Daily Archives: February 18, 2015

Tinea cruris

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Jock Itch Rash

Tinea Cruris (Fungal Groin Infection)

Tinea cruris also called jock itch, crotch itch, ringworm of the groin, gym itch or Tinea inguinalis is a disease caused by fungi which live on the skin. It affects the upper thigh, groin, the area of the genitalia and / or the skin of the perineum and around the anus. It appears to be the second most common infection of the skin caused by fungi.

Jock Itch pictures

Epidemiology

this infection is generally more common in men and is more frequently found in adults that in children. The routes of infection are similar to all other fungal infections caused by dermatophytes (commonly called ringworm infections). They include a direct contact with an infected person / item or a previously infected site on the body (from where, the pathogens have spread to the groin area by using an infected towel or with scratching). Most commonly, the original site of the infection includes feet (also called Tinea pedis).

Ringworm of the groin is more common in hot, humid climates and in people who emigrate from such places. The species most frequently implicated in Tinea cruris include Trichophyton rubrum, Epidermophyton floccosum, Trychophyton interdigitale and Trichophyton verrucosum.

This type of fungal infection can also be sexually transmitted and can cause epidemics in bathing facilities, dormitories or between soldiers. Affected patients may have been wearing tight-fitting garments for longer periods or have been suffering from diabetes or obesity.

Clinical presentation

It appears as a circular patch, which is easily distinguishable from the surroundings and has a raised, scaly border. Another possible clinical picture involves red, scaly changes with blisters and small bumps. Some species of fungi produce a central clearing of the plaque but others don’t. Jock itch is frequently found on both legs where it extends from the inguinal fold to the inner part of the thigh and backward towards the anus. The skin changes are often itchy, if bacteria join the infection they can even get painful. Commonly, the skin of the scrotum is affected, with some species invading the skin of the buttocks, skin of the lower back or abdomen.

Differential diagnosis

candidosis (occurs more commonly in women and classically does not present with a well demarcated border), pityriasis versicolor, erythrasma, inflammation between skin folds (common in the obese people), psoriasis, mycosis fungoides, atopic eczema, lichen simplex chronicus, contact dermatitis, Hailey–Hailey disease, Darier’s disease.

If topical corticosteroid have been used in the course of the disease, symptoms can be suppressed and the diagnosis difficult to determine.

Diagnosis

After a careful examination, the doctor might collect some scales of skin from the margin of the lesion and then examine them under a microscope. Biopsy is rarely performed.

Therapy

ringworm of the groin is typically treated with topical anti fungal medications (including Terbinafine, topical Clotrimazole and Miconasole). If the patient is unable to apply it regularly or if the infection has spread to a large area, orally taken systemic drugs might be subscribed. It is important for the patient to keep the affected part of the skin dry, clean and to change into dry clothes as soon as possible after getting wet. It is also advisable to put on socks before putting on underwear in order to refrain from spreading the infection.

Sometimes, anti fungal powders are used as a preventive measure. If obese, weight loss is strongly advised.

Prognosis

Prognosis is very good unless the subjected area is not kept dry – if not, recurrence is frequent.

Jock itch prevention

in order to properly treat jocks itch, it is essential to treat the almost always present fungal infection of the feet. In hotter areas, light clothing is preferred. If an infection is taking place, the patient should not share towels or any piece of clothing with others in order to refrain from spreading the pathogens. The underwear should be changed daily and the groin kept clean and dry.

Tinea manuum

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Tinea manuum

Tinea manuum or ringworm infection of the hands, is a fungal infection occurring on the skin of the hands. It is less common than the same infection affecting the feet and appears to be frequently misdiagnosed because its clinical presentation is similar to other dermatological diseases.

fungus on hands

Is tinea manuum contagious

Transmission:it can be acquired through contact with an infected person, soil, by touching an infected animal or by touching a previously infected part of your own body (like picking on infected feet, nails or groin area). Sometimes, the disease can start under rings or watches. Bad peripheral circulation in hands and excessive sweating can both play an important role in the development of the inflammation.

Aetiology: predominantly caused by Trichophyton rubrum, Trichophyton interdigitale or Epidermophyton floccosum. Less commonly diagnosed species include: Microsporum canis, Trichophyton verrucosum and Microsporum gypseum.

