Tinea capitis: current concepts

Trichoscopic signs of tinea capitis: a guide for selection of appropriate antifungal

BACKGROUND

Tinea capitis is the most common pediatric dermatophyte infection. Optimal treatment regimen differs according to the type of the dermatophyte involved.

OBJECTIVES

The aim of this work was to study the trichoscopic signs in relation to isolated organism in a sample of Egyptian patients with tinea capitis and the possibility of using them as a guide for selection of appropriate antifungal.

METHODS

This study was carried out on 60 subjects with tinea capitis. Patients were mycologically examined, both direct microscopy with KOH preparation and culture of the scraped hair materials on Sabouraud dextrose agar. Culture mounts were used for identification of the organism. Trichoscopic examination of all patients was performed using the Dermlite DLIII dermoscope.

RESULTS

There was significant higher prevalence of both comma and corkscrew hair in endothrix infection and T. violaceum-infected cases. On the other hand, there was significant higher prevalence of zigzag, barcode hairs, and white sheaths in ectothrix infection and M. canis-infected cases.

CONCLUSION

While some trichoscopic findings are nonspecific, others were found to be more specific. Finding zigzag hairs and barcode hairs points to ectothrix infection (M. canis), and it is recommended to start treatment with griseofulvin. On the other hand, finding comma hairs and corkscrew hairs without zigzag hairs and barcode hairs points to endothrix infection (T. violaceum), and it is recommended to start treatment with terbinafine in the usual dose.

Tinea capitis in schoolchildren from lvory Coast (western Africa). A 1998-1999 cross-sectional study

BACKGROUND

Tinea capitis is a worldwide public health problem that poses specific therapeutic challenges. This dermatophytosis of the scalp is endemic in Africa. The objectives of this study were to determine the prevalence, the associated demographic factors, causative species, and clinical types of tinea capitis in Abidjan, Ivory Coast.

METHODS

From June 1998 to March 1999, 1913 children aged between 4 and 15 years, and schooling in seven urban primary schools of Abidjan (Ivory Coast), were examined clinically for tinea capitis. Among all children showing symptoms suggestive of scalp ringworm, hair stumps and scales were collected and exposed to direct microscopic examination using 30% potassium hydroxide solution, and cultivation on Sabouraud's dextrose agar with or without actidione.

RESULTS

Among 227 symptomatic children, cultures positive for fungi were found in 217, yielding an overall tinea capitis prevalence of 11.34% [95% Confidence Interval (CI), 9.97-12.85]. By univariate analysis, tinea capitis was significantly associated with boys [odds ratio (OR) 7.85; CI 5.22-11.81] and in children belonging to the intermediate 8-11 years age group (OR 1.93; CI 1.29-2.90). Trichophyton soudanense and Microsporum langeronii were the most prevalent etiologic agents (63.6% and 31.3%, respectively), whereas a mixture of both T. soudanense and M. langeronii was observed in a 2.8% proportion. Finally, 2.3% of isolated species were represented by T. violaceum.

CONCLUSIONS

Our survey provided evidence that tinea capitis is endemic in Ivory Coast, constituting a substantial infectious dermatological disturbance. T. soudanense was the most frequent causative agent, whereas T. violaceum was isolated for the first time in this sub-Saharan western African country.