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Tinea capitis, a common public health problem in developing countries, has severe forms such as kerion. However, the underlying mechanisms and standard treatments for persistent cases of tinea capitis or kerion remain controversial. In this work, we investigate the ingrown hairs and corresponding treatment in persistent kerion of children. Children with persistent kerion were enrolled among 312 cases of tinea capitis at the Department of Dermatology, Hangzhou Third People's Hospital from January 2020 to June 2024. The presence of fungal infection was ascertained by direct microscopic examination under calcofluor white staining and routine culture. The structure of the ingrown hairs was observed directly by a dermatoscope, which was subsequently extracted using sterile tools. A total of six cases of persistent kerion among 312 cases of tinea capitis were enrolled. Ingrown hairs were ascertained under dermatoscopy and extracted by minor operation. Except for one patient who continued oral terbinafine, the other five cases were cured by removal alone. Ingrown hairs, induced by fungal infection, may be an aggravating factor of persistent course of tinea capitis. Our study demonstrated that the presence of ingrown hairs could be confirmed through direct dermatoscopy, and patients experienced significant improvement following removal treatment under dermatoscopy. [ABSTRACT FROM AUTHOR]

This literature review aims to comprehensively evaluate the clinical and dermoscopic presentations of common pediatric diseases among children with skin of color (SoC) while also addressing potential variations based on racial backgrounds. This review encompasses various conditions, such as nevi subtypes, viral infections, infestations, and inflammatory dermatoses, as well as hair diseases and abnormal vascular formations, occurring in pediatric populations. Overall, we identified 7 studies on nevi subtypes, 24 studies on skin infections, 6 on inflammatory dermatoses, 10 on hair diseases and disorders, and 14 on miscellaneous disorders that also satisfied our SoC- and race-specific criteria. In case of no results, we assumed that dermoscopic findings are similar between SoC adults and children, confirming the hypothesis with our cases of dark-skinned Indian child patients. Inflammatory dermatoses such as psoriasis, eczema, and cutaneous mastocytosis, as well as skin infections like cutaneous leishmaniasis, appear with brownish backgrounds or exhibit dark structures more frequently than the respective dermoscopy images of Caucasian populations. Dermoscopy traits such as erythema in tinea capitis are uncommon or even absent on a dark-colored scalp, while a dark skin tone often obscures many characteristic features, such as dark and yellow dots in alopecia areata and even parts of an intradermal parasite in the case of scabies. Race-specific traits were also observed, such as corkscrew hair in tinea capitis, primarily seen in patients of African origin. Many dermoscopic images are consistent between SoC and non-SoC in various skin lesions, including vascular anomalies, juvenile xanthogranuloma, mastocytoma, and viral skin lesions like molluscum contagiosum, as well as in various hair disorders such as trichotillomania, while tinea capitis displays the most diverse reported dermoscopic features across SoC- and race-specific studies. [ABSTRACT FROM AUTHOR]

Introduction: Griseofulvin, discovered in 1939 and commercially available since 1959, was the first oral antifungal agent effective against dermatophytosis, particularly tinea capitis. Although it was eventually superseded by azole antifungals due to its long treatment duration and reliance on keratopoiesis, griseofulvin remains notable for its effectiveness and safety in treating tinea capitis, especially when caused by Microsporum canis. However, due to a decline in cases and commercial unavailability, alternative treatments are now required. Areas Covered: The following topics regarding to other treatments were discussed: (I) The efficacy of alternative antifungal agents such as terbinafine, itraconazole, and fluconazole, in the treatment of tinea capitis. (II) The use and role of topical therapies. (III) Experience in the management of tinea capitis. Expert Opinion: The usefulness of oral terbinafine as a replacement for griseofulvin in the treatment of tinea capitis and why it is the preferred drug in elderly patients was discussed. Challenges with Microsporum spp. and the use of fluconazole in pediatric patients were also analyzed. Support for the use of topical treatment as an adjunctive treatment for tinea capitis was highlighted. [ABSTRACT FROM AUTHOR]

