Trichophyton Tinea Capitis Research Articles

A Case Report of Tinea Capitis in Children: Utility of Trichoscopy

Background: Tinea capitis (TC) is the most prevalent pediatric superficial dermatophyte infection. Scalp dermoscopy or “trichoscopy” represents a valuable, noninvasive technique for the evaluation of patients with hair loss due to TC. Purpose: To characterize trichoscopic findings in children with clinical findings suggestive of TC. Case: A 13-year-old boy was presented with a scaled plaque on his scalp that had appeared 1 month earlier. A physical examination revealed a scaly, nonerythematous, rounded lesion in the parietal area of the head. Wood’s lamp yielded a blue fluorescence. Microscopic morphology from fungal culture found the typical spindle-shaped macroconidia of Microsporum canis. Trichoscopy showed mainly comma hair, corkscrew hair, morse code hair, bent hair, and zig zag hair. The patient was started on oral griseofulvin 20 mg/kg/day and antifungal shampoo for 8 weeks. The patient was cured after two months of treatment and trichoscopy returned to normal. Discussion: Fungal culture remains the gold standard in TC diagnosis, but it needs time. Trichoscopy can be an additional tool to help evaluate the diagnosis, aetiology, and follow up of this disorder. The presence of characteristic trichoscopic features (comma hairs, corkscrew hairs, Morse code-like hairs, zigzag hairs, bent hairs, block hairs, and i-hairs) is predictive of TC. The present analysis confirmed that trichoscopy is a useful method in differentiating between Microsporum and Trichophyton TC, which is important from the perspective of a different therapeutic approach. Conclusion: Trichoscopy is not only of value in the diagnosis of TC but also for the etiologic agent and follow-up after treatment in this case.

Trichoscopy of Tinea Capitis: A Systematic Review.

IntroductionAn increased incidence of tinea capitis has been observed over the last few decades. Trichoscopy is a non-invasive, in-office method helpful in establishing the correct diagnosis in patients with hair loss and inflammatory hair disorders. The objective was to review and analyze current data on the trichoscopy of tinea capitis.MethodsA systematic review of the literature was conducted using the PubMed, EBSCO and Scopus databases. The search terms included ‘tinea capitis’ combined with ‘trichoscopy’, ‘dermatoscopy’, ‘dermoscopy’, ‘videodermatoscopy’ or ‘videodermoscopy’.ResultsOf 326 articles, 37 were considered eligible for the quantitative analysis. The most characteristic (with a high predictive value) trichoscopic findings of tinea capitis included comma hairs (51%), corkscrew hairs (32%), Morse code-like hairs (22%), zigzag hairs (21%), bent hairs (27%), block hairs (10%) and i-hairs (10%). Other common, but not characteristic, trichoscopic features were broken hairs (57%), black dots (34%), perifollicular scaling (59%) and diffuse scaling (89%). Morse code-like hairs, zigzag hairs, bent hairs and diffuse scaling were only observed in Microsporum tinea capitis (8/29, 28%; 6/29, 21%; 4/29, 14% and 4/29, 14%, respectively). In Trichophyton tinea capitis, corkscrew hairs were more commonly detected compared to Microsporum tinea capitis (21/38, 55% vs 3/29, 10%).ConclusionThe presence of characteristic trichoscopic features of tinea capitis is sufficient to establish the initial diagnosis and introduce treatment before culture results are available. Trichoscopy may be useful in distinguishing between Microsporum and Trichophyton tinea capitis.

Continuous increase of Trichophyton tonsurans at the expense of Microsporum audouinii var. langeronii as a cause of tinea capitis in the urban area of Paris: A five-year long study

Tinea capitis (TC) remains a public health in pediatric population in urban areas. The dermatophytes responsible can be divided into three major groups: anthropophilic, zoophilic, and geophilic species. Our objective was to analyze the recent epidemiology of TC in our hospital in Paris, France. We included all the patients seen from October 2010 to September 2015 in our laboratory for suspicion of TC. Suspected lesions were sampled and epidemiological data were recorded. After a direct microscopic examination, hair samples were seeded on Sabouraud medium agar slant and kept 3 weeks at 26 °C. The species identification was based on macroscopic and microscopic examination. We obtained 3372 samples from 3090 patients (sex ratio 0.93; median age: 8 years, range: 1 month-89 years). We observed 36% of infections, with an overrepresentation of young boys (71%) and 7.5% of patients were defined as carriers. Three anthropophilic species were predominant (96%): Trichophyton soudanense, Trichophyton tonsurans, and Microsporum langeronii. For a given family (n = 233.2 to 6 members), the same species was identified when several TCs were diagnosed except for five. Therefore, we counted one family as one case to analyze the evolution over time. Globally, the incidence of T. tonsurans increased over time and it was the first species isolated in 2014. When considering the geographical origin, we observed a continuous increase of T. tonsurans in the sub-Saharan African patients, mainly at the expense of M. langeronii, T. soudanense remaining quite stable ( Fig. 1 ). In the Caribbean patients, T. tonsurans remained majority, although T. soudanense was present, suggesting transmission between communities. This increase of T. tonsurans could be due to a better fitness of this species for transmission between individuals through community contacts or by common hairdressers. Another explanation could be the less susceptibility of T. tonsurans to griseofulvin, the main agent used in the pediatric population to treat TC. This study showed that T. tonsurans became in 2014 the major agent of TC in the urban area of Paris, as already reported in London. Although British and American guidelines supporting terbinafine as the first choice to treat Trichophyton TCs, the French recommendation is griseofulvin since terbinafine does not have governmental approval in children. These recommendations could be challenged in case of continuous increase of T. tonsurans in TC.