Tiña de la cabeza: descripción de los hallazgos dermatoscópicos en 37 pacientes / Tinea capitis. Dermoscopic findings in 37 patients

Antecedentes. La tiña de la cabeza (tinea capitis) es la tiña más común en niños. El diagnóstico clínico se confirma con el estudio micológico, que incluye examen directo con hidróxido de potasio o negro de clorazol, así como el cultivo. Mediante dermatoscopia se ha descrito la presencia de pelos «en coma», «en sacacorchos» («tirabuzón»), además de pelos cortos y puntos negros. Objetivos. Describir los patrones dermatoscópicos que se encuentran en la exploración tricoscópica en pacientes con diagnóstico de tiña de la cabeza. Métodos. Estudio descriptivo, observacional y transversal. Se incluyeron 37 pacientes con diagnóstico de tiña de la cabeza, atendidos en el mes de mayo de 2012 en el Departamento de Dermatología del Hospital General Dr. Manuel Gea González, de México, y el Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, de República Dominicana. Se llevó a cabo la evaluación clínica, micológica y dermatoscópica. Resultados. Se evaluaron 37 pacientes, 28 mulatos de República Dominicana y 9 mestizos de México, con un 76% de varones y un 24% de mujeres. El 94% de los casos fueron niños. Se corroboró la presencia de los patrones dermatoscópicos ya descritos: pelos «en coma» (41%), «en sacacorchos» (22%), cortos (49%) y puntos negros (33%); además, se constató la presencia de escamas (89%), vainas peripilares (46%), alopecia (65%), pústulas (8%) y costras melicéricas (16%). Conclusiones. El estudio dermatoscópico puede confirmar el diagnóstico de tiña de la cabeza, y complementa el estudio micológico, al encontrar pelos «en coma» y «en sacacorchos»; además, se observó la presencia de escamas, vainas peripilares y alopecia. Es deseable instaurar este método diagnóstico en lugares en los que no se cuente con un microscopio óptico o un laboratorio de micología de referencia (AU)

Background. Tinea capitis is a common fungal infection in children. Diagnosis is confirmed by mycological study, including direct examination of the samples with potassium hydroxide/chlorazol black and culture. Previous studies have reported the presence of 'comma hairs' and 'corkscrew hairs', as well as short hairs and black dots. Aims. To describe the dermoscopic patterns in the trichoscopic examination in patients with tinea capitis. Methods. A descriptive, observational and cross-sectional study was conducted on 37 patients with tinea capitis, studied during May, 2012, at Dr. Manuel Gea González General Hospital in Mexico, and the Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, in the Dominican Republic. Clinical, mycological and dermoscopic evaluations were performed. Results. Of the 37 patients included, 28 were of mixed race from Dominican Republic and 9 mixed race cases from Mexico. Seventy six percent were male and 24% female, and 94% were children. The following dermoscopic patterns were confirmed: 'comma hairs' (41%), 'corkscrew hairs' (22%), short hairs (49%), and black dots (33%). The presence of scales (89%), peripilar casts (46%), alopecia (65%), pustules (8%), and meliceric crusts (16%), were also observed. Conclusions. Dermoscopy in tinea capitis showed the presence of 'comma hairs', and 'corkscrew hairs'. Scales, peripilar casts and alopecia were also found. It would be desirable to establish this diagnostic tool, particularly when an optical microscope or a mycology reference laboratory are not available (AU)

[Tinea capitis. Dermoscopic findings in 37 patients]. / Tiña de la cabeza: descripción de los hallazgos dermatoscópicos en 37 pacientes.

BACKGROUND: Tinea capitis is a common fungal infection in children. Diagnosis is confirmed by mycological study, including direct examination of the samples with potassium hydroxide/chlorazol black and culture. Previous studies have reported the presence of "comma hairs" and "corkscrew hairs", as well as short hairs and black dots. AIMS: To describe the dermoscopic patterns in the trichoscopic examination in patients with tinea capitis. METHODS: A descriptive, observational and cross-sectional study was conducted on 37 patients with tinea capitis, studied during May, 2012, at Dr. Manuel Gea González General Hospital in Mexico, and the Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, in the Dominican Republic. Clinical, mycological and dermoscopic evaluations were performed. RESULTS: Of the 37 patients included, 28 were of mixed race from Dominican Republic and 9 mixed race cases from Mexico. Seventy six percent were male and 24% female, and 94% were children. The following dermoscopic patterns were confirmed: "comma hairs" (41%), "corkscrew hairs" (22%), short hairs (49%), and black dots (33%). The presence of scales (89%), peripilar casts (46%), alopecia (65%), pustules (8%), and meliceric crusts (16%), were also observed. CONCLUSIONS: Dermoscopy in tinea capitis showed the presence of "comma hairs", and "corkscrew hairs". Scales, peripilar casts and alopecia were also found. It would be desirable to establish this diagnostic tool, particularly when an optical microscope or a mycology reference laboratory are not available.

Rhinofacial conidiobolomycosis (entomophthoramycosis).

Conidiobolomycosis is a tropical rhinofacial subcutaneous mycosis caused by Conidiobolus coronatus. It is characterized histopathologically by the presence of hyphae surrounded by an eosinophilic halo, the so-called Splendore-Hoeppli phenomenon. There is no standard treatment, but itraconazole is an effective option.

Chromoblastomycosis.

