THE HISTORY, CLINICAL FEATURES, AND TREATMENT OF TINEA CAPITIS DUE TO TRIGHOPHYTON TONSURANS AND TRICHOPHYTON VIOLACEUM

The history of annular lesions of skin diseases

Annular skin eruptions encompass a wide array of different cutaneous afflictions that are a common occurrence in the practice of dermatology. Annular lesions present as oval or circular shaped patches and plaques with central clearing. The term annular has been employed in the vernacular since the 16th century; yet, it does not seem to have appearedin the dermatologic literature until the early 20th century. Such lesions are described and even illustrated but with different phraseology. We describe the history of annular terminology and its use in various afflictions of the skin.

The molecular immunology of human susceptibility to fungal diseases: lessons from single gene defects of immunity

INTRODUCTION

Fungal diseases are a threat to human health. Therapies targeting the fungus continue to lead to disappointing results. Strategies targeting the host response represent unexplored opportunities for innovative treatments. To do so rationally requires the identification and neat delineation of critical mechanistic pathways that underpin human antifungal immunity. The study of humans with single-gene defects of the immune system, i.e. inborn errors of immunity (IEIs), provides a foundation for these paradigms. Areas covered: A systematic literature search in PubMed, Scopus, and abstracts of international congresses was performed to review the history of genetic resistance/susceptibility to fungi and identify IEIs associated with fungal diseases. Immunologic mechanisms from relevant IEIs were integrated with current definitions and understandings of mycoses to establish a framework to map out critical immunobiological pathways of human antifungal immunity. Expert opinion: Specific immune responses non-redundantly govern susceptibility to their corresponding mycoses. Defining these molecular pathways will guide the development of host-directed immunotherapies that precisely target distinct fungal diseases. These findings will pave the way for novel strategies in the treatment of these devastating infections.

Tinea capitis: a current perspective

During the past 50 years, the predominant etiologic agent of tinea capitis in the United States and in Western Europe has changed from Microsporum audouinii to Trichophyton tonsurans. This is thought to be due in part to the sensitivity of M audouinii to griseofulvin treatment and, in part, due to the importing of T tonsurans by people emigrating from geographic areas where that vector had been the prominent cause of tinea capitis. With these changes, prospects for newer therapies with the novel antimycotic agents itraconazole, fluconazole, and terbinafine are reviewed. (J Am Acad Dermatol 2000;42:1-20.)

LEARNING OBJECTIVE

At the conclusion of this learning activity, participants should be familiar with the history, epidemiology, and current knowledge of tinea capitis, as well as the newer antifungal agents (ie, itraconazole, fluconazole, and terbinafine) to treat this infection.

An epidemic of infection with Trichophyton tonsurans revealed in a 20-year survey of fungal infections in Chicago

Trichophyton tonsurans has long been recognized as an important, but hitherto uncommon, cause of tinea capitis in the United States. Today it is known to be more common, but infection of the glabrous skin by this organism is still not well appreciated. In an epidemiologic study during the two decades from 1961 to 1980, 1,292 isolates of thirteen species of dermatophytes were obtained from patients at Cook County Hospital, Chicago. During the last 3 years of study, T. tonsurans accounted for 207 cases (96%) of tinea capitis and ninety-seven cases (75%) of tinea corporis. Ninety-five percent of cases of tinea capitis caused by T. tonsurans occurred in children (59% girls, 41% boys). By contrast, 62% of cases of tinea corporis caused by that organism occurred in adults. Substantially more women than men were affected in a ratio of nearly six to one. The majority of the women were between 15 and 29 years of age; about half of all had lesions on the arm. Over the past 20 years, T. tonsurans has emerged as a major cause of both tinea capitis and tinea corporis in Chicago. The disproportionate number of cases of tinea corporis in women of childbearing age may be due to their more frequent contact with infected children.

Superficial mycoses

Twenty-five years ago many of the topical remedies for superficial mycoses were irritating, toxic, or allergenic. Total x-ray depilation of the scalp was the accepted mode of therapy for tinea capitis. The introduction of topical nystatin for candidiasis and tolnaftate for dermatophytosis were major advances, but tinea capitis, onychomycosis, and chronic tinea pedis still presented problems. Soon after its introduction in 1958, griseofulvin became the definitive form of therapy for all types of dermatophytosis and played a major role in abolishing large-scale epidemics of tinea capitis in some countries. Recently, haloprogin and the imidazole derivatives, miconazole and clotrimazole, which are topically active against dermatophytes and Candida albicans, have become available. Selective indicator media for isolating dermatophytes are useful diagnostic tools, but quicker methods of diagnosis which require little interpretation are still lacking. Epidemiologic studies in Vietnam again revealed the effects of climate and occlusion on the prevalence, incidence, and severity of superficial mycoses and led to renewed interest in host susceptibility, environment, and prevention of infections.