Querión Celso, dermatofitosis del cuero cabelludo infantil / Kerion Celsi, dermatophytosis of the scalp in young boy

Resumen Querión Celso es una micosis ocasionada por hongos dermatofitos que daña el cuero cabelludo principalmente a niños y en raras ocasiones a adultos. La forma de infección para los humanos proviene de los animales y del suelo y se relaciona con mala higiene personal, hacinamiento en las viviendas, condiciones de subdesarrollo y pobreza. Se presenta un caso de un niño de 9 años con una úlcera de 7 cm de diámetro en el cuero cabelludo y en forma de placa circular que presentaba material purulento, pelo quebradizo y un área alopécica. Al inicio, se abordó de manera terapéutica como una infección bacteriana; posteriormente, se solicitó estudio micológico que evidenció una coinfección por el microorganismo Microsporum gypseum. Se le confirmó el diagnóstico de tiña capitis con afección inflamatoria y se le prescribió griseofulvina, lo que resultó en una curación completa.

Abstract Kerion Celsi is a mycosis caused by dermatophyte fungi that mostly affects children and rarely adults, causing damage to the scalp. The form of infection for humans comes from animals and the soil. The infection is related to poor personal hygiene, overcrowded homes, underdeveloped conditions, and poverty. A case of a 9-year-old boy with a 7cm diameter ulcer on the scalp and in the form of a circular plaque that presented purulent material, brittle hair and an alopecic area is presented. Initially it was therapeutically addressed as a bacterial infection, a mycological study was requested, which showed coinfection by the microorganism Microsporum gypseum, the diagnosis of tinea capitis with inflammatory condition was confirmed, and Griseofulvin was prescribed, resulting in complete cure.

Prevalence and risk factors associated with canine dermatophytoses among dogs in Kwara and Osun States, Nigeria

Background: Dermatophytosis (ringworm) is a zoonotic fungal skin infection caused predominantly by Microsporum canis, Microsporum gypseum and Trichophyton spp. It is highly transmissible and, while normally self-limiting, could be problematic due to its potential to cause disease in certain human populations. The occurrence and associated risk factors of dermatophytoses in dogs presented at three veterinary clinics in Osogbo, and Ilorin, Nigeria between July and November 2019 were investigated in this study. Methodology: This was a descriptive cross-sectional study of 325 dogs with lesions suggestive of dermatophytosis, selected by simple random sampling from veterinary clinics of two hospitals, purposively selected for the study due to high patronage of the veterinary hospitals by dog owners. Using conventional mycological sampling techniques, plucked hairs and skin scrapings were obtained the dogs. The samples were emulsified in 10% potassium hydroxide, examined microscopically for fungal elements and cultured using standard mycological procedures. Information on dog demographic characteristics and risk factors for dermatophytosis were collected using structured questionnaire. The association between risk factors and demographic variables with the occurrence of dermatophytoses was determined using Chi-square test (with Odds ratio and 95% confidence interval) and p value < 0.05 was considered statistically significant. Results: Positive cultures for dermatophytes were obtained from samples of 48 (14.8%) dogs with M. canis 37.5% (18/48), M. gypseum 27.0% (13/48) and T. mentagrophytes 8.3% (4/48). Other fungi identified were Aspergillus flavus 12.5% (6/48) and Malassezia canis 12.5% (6/48). The age distribution of positive dogs were < 1 year (50.0%, n=24), 1-3 years (29.2%, n=14) and > 3 years (20.8%, n=10), while the risk factors associated with dermatophytosis included sex of dogs (p=0.0428), history of dermatophytosis (p<0.0001), clinical presentation (p<0.0001) and lesion type, especially kerion and pustular lesions (p=0.0297). Conclusion: These findings established the occurrence of dermatophytosis in dogs kept for companionship (i.e., pets), security and breeding purposes in one northern and southern States of Nigeria. Our findings underscore the need for routine mycological investigations in dogs to facilitate early detection of cases and prompt institution of treatment interventions, thereby preventing zoonotic transmission of dermatophytes to their owners, handlers and veterinarians.