Tinea capitis presents a significant public health care challenge due to its contagious nature, and potential long‐term consequences if unrecognized and untreated. This review explores the prevalence, risk factors, diagnostic methods, prevention strategies, impact on quality of life, and treatment options for pediatric tinea capitis. Epidemiological analysis spanning from 1990 to 1993 and 2020 to 2023 reveals prevalence patterns of pediatric tinea capitis influenced by geographic, demographic, and environmental factors. Notably, Trichophyton species is most prevalent in North America; however, Microsporum species remain the primary causative agent globally, with regional variations. Risk factors include close contact and environmental conditions, emphasizing the importance of preventive measures. Accurate diagnosis relies on clinical evaluation, microscopic examination, and fungal culture. Various treatment modalities including systemic antifungals show efficacy, with terbinafine demonstrating superior mycological cure rates particularly for Trichophyton species. Recurrent infections and the potential development of resistance can pose challenges. Therefore, confirming the diagnosis, appropriately educating the patient/caregiver, accurate drug and dose utilization, and compliance are important components of clinical cure. Untreated or poorly treated tinea capitis can lead to chronic infection, social stigma, and psychological distress in affected children. Prevention strategies focus on early detection and healthy lifestyle habits. Collaborative efforts between healthcare providers and public health agencies are important in treating pediatric tinea capitis and improving patient outcomes. Education and awareness initiatives play a vital role in prevention and community‐level intervention to minimize spread of infection. Future research should explore diagnostic advances, novel treatments, and resistance mechanisms in order to mitigate the disease burden effectively. [ABSTRACT FROM AUTHOR]

Oral–facial–digital syndrome type 1 (OFD1) is an X‐linked dominant development disorder due to mutations in the OFD1 gene. It is characterized by facial, oral, and digital malformations, although expression is variable. Skin manifestations are frequent (20%–30% of patients) and characterized by evanescent milia and patchy alopecia. Trichoscopic findings (broken hairs, black dots, pili torti) can resemble tinea capitis, although such findings have not been well characterized. High clinical suspicion of ectodermal dysplasia‐like syndromes due to trichoscopy findings, absence of response to long‐term antifungal therapy, and the presence of midline anomalies can raise suspicion for OFD1, which can be confirmed by genetic testing and enable diagnosis. [ABSTRACT FROM AUTHOR]

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Tinea capitis, or dermatophytosis, is a prevalent infection in school-age children worldwide, leading to school absenteeism and educational setbacks. Ginger (Zingiber officinale) and garlic (Allium sativum) have demonstrated antifungal properties. This study aimed to assess the efficacy of three extracts (aqueous, ethanolic 70%, and methanolic 70%) of Zingiber officinale and Allium sativum against dermatophytic fungi isolated from the hair scrapings of 60 elementary school students with clinical signs of Tinea capitis in Balanga LGA Gombe State, North-East Nigeria. The antifungal susceptibility was determined using the cup plate method and compared with griseofulvin at 1 mg/mL. The dermatophytes isolated included Trichophyton mentagrophytes (25%), Microsporum canis (20%), Microsporum gypseum (12%) Trichophyton rubrum (14%), Trichophyton verrucosum (10%), Trichophyton schoeleinii (8%), and Trichophyton tonsurans (8%). The efficacy of garlic and ginger varied among the dermatophyte species. Trichophyton rubrum showed the highest susceptibility to the methanolic garlic extract, followed by Microsporum gypseum, Trichophyton mentagrophytes, Microsporum canis, Trichophyton verrucosum, Trichophyton schoeleinii, and Trichophyton tonsurans. For ginger, Trichophyton mentagrophytes was most susceptible, followed by Microsporum gypseum, Trichophyton schoeleinii, Trichophyton verrucosum, Trichophyton tonsurans, Trichophyton rubrum, and Microsporum canis. The methanolic garlic extract and the ethanolic ginger extract showed inhibition zones ranging from 12.93 to 25.87 mm and 12.0 to 24.9 mm, respectively. Aqueous extracts of both herbs exhibited the lowest inhibition zones. Trichophyton mentagrophytes were identified as the primary agent of Tinea capitis in the study area, caused by both anthropophilic and zoophilic dermatophytes. The study confirmed that ginger and garlic extracts significantly inhibited the growth of isolated dermatophytes, supporting their potential as sources of antifungal medications for managing dermatophytic diseases

