BACKGROUND: Tinea capitis manifests either as a non-inflammatory or inflammatory type including kerion, which may cause permanent alopecia. In addition to antifungals, systemic corticosteroids (prednisolone at 1~2 mg/kg/day) have been used to reduce inflammation in patients with kerion. OBJECTIVE: We studied the clinical and laboratory features, treatments, and prognosis of tinea capitis. METHODS: We performed a retrospective review of 12 cases of kerion and 12 cases of non-inflammatory tinea capitis (median age, 8 years; range, 3 months~80 years) diagnosed using a potassium hydroxide mount at the National Health Insurance Service Ilsan Hospital between November 2011 and April 2018. RESULTS: Fungal cultures showed Microsporum species in 6 cases and Trichophyton species in 1 case. The duration of diseases and extent of lesions were greater in the kerion group than in the non-inflammatory tinea capitis group (p<0.05). Sixteen patients were treated with systemic antifungals. In the kerion group, 10 patients were treated with systemic antifungals (6 with itraconazole [median, 26 days; range, 21~58 days] and 4 with terbinafine [median, 24.5 days; range, 13~31 days]). The median intervals between the onset of treatment and scalp clearing (in 10 cases), the onset of new hair growth (in 9 cases), and complete regrowth of hair (in 7 cases) were 27 (range, 13~77), 33 (range, 19~63), and 89 (range, 42~180) days, respectively, in the kerion group. The median dosage of prednisolone used in patients with kerion was 0.26 mg/kg/day (range, 0.15~0.42) with good clinical response. CONCLUSION: The patients with kerion responded well to antifungal treatments. A lower dose of prednisolone was adequate when systemic corticosteroids were required for the treatment of kerion.
Adrenal Cortex Hormones ; Alopecia ; Hair ; Humans ; Inflammation ; Itraconazole ; Microsporum ; National Health Programs ; Potassium ; Prednisolone ; Prognosis ; Retrospective Studies ; Scalp ; Tinea Capitis ; Tinea ; Trichophyton

BACKGROUND: Tinea capitis remains a prevalent health problem among school-aged children. OBJECTIVE: To estimate the prevalence of tinea capitis among primary school students, in Fayoum, Egypt with identification of etiological agents in both public and private primary schools. METHODS: A cross-sectional study was conducted in twelve primary schools. The students were selected from different grades with a total number of 12,128 students. Hair and scalp were clinically examined for any lesions that may suspect tinea capitis and mycological samples were collected for direct microscopy and culture. RESULTS: The prevalence of tinea capitis in the study group was 0.4% and higher in public than private schools (73.5% versus 26.5% respectively). Boys were more affected than girls with boy to girls' ratio 5:1. Intrafamily history of infection was present in 40.8% of tested group while 51% showed low social standard profile. Mycological culture revealed that Microsporum canis was the predominant isolated organism followed by M. audouinii (52% and 36% respectively). CONCLUSION: M. canis is replacing Trichophyton violaceum as an etiology for tinea capitis in Egypt with lower prevalence rate than reported previously.
Child* ; Cross-Sectional Studies ; Egypt* ; Epidemiology* ; Female ; Hair ; Humans ; Male ; Microscopy ; Microsporum ; Prevalence ; Scalp ; Tinea Capitis* ; Tinea* ; Trichophyton

BACKGROUND: Tinea capitis has been recognized as the most commonly misdiagnosed scalp disease. Inappropriate medication and delayed intervention leads to a broad array of complications from prolongation of treatment to scarring of the scalp. The financial deficits and problems imparted on patients continue to be a clinical and social burden. OBJECTIVE: The clinical and financial aspects between the initially misdiagnosed group and the properly diagnosed group were analyzed, to provide the epidemiologic basis and to address improvements for misdiagnoses of tinea capitis. METHODS: A retrospective review of electronic and written chart was performed on all patients diagnosed of tinea capitis at Daegu Catholic University Medical Center (DCUMC) from January 2006 to June 2016. A total of 100 patients were included in the study and an initially misdiagnosed group and initially diagnosed group were evaluated. RESULTS: Significant differences between the groups were not observed in variables including age, sex and occupation. The highest diagnostic precision was observed in dermatologists (78.4%) by using standard microscopic (31.0%) and culture studies (13.0%). Misdiagnosis rate was highest in pediatrics (34.9%) and erroneous examination such as laboratory test (48.4%) and Gram stain (19.4%) were countered in the misdiagnosed group. Additional clinic visits, prescriptions and extra trips to clinics resulted financial disadvantage in the misdiagnosed group. CONCLUSION: The misdiagnosed tinea capitis was found to arise from unawareness of the disease that leads to inappropriate approach and medication prescription. The duration, complications and financial loss were reported to be higher in misdiagnosed group based on the study.
Academic Medical Centers ; Ambulatory Care ; Cicatrix ; Daegu ; Diagnostic Errors ; Humans ; Occupations ; Pediatrics ; Prescriptions ; Retrospective Studies ; Scalp ; Tinea Capitis* ; Tinea*