Tinea faciei por Trichophyton violaceum: primer caso alóctono reportado en Chile

Trichophyton violaceum es un dermatofito antropofílico endémico en África, Europa, Centroamérica y China. El incremento de los fenómenos de movilidad humana ha contribuido a su aparición en áreas no endémicas. Su principal manifestación clínica es la tinea capitis, seguida por la tinea corporis. En la población pediátrica afecta con mayor frecuencia el cuero cabelludo; y en adultos, la piel glabra. Presentamos el primer caso en Chile de tinea causada por T violaceum. Correspondió a una mujer chilena de 21 años que presentó placas faciales de un mes de evolución después de un viaje a Tanzania, África, sin respuesta a tratamientos médicos previos. Se sospechó una dermatofitosis alóctona y mediante cultivos especiales, se identificó una colonia de crecimiento lento, coloración violeta-negruzca, superficie cerosa y rugosa, con vellosidades aterciopeladas; compatible con T violaceum. Se confirmó mediante secuenciación de ADN ribosomal amplificando la región ITS. Se trató con terbinafina oral con respuesta clínica completa.

Trichophyton violaceum is an anthropophilic dermatophyte endemic in Africa, Europe, Central America and China. The increase in human mobility has recently contributed to the appearance in non-endemic areas. The main clinical manifestation is tinea capitis followed by tinea corporis. We present the first case in Chile of tinea caused by T violaceum. The case was a 21 year-old Chilean woman who presented asymptomatic facial plaques one month after arriving from Tanzania, Africa, with no clinical response to previous medical treatments. An allochthonous dermatophytosis was suspected and with special cultures, a slow-growing colony was identified with a violet-blackish color, waxy and rough surface, and velvety villi; all characteristics of T violaceum. The diagnosis was confirmed by ribosomal DNA sequencing amplifying the ITS region. She was treated with oral terbinafine obtaining a complete clinical response.

An outpatient-based observational study on demography, self-medication practice, and prescribing pattern in dermatophytosis at a tertiary care teaching hospital in Eastern India

Background: Appropriate use of drugs is essential in dermatophytosis to reduce morbidity and associated financial burden to the sufferers. Aims and Objectives: To explore the demographic characteristics along with the prescription pattern, self-medication practice, and price variability of the prescribed brands in the treatment of the dermatophytosis patients. Materials and Methods: Newly diagnosed consented dermatophytosis patients were enrolled in this cross-sectional observational study. Their baseline demographic characteristics were documented in the case report form along with the prescription details with self-medication history and Maximum Retail Price of each prescribed brand of drug. Results: Among total of 114 subjects (68 males, 46 females), majority were young (56.14%, <33 y). Most common diagnosis was tinea cruris followed by combination of tinea cruris and corporis. Average monthly family income was 11469.29 ± 10027.5 INR. Brand prescription was (74.15%), higher than generic (25.84%). Oral formulations were more prescribed (54.83%) than topical (45.16%) whereas individually luliconazole (cream) topped (23.18%) in the list. No topical or systemic steroid was prescribed. The commonest drug regimen was capsule itraconazole, luliconazole cream, and cetirizine or levocetirizine tablet with or without ketoconazole soap or tea tree body wash (71/114, 62.28%). About 39.47% subjects practiced self-medication, topical steroids (37.20%) mostly used. Price variability (percentage) among brands of the same drug was highest in ketoconazole soap (138.66%), followed by terbinafine tablet 250 mg (89.50%) followed by itraconazole capsule (83.33%). Conclusion: Luliconazole cream, itraconazole (capsule/tablet), terbinafine (tablet) and ketoconazole soap were the highly prescribed antifungal agents whereas topical steroid was mostly preferred as self-medication. Prescription of generic drugs should be promoted as well as inappropriate use of self-medication should be discouraged among the prescribers and the patients respectively.