Background Dermatophytes are the most common superficial fungal infections worldwide and are treated with prescribed regimens of terbinafine and itraconazole, or with weekly doses of fluconazole. Dermatologists are increasingly encountering treatment failures, and experts suggest that standard treatment regimens are not applicable anymore. We planned an open-label study to evaluate the results of fluconazole 150 mg daily for 8 weeks in patients with tinea cruris and tinea corporis. Methods Patients were enrolled from the La’Mer Clinic, Mumbai, India. We included adult subjects with uncomplicated dermatophytosis confirmed by microscopic examination of skin scrapings. Pregnancy, poor renal function, and recent exposure to anti-fungal therapy were exclusion criteria. Patients were reviewed on days 14, 28 and 56. The treating doctor scored the severity of erythema, scaling, and pruritus on a four-point scale: absent, mild, moderate, and severe. Of 107 subjects screened, 100 were finally included in the study. Eleven were lost to follow up and one subject withdrew consent. Results The site of disease was body alone in 29, groin alone in 7, and both body and groin in 64 cases. At 5 weeks, 98%, 100%, and 97% of patients had no scaling, erythema, and pruritus, respectively. Skin scrapings showed 100% mycological cure. In one patient the alanine transaminase level rose from 54.9 to 100.2 U/L, and qualified as a grade 1 adverse event not requiring intervention. No other significant adverse events were noted. Conclusions Our results suggest that fluconazole 150 mg daily for eight weeks effectively treats dermatophytosis. This regimen is safe and well-tolerated even in patients with co-morbidities. Fluconazole is about eight times less expensive than itraconazole or terbinafine and may be the preferred therapy. Registration The trial was registered with Clinical Trials Registry, India (Registration number CTRI/2020/06/026110) on 24 June 2020. FDC Company, India, provided financial support for the study.

Microsporum canis is considered one of the filamentous fungi that cause surface fungal contagion in the humans and animals. The present study aimed to diagnose M. canis via the molecular method and differentiating its local Iraqi isolates from global isolates. Microscopic examination showed 55 specimens with M. canis from 130 specimens collected from children aged between 4-10 years suspected of dermatophytes who attended Medical City Laboratories and Baghdad Hospital in Baghdad city from 1/12/2022 to 1/3/2023. The results showed that the frequency of M. canis infections was 55/130 (42.31%). The results demonstrated significant differences in the animals' contact (p <0.0001), lesions (0.03) and habitation area (p =0.002). Whilst the ages appeared with non-significant differences (p =0.6). In order to confirm the microscopic examination and compare the Iraqi isolates with other global ones, the 55 positive results with M. canis were further diagnosed by using internal transcribed spacer (ITS) 1 and 4 universal primers with a size of 550 bp for PCR amplicons. PCR amplicons sequencing showed only one isolate of M. Canis that differed from global isolates registered in the database of NCBI. The Iraqi local isolate of M. canis was registered with accession number: OM185328. In conclusion, the PCR technique using ITS rDNA aided in confirming the detection of dermatophytes. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis is an infectious dermatosis frequent in children, causative fungi variable over time and space. The risk factors associated with this disease are still poorly understood. The objective of this study was to estimate the prevalence of tinea capitis among schoolchildren in Lomé (Togo), identify the fungal species involved and assess the associated risk factors. Patients and Methods: It was a cross‐sectional and case–control study conducted in primary schools in Lomé from November 2020 to April 2021. All pupils presenting tinea capitis suspected lesions have been sampled, and the scraping and hair were examined by direct microscopy in KOH solution and cultured in Sabouraud dextrose agar with chloramphenicol and cycloheximide. Positive children were matched by age and sex with those without symptoms for case–control study. Results: Out of the 15,087 pupils enrolled, 465 had positive cultures for dermatophytes, corresponding to the tinea capitis prevalence of 3.08% (95% CI [2.59–3.57]). Trichophyton mentagrophytes (81.86%) and Trichophyton soudanense (13.12%) were the majors isolated dermatophytes. The risk factors were mostly living in households with domestic animals, showering less than twice a day, having a history of ringworm, having similar lesions in the same household and sharing personal hygiene items. Conclusion: This study highlights the low prevalence of tinea capitis in schoolchildren in Lomé (Togo), the causative species dominated by T. mentagrophytes and emphasises the importance of environmental and behavioural factors in the mycosis transmission. Implementing preventive measures addressing the identified factors could help to reduce the prevalence of this disease. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In examining any scalp itch or skin lesions, especially in children with long hair, fungal lesions under the hair may not be diagnosed in a timely manner. Additionally, fungal infection of the scalp, known as tinea capitis, is considered a chronic condition and if left untreated, it can lead to alopecia (hair loss) and permanent scarring. Tinea capitis (TC) is a common cutaneous fungal infection in childhood. In this report, we describe the case of an 8‐year‐old child presenting with erythematous scalp lesions accompanied by hair loss. Upon examination, palpation revealed a swollen and tender left parotid gland. Notably, the frontal region of the scalp exhibited erythematous lesions and scaly red plaques resembling yellowish paste‐like dough. Subsequent clinical evaluation and culture analysis confirmed the diagnosis of TC. The patient received treatment with Terbinafine 125 mg for a duration of 8 weeks. Follow‐up examinations conducted after 3 months showed no signs of recurrence. Accurate diagnosis and timely treatment, along with adherence to medication regimens, are crucial in cases of TC, and differential diagnoses should be considered. Treatment should commence promptly upon diagnosis to prevent complications such as scalp baldness and transmission to others. This case report underscores the significance of establishing a precise diagnosis and effective treatment for this dermatophytosis to mitigate the risk of recurrences or therapeutic shortcomings, particularly in infants. [ABSTRACT FROM AUTHOR]