Tinea manuum symptoms

it presents with scaly, demarcated patches, which show signs of hyperkeratosis (thickening of the horny layers of the skin). Blisters and crops may be seen. The peripheral part of the lesion is well demarcated and the centre often appears to be clearing off. They are found on palms but can extend to the dorsum of the hand. Sometimes, hair follicles may be involved. The lesions are often found on just one hand (the dominant one more commonly) and are associated with Tinea pedis (fungal infection of feet) and Tinea cruris (fungal infection of the groin area). If the disease is chronic, nails are often affected.

Differential diagnosis: psoriasis, keratolysis exfoliativa, contact dermatitis, lichen simplex, atopic dermatitis. If topical corticosteroid creams have been used, diagnosis can be even more difficult to determine.

Diagnosis: scrapings of the skin or a fungal culture can aid in diagnosing this disease.

Course of the disease

The disease itself is chronic and does not heal spontaneously. Unless the usually concomitant nail infection is cleared, the hand infection will reoccur. Because the skin barrier is damaged, a new route for bacteria and possible infections is opened.

Treatment

For the disease to heal it is mandatory to eradicate the nail infections on both hands and feet and on the skin of feet and groin. Oral anti fungal therapy is advised and includes drugs like terbinafine, itraconasole and fluconasole (the prescribed regimen depends on the used medication).

Tinea pedis Or Athlete’s foot Or Jungle rot

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Athletes foot

Tinea pedis

Dermatophytic infection of the feet also called ringworm infection of the feet, Tinea pedis, athlete’s foot or jungle rot is a contagious fungal infection of the skin of the feet. It affects either the space between toes or the soles. Together with fungal infections of the hands, they are believed to be the most common dermatophytoses. The involved species of fungi include Trichophyton rubrum, Trichophyton interdigitale and Epidermophyton floccosum and a combined infection can sometimes be seen.

Tinea pedis - Athletes foot

Jungle rot - Fungus on feet

Epidemiology frequently affects older children and young adults and is most commonly found in those aged twenty to fifty years. It is more commonly found in males than females. As all of the fungal skin infections, it is more frequently found in hot, humid climates. Predisposing factors include wearing tight footwear and having a condition called hypertrichosis (an abnormal amount of body hair). Because of widespread wearing of modern, tight shoes and world travelling, these infections have a very high incidence. They are also commonly acquired by walking bare-feet in pool and shower areas and can be transmitted between members of the same household. If fungi are present and infect another part of the body, it is possible for them to spread to the feet.

Tinea pedis symptoms

Redness, scaling, formation of large blisters and occasional peeling is seen. Often, a fungal infection of the toenails precedes it. If a bacterial infection follows it, the skin lesion is itchy, painful and emits a foul smell. There are four different clinical pictures associated with Tinea pedis (combination of them is possible):

  • The interdigital type: is most commonly found between the forth and fifth toe and can spread to other parts of the feet. It can be dry and scaly or macerated (by definition softening by soaking in liquid). Excessive perspiration is commonly found. This is the most common form of all.
  • The moccasin type: is most commonly located on heels, soles and the lateral borders of the feet. It can affect both feet. The skin is red, with small superficial elevations called papulae on the margin, finely scaly and hyperkeratotic (excessive thickening of the horny layer of the skin).
  • The inflammatory/ bullous type: blisters filled with clear fluid are present on the sole, the instep. Pus indicates that bacteria have also infected the damaged skin.
  • The ulcerative type: is observed when the interdigital infection has extended to the plantar or lateral part of the foot. Frequently, bacterial inflammation of the skin,the lymph nodi and fever are associated with this form.

Differential diagnosis: includes several different dermatological diseases like psoriasis, eczematous dermatitis, bullous impetigo, allergic contact dermatitis and dyshidrotic eczema.

Diagnosis

Most of the times, diagnosing Tinea pedis is possible just by looking at the lesion. If the presentation is somehow misleading, the doctor may perform small scrapings of the affected skin and examine them under a microscope, use a special lamp called Wood’s lamp which makes some species of fungi glow (although species that cause athlete’s foot usually do not) or try to grow the pathogens in a special medium.

Treatment

Tinea pedis is treated with anti fungal drugs which can be taken orally or applied topically (in form of a cream, powder, gel or spray). With the moccasin type, the topical medication has to be applied to the bottom and sides of the feet, with the interdigital type to the affected part plus the soles (because often the infection spreads). The moccasin type is based on the plantar surface of the feet where the skin is thick. Sometimes, urea based creams have to be applied together with topical anti fungals in order to soften it.