The Epidemiological and Mycological Profile of Superficial Mycoses in India from 2015 to 2021: A Systematic Review

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico‑mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies(21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Disseminated dermatophytosis and acquired immunodeficiency syndrome: literature review and presentation of clinical experience / Dermatofitose disseminada e síndrome da imunodeficiência adquirida: revisão de literatura e apresentação de experiência clínica

Introduction: Dermatophytosis are very common fungal infections caused by the fungal species Microsporum, Epidermophyton or Trichophyton, which mostly affect the skin, the interdigital region, groin and scalp. Although they do not cause serious diseases, in patients with the human immunodeficiency virus the infection manifests itself and evolves exuberantly, usually with extensive and disseminated lesions. Objective: To review the literature on dermatophytosis in people living with human immunodeficiency virus and to present the experience in clinical care in a patient living with human immunodeficiency virus with extensive and disseminated dermatophytosis. Methods: A literature review on the topic was carried out in the PubMed/National Library of Medicine ­ USA databases, using the keywords dermatophytosis, or dermatophytosis associated with the words AIDS, human immunodeficiency virus or immunodeficiency, from 1988­2022. The clinical experience showed a patient living with human immunodeficiency virus developing AIDS and presenting with disseminated skin lesions. Samples of the lesion were collected by scraping, which were submitted to culture and there was growth of fungi of the Trichophyton sp genus. A biopsy of the lesion was also performed using the Grocott-Gomori's Methenamine Silver stain. Results: We found 1,014 articles, of which only 34 presented a direct correlation with our paper, and were used to discuss the main themes narrated in this article. We present clinical experience in the management of a patient with human immunodeficiency virus/AIDS and low adherence to antiretroviral treatment, showing extensive and disseminated erythematous-squamous lesions with a clinical diagnosis of tinea corporis, manifesting with a clinical picture usually not found in immunocompetent patients. The diagnosis was confirmed by laboratory tests with isolation of the Trichophyton sp fungus. The patient was treated with oral fluconazole, with complete remission of the clinical picture after two months. She was also thoroughly encouraged to use the prescribed antiretroviral medication correctly. Conclusion: Dermatophytosis in patients living with human immunodeficiency virus can present extensive and disseminated forms. The antifungal treatment is quite effective, with remission of the condition. Antiretroviral therapy is an important adjuvant for better recovery of the sickness.

Introdução: Dermatofitoses são infecções comuns, causadas pelas espécies fúngicas Microsporum, Epidermophyton ou Trichophyton, que acometem preferencialmente a pele da região interdigital, da virilha e do couro cabeludo. Apesar de não causar doenças graves, em pacientes portadores do vírus da imunodeficiência humana, a infecção se manifesta e evolui de forma exuberante, normalmente com lesões extensas e disseminadas. Objetivo: Fazer revisão de literatura sobre dermatofitose em pessoas vivendo com vírus da imunodeficiência humana e apresentar a experiência na atenção clínica em uma paciente vivendo com o vírus e dermatofitose extensa e disseminada. Métodos: A revisão de literatura sobre o tema baseou-se nos dados do Pubmed/National Library of Medicine, dos Estados Unidos, utilizando-se as palavras-chave dermatofitose, dermatofitose e AIDS, dermatofitose e vírus da imunodeficiência humana, e dermatofitose e imunodeficiência, de 1988­2022. Descreveu-se a experiência clínica na abordagem de uma paciente vivendo com vírus da imunodeficiência humana, a qual desenvolveu AIDS e apresentou lesões cutâneas disseminadas. Por raspado, foram coletadas amostras da lesão e submetidas à cultura, e constatou-se crescimento de fungos do gênero Trichophyton sp. Realizou-se também biópsia da lesão, corada pelo método da metenamina de prata de Grocott-Gomori. Resultados: Foram encontrados 1.014 artigos, dos quais apenas 34 apresentaram correlação direta com nosso trabalho, e foram utilizados para discorrer sobre os principais temas narrados neste artigo. Apresentou-se experiência clínica na abordagem de uma paciente com vírus da imunodeficiência humana/AIDS e baixa adesão ao tratamento antirretroviral, exibindo lacerações eritematoescamosas extensas e disseminadas, com diagnóstico clínico de Tinea corporis, manifestando-se com quadro clínico usualmente não encontrado em pacientes imunocompetentes. O diagnóstico foi confirmado por exames laboratoriais com isolamento do fungo Trichophyton sp. Tratada com fluconazol via oral, a paciente apresentou remissão parcial das infecções aos dois meses e completa aos seis meses. Também foi exaustivamente estimulada a usar corretamente a medicação antirretroviral prescrita. Conclusão: A dermatofitose em pacientes com vírus da imunodeficiência humana pode se apresentar de forma extensa e disseminada. O tratamento antifúngico é eficaz, com remissão do quadro. A terapia antirretroviral é importante adjuvante para melhor recuperação dos enfermos

