Neglected Adult Tinea Capitis in South China: A Retrospective Study in Nanchang, Jiangxi Province, from 2007 to 2021.

Tinea capitis (TC) in adults is much less frequently diagnosed in comparison to TC in children. In this study, we explored retrospectively adult TC in a specialized dermatology hospital, located in South China, during the years 2007-2021. Among 1037 TC cases, 168 (16.2%) patients were older than 18 years. The majority of adults with TC, 77.38% (130/168), were older than 40, with a peak in the age of 51-60 years (40/168, 23.81%). Before presenting at our hospital, many of patients did not got proper treatment due to misdiagnosis or simply did not consulted an appropriate clinic. 60.71% (102/168) of the patients reported symptoms lasting for more than 1 year and 29.76% (50/168) reported chronic scalp problems of at least 10 years. And 27.38% (46/168) of the patients had an immunocompromised status, including long-term use of corticosteroids shampoo, type 2 diabetes mellitus (DM), psoriasis vulgaris, rheumatoid arthritis, systemic lupus erythematosus or bullous pemphigoid. As for clinical presentation, 87.5% (147/168) of the cases presented as black dot type of TC and anthropophilic dermatophytes were the predominant etiology, with Trichophyton violaceum (126), T. tonsurans (15), T. rubrum (8) and T. shoenleinii (6). Grey patch type of TC (3.57%, 6/168) was seldom in Jiangxi Province and zoophilic/geophilic dermatophytes were rare. Our study indicates that anthropophilic Trichophyton species can cause long-lasting TC in adults. Not in all cases, the manifestation had symptom clearly indicating a dermatophyte-related TC. Thus, patients with long-lasting scalp inflammation, also older ones, should be examined for the presence of dermatophyte-related TC.

Epidemiological changes in tinea capitis over the sixty years of economic growth in China.

BACKGROUND: Tinea capitis is a fungal infection of the scalp occurring commonly in children. Historical data indicate that clinical manifestations and the spectrum of etiologic agents vary greatly with geography, as well as socioeconomic affected populations. OBJECTIVE: To study the possible connection between socioeconomic status, the disease patterns and the variability of etiological agents. METHODS: We reviewed tinea capitis in China through literature since 1956. The disease pattern was correlated with economic and public health management protocols. Historical data on fungal identification were mostly obtained by morphology. The accuracy of these historical results was further confirmed by use of both morphological and ITS identification on a control set of 90 isolates collected recently from local hospital. RESULTS: Full agreement of the two identification methods implies that data from the literature were sufficiently reliable to allow comparison across reported cases. In sum, 88 papers involving 25 administrative provinces and municipalities with 38,962 clinical strains met the inclusion criteria of this review. Zoophilic species Microsporum canis is the most prevalent agent within large, modernized cities in China today accounting for over 80% of infections. In contrast, anthropophilic dermatophytes, particularly Trichophyton violaceum, are geographically endemic only in some southeastern and northwestern regions. CONCLUSION: Economic development and urbanization of cities favor a shift of etiological agents from anthroponoses to zoonoses in contemporary China. Pets are becoming the most likely sources of infection in modern lifestyles, replacing the earlier human-to-human transmission mode. However, the latter transmission mode is still prevalent in less developed areas lacking adequate social and public health facilities.

Evolution of tinea capitis in the Nanchang area, Southern China: a 50-year survey (1965-2014).

Tinea capitis remains a common public health problem worldwide especially in developing areas. Aetiologic agents and clinical pattern vary with geography and history of socioeconomic conditions. Three community surveys and a prospective study were carried out over the past 50 years (1965-2014) in the Qingyunpu District of Nanchang, Southern China. Clinical presentation and spectrum of aetiological agents were monitored to understand the evolution of tinea capitis. In 1965 favus was highly epidemic and Trichophyton schoenleinii presented as the overwhelming aetiological agents of scalp infection in the study area, with a prevalence of 3.41% of the population. During a governmental campaign to eliminate tinea capitis initiated in mid of 1960s, favus was successfully controlled and the prevalence decreased to less than 0.01% in 1977. After that period, clinical presentation and spectrum of fungi changed with social development. Trichophyton schoenleinii was replaced by Trichophyton violaceum and Trichophyton mentagrophytes. Nowadays, the species corresponds with a dominant black dot type of tinea capitis in the Nanchang area. The prevalence of causative agents of tinea capitis is not only related to geography but also to socioeconomic factors. Multiple factors have to be considered for the management for control of this disease.

A chronic disseminated dermatophytosis due to Trichophyton violaceum.

A 48-year-old female had presented dandruff and breakable hair for more than 40 years, dry scaly erythema on bilateral palms and feet accompanying with nail destruction for 20 years, and scaling papules on the buttock for 5 years. Direct microscopic examination showed endothrix anthroconidia within broken hair and septate and branched hyphae within skin and nail lesion. Fungal cultures from all infected sites were examined by morphology, ITS sequencing, and random amplified polymorphic DNA fingerprinting, and were identified as Trichophyton violaceum from the same source. The patient was treated with oral terbinafine 0.25 g/day as well as with 1% terbinafine gel for external use and with 2% ketoconazole lotion for shampoo and bath. A follow-up after 4 weeks showed that the lesions decreased significantly.

The epidemiology of tinea manuum in Nanchang area, South China.

Tinea manuum is a common superficial fungal infection which is usually coexistent with tinea pedis; there are few studies available on the epidemiology of tinea manuum at present. This study aims to investigate the epidemiology of tinea manuum and its correlation with tinea pedis in south China. A total of 280 patients with tinea manuum were recruited. The epidemiological and clinical data were analyzed, and causative agents were isolated and identified mycologically. Totally, 84.3 % patients with tinea manuum had co-occurrence of tinea pedis, among which 88.4 % patients had experience of scratching their feet. There was a significant relationship between the touch habits and the hand infection (χ(2) = 65.451, P = 0.000). More than 90 % patients had quite the same species of isolates from multiple infected sites in one patient. Therefore, it seems that transmission of dermatophytes from the feet to hand by scratching might be a most common way. As for tinea manuum, whether "unilateral" or "bilateral" is just the result that pathogens spread from feet to hand(s), which is only a special clinical presentation of tinea.