Chromoblastomycosis is a chronic, subcutaneous mycosis, characterized by verrucous nodular lesions, usually involving the legs and mainly caused by Fonsecaea, Phialophora, and Cladophialophora spp. The characteristic finding on direct examination or biopsy specimen is the presence of fumagoid cells or Medlar bodies. Chromoblastomycosis can be refractory to medical treatment. Therapeutic options include oral itraconazole, terbinafine, or 5-fluocytosine, alone or combined with surgery or cryosurgery.

Subcutaneous phaeohyphomycosis (mycotic cyst).

Phaeohyphomycosis designates fungal infections caused by pheoid or melanized fungi and characterized histopathologically by the presence of septate hyphae, pseudohyphae, and yeasts. Etiologic agents include Exophiala, Phoma, Bipolaris, Phialophora, Colletotrichum, Curvularia, Alternaria, Exserohilum, and Phialemonium sp. The most common are Exophiala jeanselmei and Wangiella dermatitidis. The clinical presentation depends on the immune status of the host: superficial (tinea nigra and black piedra); cutaneous (scytalidiosis) and corneal; subcutaneous (mycotic cyst); and systemic phaeohyphomycosis in the immunocompromised host. The mycotic cyst is a localized form, characterized by subcutaneous asymptomatic nodular lesions that develop after traumatic implantation of fungi, especially on the extremities. The average size of the cysts is 2.5 cm. KOH examination reveals pigmented yeasts, pseudohyphae, and hyphae. A cutaneous biopsy specimen usually shows an abscess or a suppurative granuloma with pigmented yeasts and pseudohyphae. The treatment of choice is surgical excision, but additional anti-fungal therapy is recommended for recurrent cases and immunocompromised patients.

Inflammatory tinea capitis: kerion, dermatophytic granuloma, and mycetoma.

Inflammatory tinea capitis is the result of a hypersensitivity reaction to a dermatophytic infection. The usual forms are favus, kerion celsi, dermatophytic Majocchi granuloma, and mycetoma. Inflammatory tinea capitis can be caused by Microsporum canis, Trichophyton mentagrophytes, T tonsurans, T rubrum, and M gypseum. Histopathologic findings include a spectrum from mild suppurative folliculitis to dense granulomatous infiltrates. In mycetoma, grains must be present.

Cytobrush-culture method to diagnose tinea capitis.

This is a comparative study to isolate the dermatophytes of tinea capitis using the cytobrush and comparing it versus the standard method. A prospective, observational, comparative trial of 178 probable cases of tinea capitis was conducted in two dermatological centers. Each patient underwent mycological tests that included direct exam with KOH and cultures with either of two methods: scraping the scalp to remove hair and cell debris, and the cytobrush. A total of 135 clinically and mycologically proven cases of tinea capitis were included; 119 were non-inflammatory and 16 inflammatory tinea. A total of 131 had a positive direct exam and subsequent primary isolation cultures were obtained in 135 cases. The main dermatophytes isolated were Microsporum canis (68%) and Trichophyton tonsurans (20%). A total of 115/135 (85.1%), were detected with the traditional method, with an average of 11.2 days until positive, while the number detected with the cytobrush was 132/135 (97.7%) with an average of 8.5 days until positive. The chi-square statistical method showed that the cytobrush culture was superior to the standard one with a chi-square of 5.078 (P = 0.025), with a statistically significant difference versus the standard method.

Kerion and dermatophytic granuloma. Mycological and histopathological findings in 19 children with inflammatory tinea capitis of the scalp.

BACKGROUND: Inflammatory tinea capitis or kerion is the result of a hypersensitivity reaction to a dermatophytic infection. Majocchi's granuloma, in contrast, usually begins as a suppurative folliculitis and culminates in a granulomatous reaction. OBJECTIVES: To present clinical, mycological and histopathological findings for 19 cases of kerion of the scalp in children. METHODS: Nineteen children were investigated (14 boys and five girls) with a mean age of 6.5 years. A potassium hydroxide (KOH) exam and culture in Sabouraud dextrose agar were performed, followed by a biopsy with hematoxylin and eosin, periodic acid-schiff (PAS) and Gomori-Grocott stains. The same investigations were carried out in four control cases of noninflammatory tinea capitis. RESULTS: Clinical history varied from 2 to 16 weeks (mean 6.6 weeks). Diagnosis was confirmed by a positive KOH exam: all cases except one had a positive culture. The following dermatophytes were isolated: Microsporum canis (32%), Trichophyton mentagrophytes (27%), Trichophyton tonsurans (21%), Trichophyton rubrum (10%) and Microsporum gypseum (5%). The histopathological findings were: suppurative folliculitis (SF) 11%, SF plus suppurative dermatitis 37%, suppurative and granulomatous dermatitis (SGD) 26% and SGD plus fibrosing dermatitis 26%. Fungi were observed in 63% of the histopathological sections. Perifollicular infiltrates (PF) around the parasitized hair follicles were identified in the four noninflammatory control cases due to M. canis. CONCLUSIONS: Kerion Celsi is an inflammatory or suppurative type of tinea capitis caused by zoophylic dermatophytes (M. canis and T. mentagrophytes), but also by antrophophylic (T. tonsurans and T. rubrum) and geophylic (M. gypseum) dermatophytes. Histopathological findings showed a spectrum from mild suppurative folliculitis to dense granulomatous infiltrates without a clear relationship with the clinical features.