Patients with extensive hyperkeratotic or vesicular infections, those with accompanying infection of the nails, patients with diabetes, a compromised immune system (cancer, transplant patients) or disease of the peripheral vessels have to take oral anti fungal medications.

Complications

Because Tinea pedis can be quite itchy, scratching it can cause a bacterial infection of the already damaged skin. By touching the site of the inflammation, the pathogens can also spread to other parts of the body and cause the infection. The disease can extend to nails or cause a specific reaction called ‘id reaction’ where blisters can appear in distant parts of the body (by treating the feet it will usually go away).

Course and prognosis of the infection

This disease is commonly chronic in nature and repeats itself. If the patient has issues with veins in his legs, the pathogens can enter into more deeply lying tissues. Often, Tinea pedis will reoccur because patients do not stick to the prescribed therapy.

Prevention

  • use comfortable shoes that breathe
  • keep feet dry
  • change socks regularly
  • wear sandals when walking in public pools or shower areas
  • keep nails short and clean
  • keep all bathroom surfaces clean and disinfected
  • do not share shoes or towels with others.

Tinea faciei – Ringworm on face

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Face Fungus

Definition

Tinea facei (also called ringworm of the face) is a fungal infection of the face area (excluded the moustache and beard areas of men – called tinea of the barb). It is a condition which is commonly misdiagnosed (more than any other ringworm infections) and wrongly attributed to other diseases (lupus for example).
Tinea faciei pictures
Face Fungus

Cause

The inflammation is usually caused either by Trichophyton rubrum, Trichophyton mentagrophytes of Microsporum canis – all species of fungi.

Tinea faciei is a fairly common disease, which occurs worldwide. However, fungi that cause it like warmer, moister climates so it is more frequent in tropical areas.

Although all ages can be affected by Tinea faciei, two groups of patients show increased incidence: children who come in contact with animals more often (also possible in neonates) and those aged between twenty to forty years.

Pathogenesis: the infectious agents can spread to the skin by direct contact with an external, infected source (a pet mouse for example) or by spreading from another part of the body which is already affected. Sometimes, Tinea faciei can be seen in people practising wrestling.

Symptoms

Most of the patients show round lesions. The scaling (present in less that two thirds of cases), red, elevated periphery of the skin changes points in the direction of a fungal infection. Commonly, patients complain of itching, burning sensations which get worse after being exposed to the sun. The lesions can affect any area of the facial skin and are usually not symmetric to both sides. The most commonly affected parts of the face are as follows: cheeks, nose, area around the eyes, the chin and the forehead. If the patient has previously been using corticosteroid creams (a type of anti inflammatory drug), involvement of hair follicles can be seen. Sometimes, lesions of the facial skin can appear at the same time as the ones on the body or scalp.

Diagnosis

The doctor may perform some small scrapings from the lesion to microscopically determine the involved pathogen. Sometimes a small piece of skin has to be taken to further clarify the origin of the disease. If corticosteroids have been used, cessation of therapy of a few days can make symptoms more prominent and therefore the diagnosis easier.

Differential diagnosis

The disease can be frequently mistaken for seborrhoeic dermatitis, contact dermatitis, the rash seen in Lyme disease, lupus, photo-toxic eruptions, rosacea and skin infections with Candida.

Tinea faciei treatment

if involvement of hair follicles (called fungal folliculitis) is present, or if the infection is widely spread, oral anti fungal treatment is advised. If there is no observed folliculitis, then topical therapy will usually suffice.

Prognosis

The prognosis with this type of infection is usually good and it should respond to treatment in about four to six weeks.

References

Ali, Asra, 2007, Dermatology. New York : McGraw-Hill Medical Pub. Division.

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Burns, Tony and Rook, Graham Arthur, 2010, Rook’s textbook of dermatology. Oxford [u.a.] : Wiley-Blackwell.

