Tinea capitis: still an unsolved problem?

Tinea capitis is a fungal infection specifically involving the scalp and hair. It is the most common dermatophyte infection in children under 12 years of age, with a predominance in those of sub-Saharan African descent. Common signs include hair loss, scaling, erythema and impetigo-like plaques. Adults may also be affected, but to a lesser degree. The causative species are from the Microsporum and Trichophyton genera. Limited treatment options and diverse modes of transmission complicate the clinician's ability to address this disease adequately. Although dermatophytes are ubiquitous in our environment and tinea capitis is common, therapeutic options can be utilised to reduce morbidity.

Cutaneous lymphangioma circumscriptum: frog spawn on the skin.

Lymphangiomas are congenital malformations of the lymphatic system that may involve the skin, subcutaneous tissues, and intestines. They account for 4% of all vascular tumors, but comprise 25% of benign vascular growths in children. They are hamartomatous in nature and may be grouped into cutaneous lymphangioma circumscriptum (CLC), cavernous lymphangiomas, and cystic hygromas. CLC appears localized to the dermis, although frequently extends deeper and laterally. It is important to distinguish CLC, a potentially recurrent disease, from an unusual type of metastatic carcinoma of the skin called carcinoma telangiectoides.

Tinea cruris in children.

Tinea cruris is an intensely pruritic fungal infection of the groin and adjacent skin. Also known as crotch rot and jock itch, it can be a troubling important entity that at times is a clinical, diagnostic, and therapeutic challenge. Predisposing factors include heat, humidity, and hyperhidrosis, common accompaniments of high school-aged athletes. Furthermore, obesity and diabetes mellitus, additional risk factors for tinea cruris, are reaching unprecedented levels in adolescents. Treatment options range from improving hygiene to topical antifungal agents and systemic antifungal agents, the latter with potentially dangerous side effects.

Zosteriform lymphangioma circumscriptum.

Lymphangioma circumscriptum (LC) is a form of lymphangioma involving skin and subcutaneous tissue. It is evident as translucent vesicles of varying size, though commonly 2 to 4 mm, and of a pink, red, or black hue. It is localized to the dermis, frequently extending deeply and laterally. LC may resemble other entities, such as metastatic carcinoma of the skin, lymphangiectasis, or herpes zoster. We report an unusual verruciform, zosteriform form of LC.

Subungual melanoma: a deceptive disorder.

Subungual melanoma is an uncommon form of acral melanoma that arises within the nail bed. The incidence for acral melanomas is similar worldwide, but the proportion is higher in dark-skinned individuals. The subungual form represents about 2% of cutaneous non-sun induced melanomas in the western world, and up to 75% in Africans, 10% in Japanese, and 25% in the Chinese of Hong Kong. Up to 33% of subungual melanomas are amelanotic. Black pigmentation of the adjacent nail fold, termed Hutchinson's sign, may be a diagnostic clue. Non-specific features and symptoms along with a high incidence of amelanosis often lead to delayed diagnosis, disease progression, and a poor prognosis with challenging treatment options.