Data on the epidemiology of tinea capitis (TC), an infection of the scalp by dermatophytes, are scarce in Cameroon. This study aimed to determine the prevalence of TC among school-children in the Dschang Subdivision, Western Cameroon. A cross-sectional study was carried out in June 2021 in Dschang including pupils aged 5–13. First, a standardized questionnaire was administered to participant for the collection of sociodemographic data. Then, samples were collected and cultured onto Sabouraud-Chloramphenicol-Gentamicin Agar. The etiological agents were identified based on their morphological features and with MALDI-TOF mass spectrometry. A total of 1070 children were clinically examined and 108 (10.1%) children presented with TC lesions. The mean age of the 1070 participants was 8.3 ± 2.6 years (range: 5–13 years); 772 (72.2%) were males. The use of borehole water (OR = 0.01, 95%CI[0.001–0.03]), spring water (OR = 0.2, 95%CI[0.08–0.50]), rainwater (OR = 0.004, 95%CI[0.001–0.016]), and hairdressing salons visits (OR = 0.413, 95%CI[0.196–0.872]) were associated with a decreased TC risk in the multivariate logistic regression analysis. In contrast, sharing bed with siblings (OR = 4.48, 95%CI[2.095–9.60]) was associated with an increased TC risk in children. Among the 32 dermatophytes isolated in culture, Microsporum audouinii was the most frequent (43.8%), followed by Trichophyton rubrum (25.0%) and T. soudanense (25.0%). Microsporum canis and T. violaceum were both rarely isolated. Further studies are warranted to assess the association of TC with domestic water usage that has been highlighted in this study. [ABSTRACT FROM AUTHOR]

Study’s Excerpt/Novelty • This study provides insights into the epidemiology of Tinea capitis among primary school children in a rural community in Gombe, Nigeria, highlighting the prevalence, causative agents, and predisposing factors of the infection. • By identifying a diverse array of dermatophytes, including Trichophyton mentagrophyte and Microsporum canis, the research underscores the significant role of poor hygiene, socioeconomic status, and environmental factors in the transmission of Tinea capitis. • The findings advocate for targeted health promotion and educational interventions to mitigate the infection, emphasizing the necessity of improving personal hygiene and living conditions in affected communities. Full Abstract Tinea capitis, an infection of the scalp and hair shaft, is increasingly prevalent worldwide among children aged between six months and pre-pubertal age. This descriptive cross-sectional study aimed to assess the prevalence, identify causative agents, and the predisposing factors for Tinea capitis infection among primary school children of a rural community in Gombe, Nigeria. Scalp and hair scrapings were collected from school children with a clinical diagnosis of T. capitis for microscopic examination and fungal culture. Relevant information for investigating predisposing factors was collected using a well-structured questionnaire. Out of the 60 samples collected, the mycological analysis of 58 samples revealed dermatophyte presence, while 2 samples were contaminated with Aspergillus niger. The prevalent fungi included Trichophyton mentagrophyte (25%), Microsporum canis (20%), Trichophyton rubrum (13.3%), Microsporum gypseum (11.6%), Trichophyton schoenleinii (10%), Trichophyton verrucusum (8.3%), Trichophyton tonsurans (8.3%) and Aspergillus niger (3%). Common predisposing factors identified were sharing combs, towels, bed sheets and close contact with household pets. Additionally, low socioeconomic status, overcrowding in mud houses, and poor hygiene practices emerged as determinants of Tinea capitis transmission among children. In light of these findings, the study underscores the need for comprehensive health promotion and educational interventions, emphasizing personal hygiene and the importance of proper living conditions.