Clinico-Mycological Characteristics Of Dermatophytosis- A Comparative Study Of The Past And The Present

Background:Incidence and prevalence of dermatophytosis have increased recently. The clinico-mycological characteristics of dermatophytosis in the past and present were compared to determine the difference, if any, that canexplain the present scenario.Material and Methods:Hospital-based cross-sectional study design with retrospective data comparison was done. The clinico-mycological data of 425 patients in 2019 was compared to 124 patients in 2011 with a Chi-square statistic. Result:Significant differences were observed in the following socio-demographic and disease characteristics in the present compared to the past: female gender (57.9% vs.33.9%, P-0.000002), chronicity (29.4% vs. 16.1%, P-0.003), sharing of clothes (35.3% vs. 20.5%, P-0.0014), co-morbidity of atopy (22.6% vs. 6.5%, P-0.00005), prior use of topical antifungals (64.5% vs. 30.7%, P <0.0001), prior use of systemic antifungals (43.1% vs. 13.7%, P <0.0001), prior use of topical steroids (24.7% vs. 12.1%, P-0.0028), and infection in multiple sites (25.2% vs. 11.3%, P-0.001). T.mentagrophyteswas the most common isolate in the present compared to the past (73.6% vs. 32.8%, P-0.0035). Other isolates were T.rubrum(13.2%) and M.gypseum(13.2%) in 2019 and T.rubrum(53.1%), M. gypseum(9.4%),T. schoenleinii(1.6%) and E. floccosum(3.1%) in 2011.Conclusion:T. mentagrophyteshas emerged as thedominant species. Irrational use of topical and systemic antifungals and steroids has increased considerably.Frequent training of general practitionersregarding appropriate management andeducating patients about avoidance of tight-fitting clothing, personal hygiene, and avoidance of over the counter medications, and adherence to treatment schedule can decrease the disease burden to some extent.

Tiña Capitis en niños / Tinea capitis in children

La tiña capitis (TC) es una infección por dermatofitos con una alta prevalencia en la población pediátrica. Su epidemiología ha cambiado en las últimas décadas debido a la creciente migración poblacional alrededor del mundo. Se han identificado factores de riesgo ambientales y propios del huésped, relacionados al desarrollo de esta infección. Las manifestaciones clínicas son variables y dependen del agente causal. La dermatoscopia y la luz de Wood son herramientas útiles para la aproximación diagnóstica, sin embargo, la confirmación de la infección se basa en las pruebas micológicas. El aislamiento del agente causal permite orientar el tratamiento antifúngico adecuado, siendo estos eficaces y seguros en población pediátrica. El tratamiento se centra en la terapia antimicótica sistémica en combinación con medidas locales. El objetivo del manuscrito es hacer una revisión actualizada sobre el enfoque clínico y terapéutico de la TC en población pediátrica.

Tinea capitis (TC) is a dermatophyte infection with a high prevalence in the pediatric population. Its epidemiology has changed in recent decades due to increasing population migration worldwide. Environmental and host-specific risk factors have been identified which are with the development of this infection. The clinical manifestations are variable and depend on the causal agent. Dermatosco- py and Wood's lamp are useful tools for the diagnostic approach; however, the confirmation of in fection is based on mycological tests. The identification of the causal agent allows guiding the appro priate antifungal treatment, which is specific and safe in the pediatric population. Treatment focuses on systemic antifungal therapy combined with local measures. The objective of this paper is to carry out an updated review of the clinical and therapeutic approach to TC in the pediatric population.

