by only topical agents.

Exploring the Arsenal of Novel Antifungal Drug Targets for Combating Fungal Infections.

Fungal infections contribute to over 1.5 million fatalities each year, with cutaneous mycoses standing as prominent global infections. The spectrum of these mycoses varies widely, encompassing enduring afflictions like ringworm, localized infections such as tinea capitis, recurrent instances like vaginal candidiasis, and potentially fatal systemic infections impacting multiple organ systems. The escalating recognition of the health and socioeconomic ramifications associated with fungal pathogens underscores their importance in contemporary discourse. On a global scale, projections indicate that over 300 million individuals experience significant fungal infections annually, resulting in a mortality rate exceeding 1.5 million deaths per year. Alarmingly, resistance to commonly used antifungal drugs was on the rise, with some reports suggesting that over 10% of Candida bloodstream isolates worldwide were resistant to fluconazole, a commonly prescribed antifungal medication. Therefore, there is an immediate need to increase the accessibility of new antifungal medications while minimizing their costs and adverse effects. Fungi, as heterotrophic organisms, acquire nutrients through absorption. Their filamentous structure, composed of hyphae, facilitates efficient nutrient uptake by secreting enzymes that break down complex organic matter into simpler compounds. These organisms exhibit remarkable adaptability in responding to environmental cues, adjusting growth rates, and altering morphological features. Fungi regulate their metabolism intricately, undergoing various metabolic pathways for energy production and utilizing diverse substrates for respiration. Additionally, they exhibit distinctive reproductive strategies, employing both sexual and asexual modes of reproduction, contributing to their genetic diversity and resilience in diverse ecosystems. We now have more information than ever on the origins of infection as well as the physiology of fungi cells, giving us the chance to use it to produce new generations of antifungals. This review includes various novel antifungal drug targets showing their possible effects via different mechanisms aiming at vital functions like GPI synthesis, cell wall synthesis, hyphal growth, and other essential pathways responsible for fungal growth.

Tinea Capitis in the Elderly: Clinical experience of 36 cases in ten years.

Tinea capitis in older people is rare. Here, we describe our experience of 36 cases of tinea capitis in older individuals over a 10-year period. We present clinical, mycological and treatment characteristics.

An update on tinea capitis in children.

Tinea capitis presents a significant public health care challenge due to its contagious nature, and potential long-term consequences if unrecognized and untreated. This review explores the prevalence, risk factors, diagnostic methods, prevention strategies, impact on quality of life, and treatment options for pediatric tinea capitis. Epidemiological analysis spanning from 1990 to 1993 and 2020 to 2023 reveals prevalence patterns of pediatric tinea capitis influenced by geographic, demographic, and environmental factors. Notably, Trichophyton species is most prevalent in North America; however, Microsporum species remain the primary causative agent globally, with regional variations. Risk factors include close contact and environmental conditions, emphasizing the importance of preventive measures. Accurate diagnosis relies on clinical evaluation, microscopic examination, and fungal culture. Various treatment modalities including systemic antifungals show efficacy, with terbinafine demonstrating superior mycological cure rates particularly for Trichophyton species. Recurrent infections and the potential development of resistance can pose challenges. Therefore, confirming the diagnosis, appropriately educating the patient/caregiver, accurate drug and dose utilization, and compliance are important components of clinical cure. Untreated or poorly treated tinea capitis can lead to chronic infection, social stigma, and psychological distress in affected children. Prevention strategies focus on early detection and healthy lifestyle habits. Collaborative efforts between healthcare providers and public health agencies are important in treating pediatric tinea capitis and improving patient outcomes. Education and awareness initiatives play a vital role in prevention and community-level intervention to minimize spread of infection. Future research should explore diagnostic advances, novel treatments, and resistance mechanisms in order to mitigate the disease burden effectively.

TINEA CAPITIS IN ADULTS: ABOUT 10 CASES

Tineacapitis (TC)is a superficialfungal infection primarilyseen in school-agedchildren. Adulttineacapitis (ATC) is rare, with distinct clinicalfeatures and ofteninvolvesidentifying local and generalpredisposingfactors. We report a series of 10 adult patients.

Diagnosis and Management of Hair Loss in Pediatric

Background: Hair loss can occur in pediatric and adult populations and may have different patterns. The causes of hair loss in pediatric patients include tinea capitis, alopecia areata, telogen effluvium, traction alopecia, anagen effluvium, androgenetic alopecia, loose anagen syndrome, short anagen syndrome, congenital aplasia cutis, congenital triangular alopecia, atrichia congenita, congenital hypotrichosis, and transient neonatal hair loss.Purpose: to understand etiologies of hair loss in pediatrics, and to determine the appropriate examinations for diagnosing and managing hair loss in children.Review: Hair loss in children can be categorized as congenital or acquired. Congenital hair loss is classified based on distribution, while acquired hair loss is classified as either scarring or non-scarring. Hair loss complications in children can be irreversible. The diagnosis of hair loss in pediatric patients includes anamnesis, physical examination, and supporting examinations. The supporting examinations used for diagnosis include fungal cultures, hair pull tests, hair tug tests, light microscopy, and trichoscopy. Conclusion: There are numerous causes of hair loss in pediatric patients that need to be identified before appropriate management can be implemented. The management of hair loss requires a holistic approach, including psychosocial support. Correct diagnosis and treatment of pediatric hair loss can prevent a decrease in the patient's quality of life.