Systemic Therapy in Children
Sarah H. Wakelin, Howard I. Maibach, Clive B. Archer in Handbook of Systemic Drug Treatment in Dermatology, 2015
Tinea capitis is predominantly a complaint of pre-adolescent children; infants are affected less commonly. Oral therapy is usually required in order to eradicate the organism, alleviating disease symptoms quickly and safely and to reduce transmission to others. The choice of drug will vary according to the causative organism but as fungal culture may take up to 1 month it is reasonable to start therapy immediately. Although griseofulvin is the only drug licensed for the treatment of tinea capitis in children in the UK, newer antifungal agents are gaining popularity, due to their greater cost-effectiveness and safety. In the UK Trichophyton tonsurans is reported to account for 50–90% of dermatophyte scalp isolates, whereas in Europe Microsporum canis remains the most commonly involved organism.
Geriatric hair and scalp disorders
Robert A. Norman in Geriatric Dermatology, 2020
Oral therapy is generally necessary for treatment of tinea capitis. Griseofulvin has been the standard therapy for decades. Long-term treatment is necessary to achieve a cure and can potentially be a deterrent to therapy, especially in the elderly patient for whom compliance may be difficult. Newer oral agents have shown promise in treatment. The azole antifungals fluconazole and itraconazole and the allylamine antifungal terbinafine have all been studied in comparative trials and may be appropriate for second-line therapy130. Adjunctive therapy with 2% ketoconazole or 2.5% selenium sulfide shampoo, allowed to remain on the scalp for five minutes three times weekly, should be added to oral therapy to aid in the eradication of infection131.
The Child with a Chronic Rash
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan in Diagnosing and Treating Common Problems in Paediatrics, 2017
Tinea capitis primarily affects school-age children. It may be inflammatory (kerion), non-inflammatory or a combination of both. Patchy alopecia is frequently found. In inflammatory tinea there may be erythema, pustules and a kerion. A kerion is a painful, inflammatory, boggy mass with broken hair follicles. Non-inflammatory tinea capitis presents with ‘black dots’ on the scalp. When the hair shaft breaks at the scalp surface, the debris left in the hair follicle appears as black dots. There may be associated lymphadenopathy. T. tonsurans and M. canis are the commonest causing dermatophytes. Microsporum is spread by animal contact; trichophyton is spread by human contact. Microsporum infections fluoresce green under Wood’s light.
Strategies to improve the diagnosis and clinical treatment of dermatophyte infections
Published in Expert Review of Anti-infective Therapy, 2023
Murat Durdu, Macit Ilkit
Despite major developments in the diagnosis and treatment of dermatophytosis in economically developed countries, various complications may develop in patients from underdeveloped countries, such as African countries, due to the inability of patients with dermatophyte infections to easily access medical care and antimycotic medications [4]. Tinea capitis and tinea pedis are most commonly observed in children and young adults, respectively, whereas the incidence of onychomycosis increases with age. Tinea capitis, with a global prevalence of 200 million cases, is the primary cause of permanent baldness, particularly in poor countries, thereby indicating the remarkable extent to which fungal disease is common in this context. Even after appropriate treatment, kerion celsi causes permanent hair loss in approximately one-quarter of the affected patients [5].
Nanotechnological interventions in dermatophytosis: from oral to topical, a fresh perspective
Published in Expert Opinion on Drug Delivery, 2019
Riya Bangia, Gajanand Sharma, Sunil Dogra, Om Prakash Katare
Griseofulvin is a drug that has activity only against dermatophytes. This antifungal drug is generally considered the drug of choice for treating tinea capitis, especially Microsporum species. The mechanism of action of griseofulvin involves interference with the structure as well as function of microtubules and inhibiting cell division (Figure 1). Griseofulvin is majorly delivered to the skin through sweat and the antifungal binds to it weakly. Griseofulvin diffuses to some extent through the basal layer [47]. Griseofulvin is recommended to be administered continuously until the cure is obtained as the tissue levels in skin corresponds to the fall in plasma levels after discontinuing the antifungal agent. In the cases of chronic superficial mycotic infections and onychomycosis, failures in therapy and development of resistance to the medication are usually reported. The cure rates can be improved significantly by administering higher dosages, above 500 mg/day. Serious side effects are witnessed rarely [48]. A comparative study was conducted by Faergemann et al. for activity against tinea corporis or tinea cruris, between 150 mg fluconazole weekly administration and 500 mg griseofulvin daily administration for 4–6 weeks, in a double-blind trial. Their findings demonstrated that fluconazole and griseofulvin were effective with mycological cure rates of 78% and 80%, respectively [49]. Another study carried out by Cole et al. in 50 patients with tinea corporis depicted the cure rate of 87% with terbinafine, in comparison with that of 73% with griseofulvin [50].
Alopecia syphilitica, from diagnosis to treatment
Published in Baylor University Medical Center Proceedings, 2022
Mojahed Mohammad K. Shalabi, Brooke Burgess, Samiya Khan, Eric Ehrsam, Amor Khachemoune
Due to its low prevalence, AS can be challenging to diagnose and can be mistaken for other leading causes of alopecia such as AA, telogen effluvium, and tinea capitis. Diagnosis is made largely through a thorough evaluation including clinical history, serological testing, and histopathologic and dermatoscopic findings. Dermatoscopic findings of AS include empty ostia, yellow or black dots, dilated capillaries, and decreased hair density. First-line treatment includes benzathine penicillin G intramuscular injection, which leads to hair regrowth weeks to months after administration. Because the medical management of the various types of alopecia varies, it is of great importance for physicians to correctly identify the underlying cause of alopecia in a patient to prevent an increase in the severity and chronicity of the disease.
Related Knowledge Centers
- Antifungal
- Fungal Infection
- Microsporum
- Puberty
- Trichophyton
- Dermatophytosis
- Scalp
- Terbinafine
- Dermatophyte
- Griseofulvin