Dermatophytosis: an Epidemiological And Clinical Comparative Study in a Tertiary Care Centre

Introduction: Dermatophytosis is a common superficialmycosis associated with significant morbidity. Dermatophytosis which are recurrent and clinically unresponsive totherapy are showing an alarming increase in the last fewyears. These patients are a potential source of infection to theirfamily members and others closely associated with them. Ourstudy aimed to investigate the risk factors, clinical patternsand causative dermatophyte species in patients with chronic/recurrent dermatophytosis and patients with first episode oftypical tinea.Material And Methods: The enrolled patients werecategorized as group I consisting of 81 cases of chronic/recurrent dermatophytosis and group II consisting of 81 casesof first episode dermatophytosis. After detailed history andthorough clinical examination, wet-mount preparation fordirect microscopic examination was done along with fungalculture using Sabouraud’s dextrose agar.Results: In group I, T.mentagrophytes (51.7%) was themost common species isolated followed by T tonsurans(26.7%) and T rubrum(18.3%) while in group II, T tonsurans(43.3%) was the most common species isolated followed byT rubrum (28.4%)and T mentagrophytes(23.9%). Injudicioususe of topical steroids, non-compliance with treatment andpresence of dermatophyte infection among family memberswere the major risk factors with significant association withchronic/recurrent infections. Limitations: Lack of follow upof cases, antifungal susceptibility with clinical outcome andImmunological profile of the patients was not studied.Conclusion: Chronic and recurrent dermatophytosis areemerging as a major problem in dermatology practice.Injudicious use of topical steroid containing preparations,non-compliance, presence of intrafamilial infection are majorfactors for chronic and recurrent infections.

Clinical Assessment of Itraconazole in Dermatophytosis (CLEAR Study): A Retrospective Evaluation

roduction: The recent prevalence of dermatophytosis in India ranges from 36.6 to 78.4%. Itraconazole is commonly usedsystemic antifungal to treat dermatophytosis.Objective: The objective of the present study was to evaluate the effectiveness and safety of itraconazole given 100 mg twicedaily for the treatment of dermatophytosis.Materials and Methods: The present retrospective questionnaire-based survey was done, wherein dermatologists and generalphysicians were given survey questionnaire. Data analysis up to 4 weeks of treatment with itraconazole was considered forthis study. Efficacy evaluation was considered as percentage of patients achieving clinical cure.Results: A total of 150 doctors completed the survey involving 1100 patients. Out of 1100 patients, 341 patients (31%)responded well to topical therapy alone and were considered as clinically cured as per medical records. In remaining patientswho did not respond well to topical monotherapy, itraconazole was found to be added in 652 patients as 100 mg twice daily for4 weeks. Of these, 456 patients (70%) responded well to therapy in 4 weeks and were considered as clinically cured. Amongthe topical antifungals coprescribed with itraconazole, luliconazole was most commonly prescribed (49%). On comparison ofclinical cure rates in patients who received topical antifungal monotherapy (31%) and itraconazole cotherapy (70%), it was foundthat itraconazole cotherapy was better and the difference between the two therapies was statistically significant (P = 0.001).Conclusion: From the findings of the present analysis, clinical cure rates obtained with itraconazole were more than satisfactory.Although the standard duration of therapy ranges from 1 to 2 weeks, long-term treatment is warranted and that is with topicalantifungals and other supportive measures.

Clinico-Mycological Study of dermatophytosis in a Tertiary Care Hospital

Dermatophytes are fungi that infects the skin, hair and nails. They are hyaline septate moulds with more than hundred species described. Of these, 42 species are considered as valid and less than half are associated with human diseases. Dermatophytoses are infections produced by these and are common in tropical and subtropical areas of the country with high humidity.1 We wanted to speciate dermatophytes using phenotypic methods, analyze the risk factors, and study their clinical correlation.METHODSThe study was conducted in a tertiary care hospital in South India over a period of one year. All newly suspected cases of dermatophytosis attending Dermatology Outpatient Department were selected for the study. Thus, a total of 113 patients were enrolled in the study. Samples from these patients were subjected to direct microscopy and culture was done on Sabouraud Dextrose Agar with antibiotics. Potato dextrose agar was used for enhancement of pigment production. Culture confirmation and speciation were done by tease mount, slide culture and supplemental tests like urease test and hair perforation test. RESULTSThe present study was carried out on 113 clinically diagnosed cases of dermatophytoses. Maximum number of cases occurred in the 11-20 years age group and slight female preponderance was noted. Tinea corporis was the most common type of dermatophytosis, 68 cases (60.2%) followed by mixed type (tinea corporis + tinea cruris) 14 cases (12.4%) and tinea cruris 13 cases (11.5%). Overall positivity by culture was 39% and by direct microscopy 96%. Trichophyton rubrum was the most predominant species - 18 isolates (38.3%) and most of them were isolated from tinea corporis. Trichophyton verrucosum (25.5%) and Trichophyton mentagrophyte (21.3%) were also obtained as major isolates.CONCLUSIONSThis study highlighted that tinea corporis is the commonest clinical type. Trichophyton rubrum is the most predominant species. But we got a fairly good number of Trichophyton verrucosum and Trichophyton mentagrophyte also. Exposure to predisposing factors were present in almost half of the cases. Dermatophytosis is a trivial disease and antifungal agents are the drugs of choice for treatment but identification of predisposing factors and avoidance of these can decrease the incidence of the disease to some extent

