Treatment of tinea capitis - a critical appraisal

Microsporia in Young Children: Clinical Cases

Background. Microsporia is a zooanthroponotic mycosis of skin and hair caused by fungi genus Microsporum. Microsporia is most common among children, including infants. The microsporia incidence has slow steady increase over recent years. Clinical cases description. Follow-up results of two children of different ages (younger/older than 1 year) with microsporia are presented. Successful management approach is shown. Major limitations of drug therapy in infants as well as common therapeutic errors were analyzed. Conclusion. Diagnosis and management of microsporia in infants and young children is a challenging task. Major errors in microsporia management in patients of these age groups are associated with peculiarities of clinical picture as well as limited variations of drugs that are appropriate for the requirements on efficacy and safety of therapy among young children.

Tinea capitis: An update

Tinea capitis is an important superficial infection and affects children globally. A literature review was conducted to identify recent findings and the current understanding of this fungal infection. Here, we highlight updates on important aspects of tinea capitis including advances in dermatophyte detection and diagnosis and comparing these new methods to more traditional techniques. Additionally, aspects of treating tinea capitis are discussed, including the importance of mycological confirmation and current means of treatment, and the treatment of asymptomatic carriers are reviewed. This review also examines the subject of laboratory monitoring of patients undergoing treatment with systemic antifungals; we discuss the opinions of prominent researchers and currently accepted guidelines. Lastly, we provide answers to several common questions that practitioners may encounter when treating a child with tinea capitis.

S1 guidelines: Tinea capitis

Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.

Treatment of Tinea Capitis

Tinea capitis is a common fungal infection of the hair of the scalp affecting predominately prepubertal children. In the US, griseofulvin has been considered a first-line therapy agent for tinea capitis since the 1960s. However, it has been falling out of favor due to significant treatment failure, high cost, and long duration of treatment. Other antifungal agents have been researched as an alternative to griseofulvin. This paper will review the relevant pharmacologic properties, dosing, cost, efficacy, and adverse events profile for griseofulvin, terbinafine, itraconazole, fluconazole, and some adjuvant therapy options such as selenium sulfide shampoos and topical ketoconazole.

Parameters that determine dissolution and efficacy of itraconazole and its relevance to recalcitrant dermatophytoses

INTRODUCTION

Recalcitrant dermatophytoses is on the rise. Though myriad factors contribute to recalcitrance including terbinafine resistance, itraconazole largely remains sensitive. However, there are increasing instances of patients not responding adequately to itraconazole despite low MICs, probably due to issues plaguing the pelletization process, resulting in suboptimal quality. Data on this topic was searched on pubmed using the search items: itraconazole, MIC, MFC, quality, assay, pharmacokinetics, pharmacodynamics, dermatophytoses, and recalcitrance. Areas covered: A detailed analysis of the manufacturing process of itraconazole with emphasis on pelletization and parameters affecting the dissolution and bioavailability is presented. Important formulation factors including drug-polymer ratio, polymer type, coating thickness, bead size, and number are discussed. Also covered is the rationale of dosimetry of itraconazole in dermatophytoses based on the skin pharmacokinetics and MIC of the organism. Expert opinion: The process of pelletization has multiple components aiming to achieve maximum dissolution of the drug. Variations in the process, pellet quality, number, and polymer determine absorption. Morphometric analysis of pellets is a simple method to quantify quality of the drug. Once the process has been standardized, dosimetry depends on the route of secretion and site of infection, accounting for the variation of doses from 100 mg to 400 mg/day.

Clinico-mycological profile of tinea capitis and its comparative response to griseofulvin versus terbinafine

Background and Purpose:

Tinea capitis is the most common superficial mycosis in children. This disease is a contagious infection with worldwide distribution and is occasionally associated with permanent alopecia. The treatment of this infection usually requires the administration of appropriate oral antifungal agents. The current study was conducted to evaluate the clinico-mycological profile of tinea capitis and compare the efficiency of oral griseofulvin and terbinafine in the treatment of this disease.

Materials and Methods:

This study was conducted on 69 patients, including 23 females (33.3%) and 46 males (66.7%), clinically suspected of tinea capitis. After the confirmation of tinea capitis diagnosis through direct examination, the subjects were randomly assigned into two groups of griseofulvin and terbinafine. Demographic data, clinical and mycological characteristics, and therapeutic outcome were recorded for both groups.

Results:

According to the results, tinea capitis was more common in children younger than 15 years (73.9%), athletes (37.7%), and males (66.7%), and those with frontal involvement (34.8%), non-inflammatory type (68.1%), endothrix (69.6%), and Trichophyton tonsurans species (41.7%). The griseofulvin and terbinafine groups had the treatment success rates of 90.9% and 80.6%, respectively (P=0.311). The griseofulvin group had a shorter therapeutic course than the terbinafine group (P=0.129).

Conclusion:

Although our findings demonstrated that both griseofulvin and terbinafine were effective in the treatment of tinea capitis, griseofulvin showed a little higher efficacy in this regard. Consideration of some variables, such as age, associated risk factors, clinical type, hair involvement pattern, and dominant pathogenic species, is important in the determination of the drugs.