Fitzpatrick, Thomas B and Wolff, Klaus, 2008, Fitzpatrick’s dermatology in general medicine. New York [u.a.] : McGraw-Hill.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s colour atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical

Emedicine.medscape.com, 2015, Tinea Faciei. [online]. 2015. [Accessed 13 January 2015]. Available from: http://emedicine.medscape.com/article/1118316-overview

Tinea barbae

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Tinea barbae ringworm affects the facial hair (like the beard area)

Tinea barbae is a condition also known as Tinea sycosis or barber’s itch. Because of the specificity of the involved areas and structures (beard and moustache areas with invasion of hairs) it is a disease of adult males. It is not a very common infection, mostly affecting people working in the agriculture field (more common if working in contact with farm animals – cattle, horses or dogs may be the source). The shift of prevalence towards farmers and ranchers occurred after hygiene in barbers shops improved and the transmission by infected razors decreased. On general, Tinea barbae can be caused by fungi which have adopted to animal or human hosts (in Latin they are called zoophilic and antropophilic species respectively).

Tinea barbae ringworm also known as Tinea sycosis or barber's itch

Usually two types of clinical presentation are recognised:

  • the first type, where deep, nodular, suppurative (suppuration means the formation or discharge of pus) lesions are seen. This type develops slowly, with nodular thickening of the involved skin and swelling that reminds of kerion (a severe ringworm infection of the scalp). The most common causative pathogens are Trichophyton mentagrophytes and Trichophyton verrucosum – both types of fungi. The affected skin is visibly inflamed, the present swellings diffuse. The hairs may be absent or very loose, from the remaining follicular openings pus might be expressed. Usually the lesions are confined to one part of the face or neck skin.

tinea barbae pictures

  • the second type, where more superficial, crusted and partially bald patches with folliculitis (inflammation of a hair follicle) can be observed. The inflammation usually appears to be milder in nature and the affected hairs can sometimes be extracted with ease. If loss of hairs is present, it usually reverses with therapy. The involved pathogens include Trichophyton violaceum and Trichophyton rubrum, just rarely Epidermophyton floccosum.

In most of the cases the lesion is present on one side of the face or neck and involves the beard area (rarely moustache area and upper lip). The area appears to be itchy, tender and painful.

Diagnosis of Tinea barbae

the diagnosing process starts with the mandatory clinical inspection which in most cases suggests the underlying fungal infection. It is confirmed by microscopically examining the hairs extracted from the affected part of the skin (treated with potassium hydroxide) or by performing a skin biopsy. In some cases the doctor can make an attempt to grow a fungal culture (plant the extracted hair or a piece of skin in the appropriate medium), although this is rarely performed.

Differential diagnosis of Tinea barbae: when barber’s itch is suspected, two conditions with a fairly similar presentation must be kept in mind:

  • Inflammation of the hair follicles caused by bacteria called Staphylococci (in Tinea barbae there is usually no involvement of the upper lip and the lesions appear to be confined to one side)
  • Herpetic infections (lesions seen with herpes virus appear to be umbilicated – have a central depression)
  • Acne vulgaris, rosacea, contact dermatitis, perioral dermatitis or candidal folliculitis

Treatment of Tinea barbae

Although some forms of Tinea can be cured with topical agents this is not one of those cases. The infection show tendencies of spontaneous healing but can, however, persist for months. With barber’s itch systemic, orally taken anti fungals must be prescribed by a doctor and local creams serve merely as part of an adjunctive (joined) therapy.

References

Ali, Asra, 2007, Dermatology. New York : McGraw-Hill Medical Pub. Division.

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Burns, Tony and Rook, Graham Arthur, 2010, Rook’s textbook of dermatology. Oxford [u.a.] : Wiley-Blackwell.

Fitzpatrick, Thomas B and Wolff, Klaus, 2008, Fitzpatrick’s dermatology in general medicine. New York [u.a.] : McGraw-Hill.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s colour atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical.

Ringworm in babies

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baby ringworm

Ringworms in children and babies

ringworm babies contagious Ringworms are a class of infectious diseases caused by fungi. Despite their name they are not related to worms or parasites of any kind. These pathogens can affect people of any age, but are more common in children older that two years (also possible in younger babies but quite rarely). These common infections are not dangerous by nature.

Ringworm in babies

The child or baby can get infected with ringworms by having contacts with an infected person, animal (pets like dogs or cats), by picking it up from floors, soil or by coming into contact with an object which contains pathogens (towels, combs, different pieces of clothing).

 

Symptoms

Ringworm infection in children are usually quite specific. Usually they present as a scaly patch which can be found almost anywhere on the body (scalp, face, body, hands, legs). The patch grows with time and it’s usually round in shape, red coloured with a smooth, sometimes clear centre. The border is composed of scales, small blisters and bumps. If the lesion is located on the head, there might be scaly areas with missing or broken – off hair. This condition can be mistaken for another one called cradle cap (greasy, scaly patches that sometimes appears on the head of a baby) or for other, rash causing diseases (like psoriasis, eczema, seborrhoea or contact dermatitis). Sometimes the lesion on the skin is one and sometimes there are multiple.