Senna alata (akapulko) extract versus topical antifungals for treatment of superficial fungal skin infections: A systematic review and meta-analysis

@#<p style="text-align: justify;"><b>OBJECTIVE:</b> The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections.</p><p style="text-align: justify;"><br /><b>METHODS:</b> A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible.</p><p style="text-align: justify;"><br /><b>RESULTS:</b> We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild.</p><p style="text-align: justify;"><br /><b>CONCLUSION:</b> S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion.</p>

Analysis of Adult Patients with Tinea Capitis in Southeastern Korea

BACKGROUND: Tinea capitis is a cutaneous infection of dermatophytes and predominant in children. Although tinea capitis in Korea is controlled by oral antifungal medications and concerted public health initiatives, it's still a health issue.OBJECTIVE: To investigate changes in the epidemiological and mycological characteristics of adult patients with tinea capitis in southeastern Korea.METHODS: Using medical records from Kyungpook National University Hospital and Catholic Skin Clinic from 1989 to 2018, we retrospectively investigated the epidemiological and mycological characteristics of 266 adult patients (aged over 20) with tinea capitis.RESULTS: Among total 266 patients, 239 were KOH-positive. The annual incidence of tinea capitis ranged from 3 to 18 between 1989 and 2018. Of the total, 54 (20.30%) were male and 212 (79.70%) were female. Eighty patients (30.08%) were in their seventies, the most commonly affected age group. Of the remaining, 58 (21.80%) were in their sixties, and 41 (15.41%) in eighties. Among all, 77 (28.95%) visited the hospital in summer, 72 (27.07%) in spring, 64 (24.06%) in winter, and 53 (19.92%) in fall. Dermatophytes were cultured from 171 patients. Microsporum canis was the most common dermatophyte (42.48%), while Trichophyton rubrum was the second (15.79%). Of the 266 patients, 186 (69.92%) lived in urban areas and 80 (30.08%) in rural areas.CONCLUSION: The epidemiological and mycological characteristics of adult patients with tinea capitis were different from those of children in terms of annual incidence, sex distribution, and isolated dermatophytes. These results provide useful information for the treatment and prevention of tinea capitis.

Tiña de la cabeza / Tineacapitis

RESUMEN La tiña de la cabeza (tineacapitis) es una dermatofitosis del cuero cabelludo frecuente en niños. Es la más común de todas las micosis cutáneas en este grupo de edad a nivel mundial, y es muy rara en adultos. Se ha considerado unproblema de salud pública importante durante décadas.Algunos de los factores asociados son higiene personal deficiente, hacinamiento y bajo nivel socioeconómico.El agente etiológico frecuentemente aislado fue elMicrosporumcanis con un 82,09 %, seguido por Trichophytontonsurans con 17,91%. Enconclusión,la tineacapitis ocupa un lugar preponderante que merece ser estudiado,siendo necesarios la detección y tratamiento precoz para evitar complicaciones.Se presenta un caso de tineacapitis, en el que se evidencia clínicamente infección micótica por Microsporumcanis.

SUMMARY Ringworm of the head (tinea capitis) is a frequent dermatophytosis of the scalp in children. In fact, it is the most common of all cutaneous mycosis in this age group worldwide, being very rare in adults. It has been considered an important public health problem for decades, of the factors associated are: poor personal hygiene, overcrowding and low socioeconomic level. The most frequently isolated etiologic agent was Microsporumcanis with 82.09% followed by Trichophyton tonsurans with 17.91% In conclusion tinea capitis occupies a preponderant place that deserves to be studied, being necessary the detection and early treatments to avoid complications.A case of tinea capitis is presented, where there is clinically evidence of fungal infection by Microsporumcanis.