While mycological examinations, potassium hydroxide preparation, and fungus culture remain the gold standard for the diagnosis of superficial dermatomycoses, mycological procedures have limitations because they are rather complex, time-consuming, and require skilled personnel and additional mycological tools. Dermoscopy is a simple, non-invasive diagnostic technique that allows better visualization of morphologic structures of the skin than the naked eye. It is easily performed with a hand-held dermoscope and allows immediate diagnosis. It has been primarily used to evaluate pigmented skin lesions, but recent advances indicate that it can also be a useful and convenient tool for diagnosing superficial dermatomycoses. The determination of specific dermoscopic patterns of fungal infection, especially in selected cases involving terminal hairs or nails, could lead to a straightforward diagnosis and facilitate their differentiation from non-fungal skin diseases. In addition, dermoscopy permits better inspection of subtle clinical features caused by fungi that are less evident to the naked eye; thus, in most cases, it can enhance clinician's diagnostic accuracy and confidence level, and allow determination of the best site for adequate mycological sampling as well as therapeutic monitoring. However, it should be a part of the evaluation in combination with other mycological tests because it does not substitute confirmatory examination for superficial dermatomycoses.
Dermatomycoses* ; Dermoscopy* ; Diagnosis ; Fungi ; Hair ; Onychomycosis ; Potassium ; Skin ; Skin Diseases ; Tinea Capitis

No abstract available.
Humans ; Microsporum* ; Siblings* ; Tinea Capitis* ; Tinea*

No abstract available.
Fluconazole* ; Tinea Capitis* ; Tinea*

Kerion celsi is a severe inflammatory type of tinea capitis that presents as a boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, kerion celsi caused by T. rubrum is rare. Kerion celsi is uncommon in adult. We report a case of kerion celsi caused by T. rubrum in a 72-year-old woman. She presented with localized tender erythematous plaques with pustules with oozing purulent material on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer region for clinical isolate was identical to that of T. rubrum strain UZ1588_14 (GenBank accession number KP326579.1). She was treated with 200 mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.
Adult ; Agar ; Aged* ; Arthrodermataceae ; Base Sequence ; Female ; Glucose ; Hair ; Humans ; Itraconazole ; Onychomycosis ; Recurrence ; Scalp ; Skin ; Tinea Capitis* ; Tinea Pedis ; Trichophyton*

Kerion celsi is an inflammatory infection, caused by a vigorous T-cell mediated host response to the dermatophyte infection. In the case of severe inflammation, it can be misdiagnosed as other disease like cellulitis, impetigo, furuncle and epidermal cyst. Microsporum(M.) canis is most likely transmitted by contact of animal hosts such as cats and dogs with humans. We report the 75-year-old female who presented two months history of tender erythematous scaly plaques with pustules, crusts on right scalp area. At first, from the histopathologic findings of the lesion, the patient was diagnosed epidermal cyst because of cyst-like structure in mid-dermis. But the fungal culture revealed M. canis as the causative fungus. Herein we report a educational case of kerion celsi mistaken for ruptured epidermal cyst.
Aged ; Animals ; Arthrodermataceae ; Cats ; Cellulitis ; Dogs ; Epidermal Cyst* ; Female ; Fungi ; Furunculosis ; Humans ; Impetigo ; Inflammation ; Scalp ; T-Lymphocytes ; Tinea Capitis*

Alopecia areata (AA) is a disease in which the patient experiences a sudden loss of scalp hair leaving round patches. It has a lifetime risk of 1.7%. AA is known to occur on any part of the body, including the scalp, beard area, axilla, and even the pubic area. Although the pathogenesis of AA is poorly understood, the consensus is that AA is an organ-specific autoimmune disease that typically presents in the hair follicles. Susceptibility to the development of AA may be modified by environmental factors, including exposure to pro-inflammatory agents and other modulators. The differentiation of AA can sometimes be challenging as several conditions (such as trichotillomania, tinea capitis, telogen effluvium, and lupus) may resemble AA. Obtaining the patient's history, performing a hair pull test, and skin biopsy or dermoscopic findings can be helpful for confirmation. Treatment for AA is usually based on patient age and the extent of hair loss, but there are no therapeutic agents that are curative or preventive for AA. AA can progress unpredictably. Indicators of poor prognosis include atopy, co-occurring immune diseases, positive family history, young age of onset, and ophiasis.
Age of Onset ; Alopecia Areata* ; Alopecia* ; Autoimmune Diseases ; Axilla ; Biopsy ; Consensus ; Diagnosis* ; Hair ; Hair Follicle ; Humans ; Immune System Diseases ; Prognosis ; Scalp ; Skin ; Tinea Capitis ; Trichotillomania

No abstract available.
Adult* ; Humans ; Tinea Capitis* ; Trichophyton*