If the child’s organism responds to the ringworm infection with a vivid immune response, a condition called kerion might follow. It is characterised by a swollen, moist area of inflammation with pus filled bumps (called pustules).

Diagnosing ringworm in babies

when the doctor inspects the child for possible ringworm infection he might be able to diagnose it just by looking at the lesion. If the diagnosis is not as straightforward, he might use a special lamp called Wood’s lamp or perform a small scraping of the diseased skin which will get examined under a microscope.

Treatment of ringworms in babies

when a ringworm is suspected in a child, an appointment with the doctor is to be scheduled. The prescribed treatment depends on the site, where the inflammation is taking place. If the lesions are located on the body of the baby, topical anti fungal creams will usually be enough (for example clotrimasole cream used twice daily). In most of the cases, in a couple of weeks the infection should go away (about three to four). After there are no more visible signs of the disease, the cream should be used for another seven days to prevent possible relapses. Some children might be sensitive or even allergic to prescribed creams. In that case, the paediatrician has to be consulted. In most of the cases, topical medications will suffice, only sometimes oral anti fungals will be recommended (when the infection is located on the scalp of the baby).

How to prevent ringworm in babies – Precautions

  • Sometimes the changes on the child’s skin can be itchy. When scratched, dirt and bacteria can get in the already damaged skin and cause a bacterial infection. It is therefore very important to keep the child s nails short and clean.
  • The clothes and the bedding have to be thoroughly washed to prevent a reinfection.
  • If the child is in daycare or school, consult with his teacher and/or doctor on whenever you should keep him at home to prevent from spreading the disease to others.
  • After applying anti fungal creams, the parent have to wash their hands with soap and hot water
  • Pets should be taken to the vet for a check – up (they can show symptoms or not)
  • If the baby has Tinea capitis (ringworm located on the scalp), all the household members are advised to use anti fungal shampoos for an appropriate amount of time
  • Children should use appropriate footwear when walking around pool areas and avoid sharing personal care objects like combs, towels etc.
  • The affected child should wear light, cotton made garments which breathe in order to stay dry.

References

Askdrsears.com, 2015, [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.askdrsears.com/topics/health-concerns/skin-care/ringworm

BabyCenter, 2015, Ringworm | BabyCenter. [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.babycenter.com/0_ringworm_10902.bc?page=2

conditions, Baillnesses, 2015, Ringworm. BabyCentre [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.babycentre.co.uk/a548378/ringworm

HealthyChildren.org, 2015, Ringworm. [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.healthychildren.org/English/health-issues/conditions/skin/Pages/Ringworm.aspx

Melbourne, The, 2015, Kids Health Info : Ringworm. Rch.org.au [online]. 2015. [Accessed 13 January 2015]. Available from: http://www.rch.org.au/kidsinfo/fact_sheets/Ringworm/

TheBump.com, 2015, Ringworm in Babies. [online]. 2015. [Accessed 13 January 2015]. Available from: http://pregnant.thebump.com/new-mom-new-dad/baby-symptoms-conditions/articles/ringworm-baby.aspx

Tinea capitis

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Tinea capitis: affects the head (usually found in children)

Tinea capitis is also called ringworm of the scalp/ hair, tinea tonsurans or herpes tonsurans. It is a condition where the dermatophytes affect the hair shaft and scalp. It is most often seen in young people (children between 3 and 14 years of age), is much more common in Afro-American individuals that Caucasians and affects more boys than girls. Although this is an infection that mainly occurs in children and usually does not persist past age sixteen, it may be seen in adults with AIDS. Tinea capitis is very rare in children younger that one year, but still possible. Usually these infants are immunologically normal, but an underlying disorder must be excluded.

Usually the lesions persist from weeks to months.

The presentation of the tinea capitis: can vary greatly- from scaling that does not appear inflamed to scaling with broken hair and even severe inflammation with painful nodules with pus (called kerion). The latter can result in alopecia (loss of hair) due to scarring. Itching might be present or not.

There are more than eight species of dermatophytes that cause tinea capitis. It is difficult to determine the species that predominates because the incidence varies from country to country, form continent to continent. It may even change in time because of people immigrating abroad.