Effectiveness of modified Whitfield’s ointment with oral griseofulvin in the treatment of dermatophytosis poorly responsive to standard antifungal therapy: a randomized, double blind, within patient placebo control

Background:Dermatophytosis is a superficial fungal infection found in hot and humid areas particularly in tropical regions and affects thekeratinized regions of the body. It is usually treated with a combination of topical and systemic antifungal therapy as well as improved hygienic measures. Over the last few decades there has been an increase in the prevalence of dermatophyte infections which are poorly responding to standard antifungal therapy.Methods:Modified Whitfield’s ointment is a combination of 5%-5% Salicylic acid and Benzoic acid with an emulsifying ointment as a vehicle which has both a fungistatic and a keratolytic action. Oral Griseofulvin is a systemic antifungal agent which is a fungistatic agent. The combination of the above agents is synergistic. A randomized double blind, within-patient-placebo-controlled trial was designed for the treatment of dermatophytosis poorly responsive to standard antifungal therapy.Conclusions: This may shed light on the treatment of dermatophytosis poorly responsive to standard antifungal therapy.Trial Registration:This trial is registered with WHO trial registry number (Universal trial number): U111-1235-8791

Dermoscopy - a simple and rapid in vivo diagnostic technique for tinea incognito

Abstract Tinea incognito resulting from corticosteroid abuse is becoming very common in the tropics. Its diagnosis is tricky owing to its confusing morphology, as well as practical and technical issues associated with mycological tests. Dermoscopy has now evolved as a novel diagnostic tool for diagnosing tinea incognito in such challenging situations, since the typical hair changes such as Morse-code hairs, deformable hairs, translucent hairs, comma and cork screw hairs, and perifollicular scaling may be seen despite steroid use, irrespective of mycological results.

Generalized eczematous rash in a patient with shoe contact dermatitis: a case report

The id reaction, which is also known as autoeczematisation or autosensitisation dermatitis, refers to the acute development of dermatitis at a site distant from the site of the primary inflammatory cutaneous reaction. Many stimuli have been reported as causes of id reactions, including allergic contact dermatitis. The exact prevalence of id reaction is unknown, however, id reactions have been found to occur in 4%-5% of cases of dermatophyte infections and in up to 37% of patients with stasis dermatitis. This condition has no known predilection for any race, sex or age groups. Shoe dermatitis is a type of contact dermatitis developed following the contact of the foot’s skin with shoe’s parts that contain different chemical substance that harbor the potentiality to be an immune trigger. Among the potential allergens, rubber is found to be the most common shoe-related allergen reported in the literature. Other known allergens include: cements, dichromats used in tanning, dyes, anti-mildew agents, formaldehyde, and nickel eyelets or nickel arch supports. The pathogenesis of allergic contact dermatitis is a type IV, delayed-type immune response that provoked by cutaneous contacts with different material that have the ability to stimulate antigen-specific T-helper 1 (TH1) in a sensitized individual. The clinical presentation of id reaction includes acute onset of pruritic erythematous eruption with symmetrical distribution that follows the primary dermatitis by one to two weeks. Authors report a 27-year-old male who presented with generalized, symmetric pruritic and eczematous eruption following localized shoe dermatitis.

Prevalence of dermatophytic infections including antifungal susceptibility pattern of dermatophytes in a tertiary care hospital