Introduction: Although the diagnosis of tinea capitis is mainly microbiological, the risk of evolution towards cicatricial alopecia in the most severe cases requires empirical treatment based on physical examination and complementary examinations. Methods: Two patients were evaluated by physical examination, cutaneous ultrasound and microbiological examination. Results: Ultrasound showed follicular widening and increased vascularization in Doppler mode. In one of them, the finding of severe inflammatory activity led to the indication of oral corticotherapy. Discussion: Cutaneous ultrasound could play a role not only in supporting the clinical diagnosis but that it may even guide the indication of treatment in the presence of severe inflammation that sometimes may not manifest itself clinically. Conclusion: Cutaneous ultrasound may constitute an additional test of considerable usefulness in the diagnosis and evaluation of inflammatory activity in cases such as the ones presented, fast, non‐invasive and of high accessibility. [ABSTRACT FROM AUTHOR]

The article discusses a case report on the successful treatment of tinea capitis caused by Trichophyton rubrum in a patient with autoimmune chronic hepatitis using daylight photodynamic therapy with BF‐200 ALA combined with topical terbinafine. The standard treatment for tinea capitis involves systemic antifungal medications, but in this case, systemic antifungals were contraindicated due to the patient's liver condition. The combination of photodynamic therapy with oral antifungal medications showed improved treatment efficacy, leading to complete resolution of the infection in the patient. The treatment was well-tolerated, and the patient remained in remission 15 months after the therapy. [Extracted from the article]

Background: Pediatric alopecia is increasingly common, influenced by conditions like alopecia areata and infections such as tinea capitis, primarily caused by Microsporum canis. Diagnosing tinea capitis in primary care is challenging due to limited access to advanced tools, leading to treatment delays. Objectives: This study evaluates the effectiveness of Wood's lamp for early diagnosis of tinea capitis and its role in distinguishing it from other pediatric alopecia types. Methods: Fifty pediatric patients under 12 with alopecia were enrolled from March 2023 to March 2024. Data collected included contact history, CFW microscopy, fungal cultures, Wood's lamp examinations, treatments, and follow-ups. Results: Wood's lamp identified 22 cases linked to animal contact, confirmed as Microsporum canis. Overall, 30 tinea capitis, 15 alopecia areata, and 5 trichotillomania cases were diagnosed. Post-treatment, fluorescence decreased in tinea capitis patients, who also showed hair regrowth, with no recurrence during follow-up. Conclusions: Wood's lamp is a valuable, cost-effective diagnostic tool for tinea capitis, especially when combined with animal contact history, supporting its use in primary healthcare.

Tinea capitis is defined as an infection or parasitism of the hair, scalp, eyebrows, and eyelashes. The clinical presentation is variable, depending on the type of hair invasion, the level of resistance, and the degree of host inflammatory response. The most severe reaction pattern is known as kerion Celsi, caused mainly by zoophilic dermatophytes, Microsporum canis and Trichophyton tonsurans. It begins as a dry ringworm, which later presents with erythema, inflammation, pustules, and honey-colored crusts, from which abundant pus drains. Due to this clinical appearance, it takes the name kerion, which means "honeycomb". It can be associated with regional lymphadenopathy, fever, malaise, local pain, and often resolves, leaving an area of scarring alopecia. Early diagnosis and timely treatment are important to avoid these sequelae. [ABSTRACT FROM AUTHOR]

Background: Microsporum audouinii has resurged recently. Infections with the dermatophyte are difficult to treat, which raises the question if we treat M. audouinii infections with the most effective antifungal (AF) agent. Objectives: The aims of this study was to investigate an outbreak of tinea capitis (TC) in Denmark, address the challenges in outbreak management and to conduct two reviews regarding previous outbreaks and minimal inhibitory concentration (MIC). Methods: We used Wood's light, culture, direct microscopy, and PCR for screening and antifungal susceptibility testing (AFST) for treatment optimization. We performed two reviews to explore M. audouinii outbreaks and MIC values using broth microdilution method. Results: Of 73 screened individuals, 10 had confirmed M. audouinii infections. Clinical resistance to griseofulvin was observed in 4 (66%) cases. While previous outbreaks showed high griseofulvin efficacy, our study favoured terbinafine, fluconazole and itraconazole in our hard‐to‐treat cases. AFST guided the choice of AF. Through the literature search, we identified five M. audouinii outbreaks, where differences in management included the use of Wood's light and prophylactic topical AF therapy. Terbinafine MIC values from the literature ranged from 0.002 to 0.125 mg/L. Conclusion: Use of Wood's light and preventive measurements were important for limiting infection. The literature lacked MIC data for griseofulvin against M. audouinii, but indicated sensitivity for terbinafine. The clinical efficacy for M. audouinii treatment was contradictory favouring both terbinafine and griseofulvin. AFST could have a key role in the treatment of difficult cases, but lack of standardisation of AFST and MIC breakpoints limits its usefulness. [ABSTRACT FROM AUTHOR]