The transmission of the infection occurs from person to person, from animals to people, with contaminated objects (combs, towels, pillows, theater seats and so on) or by contact with an asymptomatic carrier (a person who does not appear to have an active inflammation). The transmission is more common were there is poor hygiene, overcrowding and a low socio- economic status. There are also some risk factors that predispose for a more serious curse of the infection: malnutrition of the patient, chronic disease or debilitation.

The clinical appearance depends on the type of the infection and the host immune response. Generally speaking, it usually results in scaling, breakage and loss of hair and a inflammatory response that extends to different degrees. When describing Tinea capitis it is useful to recognize these commonly seen forms:

  • Gray patch tinea capitis: it occurs in epidemic and endemic forms. The epidemic form has almost disappeared from North America, but the endemic form contracted from domestic pets still persists. The infection begins with a red colored patch on the scalp that scales and grows centrifugally for some weeks of even months. After that the growth stops and the patch persists for a long time. The lesion can be solitary or multiple, in the infected area the hair breaks about a millimeter or two above the skin. In some patients the appearance of the lesion changes, becomes elevated, painful with nodules (kerion). This is the result of the body answering to the fungal invasion which can, in some cases, become complicated by a bacterial infection. Sometimes even the lymph nodes may become enlarged and painful.

Gray patch tinea capitis

  • Black dot tinea capitis: is the most common form of Tinea capitis in the United states. Usually seen in children, it can occur in adults – especially older people. It spreads by direct contact with the infected, by contact with the infected items or by contact with a asymptomatic individual. Afro- American children appear to be more susceptible. Usually, the infection begins as an asymptomatic, reddish scaling patch on the scalp which enlarges slowly. Because it may not cause a lot symptoms, it is easily overlooked until te hair starts to break off. When the hair falls off, the opening left behind appears as a black dot – hence the name black dot tinea capitis. Sometimes there is so much inflammation that the condition can be easily mistaken for a bacterial infection of the skin. If the condition remains untreated, it can progress to permanent scarring and hair loss.

Black dot tinea capitis

  • Favus: this form of disease persist in certain parts of the world (China, Nigeria and Iran), elsewhere its occurrence has decreased. Usually, the disease starts with redness around the hair follicles that evolves forming concave, cup-like shaped yellow crusts (called scutula). These crusts are composed of dead inflammatory cells, fungi, dried scalp secretions and skin cells. If the condition is left untreated the crusts confluent and the hair under them falls out. It appears that prolonged contact is needed for the spread of the infection.

Favus

Diagnosis of Tinea capitis

KOH examination (treating the scrapings of the sking with potassium hydroxide) may be enough for diagnosis. The Wood lamp (UV lamp for detecting certain fungi species) can be used but not all of the species will glow under it. Sometimes dermoscopy findings (a noninvasive diagnostic technique that enables an experienced clinician to perform direct microscopic examination of skin lesions) might be of help in determining a ringworm infection of the scalp. Specific findings include curved and broken (comma) hairs and corkscrew-shaped hairs.

Tinea capitis Picture

Treatment of Tinea capitis

because the pathogens in this disease are out of reach for topical medications, oral antifungals usually have to be used. The systemic treatment usually consists of griseofulvin, terbinafine, itraconasole or fluconasole that must be taken (on average) a couple of weeks. The treated patient must be scheduled for follow-up visits with the doctor and the treatment prolonged if there are signs of active disease at the end of the planed course.

It is important for the household members of the infected individual to be scanned for a possible infection and if so, treated with appropriate medications.

Children can benefit from use of shampoo preparations of selenium sulfide, zinc pyrithione, povidone iodine or ketoconazole as additional therapy 2-4 times weekly for 2-4 weeks. The same treatment is also advised for the patient’s household members to prevent reinfections.

Although trials showed no difference in cure rates when using antifungal agents plus anti inflammatory drugs in contrast to using antifungals alone when treating kerion, the anti inflammatory glucocorticoids can still be used to relive discomfort.

Course of the disease

The prognosis of Tinea capitis is somehow difficult to assess because of many factors that have to be included and a very variable presentation. It is mandatory for the patient to stick with the prescribed treatment regimens and to keep the environment and himself clean. If left untreated, kerion and favus can result in scarring and loss of hair. If the patient is treated with oral antifungal agents regrowth of hair is to be expected. Favus is a condition that can persist into adulthood.