Background: Dermatophytosis is a commonly encountered superficial fungal infection in the tropical and subtropical countries. The present study was undertaken to study the clinicomycological profile of dermatophytosis and perform antifungal susceptibility testing for the isolated dermatophytes.Methods: This is 2 years cross- sectional observational study including 433 clinically suspected cases of dermatophytoses. Skin, hair and nails were collected, subjected to direct microscopy by Potassium hydroxide (KOH) mount and culture on Sabouraud’s Dextrose Agar (SDA) with chloramphenicol and cycloheximide. Positive growth on culture media was further identified by LPCB mount, slide culture test, growth on Dermatophyte Test Medium, pigment production in corn meal agar with 1% dextrose, urease test and hair perforation test. The isolated dermatophytes were subjected to antifungal susceptibility testing by agar based disc diffusion method.Results: Out of 433 samples, fungal filaments were seen in 308 (71.1%) samples by KOH mount, 259 (59.8%) dermatophytes were isolated from culture. Males (60.5%) were more commonly affected than females (39.5%). Most common age group affected was 21-30 years. Trichophyton mentagrophytes (57.5%) was the most common isolate followed by Trichophyton rubrum (30.1%). Tinea corporis was the most common clinical presentation (52.7%) followed by Tinea unguium (14.1%). Antifungal susceptibility testing showed itraconazole as the most sensitive antifungal agent, while fluconazole was least sensitive.Conclusions: This study provides a scope for assessment of prevalence and clinicomycological profile, which could help in estimation of the problem and hence prevent spread of dermatophytoses with adequate control measures.

A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India

Background: Recurrent and clinically unresponsive dermatophytosis is being increasingly encountered in our country. It runs a protracted course with exacerbations and remissions. However, there is little information regarding the extent of the problem and the characteristics of recurrent dermatophytosis in published literature. Aims: We sought to determine the prevalence, risk factors and clinical patterns of recurrent dermatophytosis in our institution. We also investigated the causative dermatophyte species and antifungal susceptibility patterns in these species. Methods: One hundred and fifty patients with recurrent dermatophytosis attending the outpatient department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India were enrolled in the study conducted from January 2015 to December 2015. A detailed history was obtained in all patients, who were then subjected to a clinical examination and investigations including a wet preparation for direct microscopic examination, fungal culture and antifungal susceptibility tests. Results: Recurrent dermatophytosis was seen in 9.3% of all patients with dermatophytosis in our study. Trichophyton mentagrophytes was the most common species identified (36 patients, 40%) samples followed by T. rubrum (29 patients, 32.2%). In-vitro antifungal susceptibility testing showed that the range of minimum inhibitory concentrations (MIC) on was lowest for itraconazole (0.015–1), followed by terbinafine (0.015–16), fluconazole (0.03–32) and griseofulvin (0.5–128) in increasing order. Limitation: A limitation of this study was the absence of a suitable control group (eg. patients with first episode of typical tinea). Conclusion: Recurrence of dermatophytosis was not explainable on the basis of a high (MIC) alone. Misuse of topical corticosteroids, a high number of familial contacts, poor compliance to treatment over periods of years, and various host factors, seem to have all contributed to this outbreak of dermatophytosis in India.

The Efficacy Of Panchtiktaghrit Gugglu And Shirishadi Lepa In The Management Of Mandal Kushth W.s.r To Tinea Corporis

Skin is one of the five 慓yanindriyas� as described in Ayurvedic texts. It is responsible for 慡parsh Gyan� or touch sensation; therefore it plays a great role in physical and mental health of any individual. It is most affected by fungal infections. According to modern science the fungal infections caused by dermatophytes are called as dermatophytosis. Tinea or Ringworm infection presents with of the circular skin lesions with elevated edges. In Ayurveda, all skin diseases have been discussed under the broad heading of Kushta. The study comprised of a series of 10 patients of Mandal kushta. The patients were selected from OPD and IPD of Kayachikitsa of Sri Krishna Ayurvedic Medical College, Varanasi. In the present study a clinical trial is done with trial drug Panchtiktkta ghrit gugglu and external application of Shirisadi lepa. Panchtiktkta ghrit gugglu is cited from Bhaishajya Ratnavali and Shirisadi lepa is cited from Charak Samhita. Panchtiktkta ghrit gugglu is given in a dose of 2 tablets 3times in a day with the combination of external application of Shirisadi lepa twice in a day for 45 days. Three follow ups with duration of 15 days were done. A remarkable changes were found in various sign and symptoms based on assessment criteria which are Kandu (itching), Sotha (inflammation), Srava (secretions), Vivarnata (discolouration) and Vrana (lesion). It was indeed a proper and suitable approach for this chronic skin disorder as the patients of Mandal Kustha combat a lot for this dreadful disease as it persists for long time and spread rapidly.