Tinea capitis (TC) is still a frequent dermatophytosis in France, both autochthonous and imported. A nationwide retrospective survey was performed and a total of 4395 TC cases were recorded within 36 French mycology laboratories during a 6-year period. TC is a disease that occurs in childhood with 85% of the cases occurring before 10 years old and 94% before the age of 15. Anthropophilic origin was predominant with 779 cases of Trichophyton tonsurans (32.6%), 738 cases of Trichophyton soudanense/T. violaceum (31%), and 445 cases of Microsporum audouinii (19.2%). Of note, T. tonsurans represents more than 80% of the cases in the French West Indies (Martinique and Guadeloupe). By contrast, zoophilic species were less prevalent with mainly M. canis (10.3%) confirming the shift from zoophilic to anthropophilic species observed in many centers during the last decades. During this survey, diagnosis methods were also collected. Most labs had a classical process for the diagnosis: microscopic direct examination associated to cultures on Sabouraud and Sabouraud-cycloheximide media (incubated between 25 ± 5°C for at least 3 weeks) in all laboratories. Identification of the causal dermatophyte was performed by microscopic and macroscopic examination of the cultures in 100% of the labs, with various specific culture media available when fructification was insufficient (mainly malt or potato-dextrose agar, or Borelli medium). New techniques were also implemented with the introduction of MALDI-TOF mass spectrometry identification in more than two third of the labs, and molecular identification available if necessary in half of the labs. [ABSTRACT FROM AUTHOR]

Background: Kerion is a severe type of tinea capitis that is difficult to treat and remains a public health problem. Objectives: To evaluate the epidemiologic features and efficacy of different treatment schemes from real‐world experience. Methods: From 2019 to 2021, 316 patients diagnosed with kerion at 32 tertiary Chinese hospitals were enrolled. We analysed the data of each patient, including clinical characteristics, causative pathogens, treatments and outcomes. Results: Preschool children were predominantly affected and were more likely to have zoophilic infection. The most common pathogen in China was Microsporum canis. Atopic dermatitis (AD), animal contact, endothrix infection and geophilic pathogens were linked with kerion occurrence. In terms of treatment, itraconazole was the most applied antifungal agent and reduced the time to mycological cure. A total of 22.5% of patients received systemic glucocorticoids simultaneously, which reduced the time to complete symptom relief. Furthermore, glucocorticoids combined with itraconazole had better treatment efficacy, with a higher rate and shorter time to achieving mycological cure. Conclusions: Kerion often affects preschoolers and leads to serious sequelae, with AD, animal contact, and endothrix infection as potential risk factors. Glucocorticoids, especially those combined with itraconazole, had better treatment efficacy. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis (T. capitis), commonly known as scalp ringworm, is a fungal infection affecting the scalp and hair. Among the causative agents, Microsporum canis (M. canis) stands out, often transmitted from cats to humans (zoonotic disease). In this study, we investigated the efficacy of Carica papaya (C. papaya), fruit extract against dermatophytes, particularly M. canis, both in vitro and in vivo. Additionally, we aimed to identify the active compounds responsible for suppressing fungal growth and assess the toxicity of C. papaya on human cells. Methodology: It conducted in two parts. First, In Vitro Study include the preparation of C. papaya fruit extract using methanol as the solvent, Phytochemical analysis of the plant extract including Gas chromatography-mass spectrometry (GC-MS) and Fourier-transform infrared spectroscopy (FTIR) was conducted, Cytotoxicity assays were performed using HUH-7 cells, employing the MTT assay (1-(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide), Antimicrobial activity against M. canis was evaluated, including: Zone of inhibition (ZI), Minimum inhibitory concentration (MIC), Minimum fungicidal concentration (MFC), M. canis cell alterations were observed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Second, In Vivo, Albino Wistar male rats were included. Results: The phytochemical analysis of the methanolic extract from papaya revealed several functional groups, including hydroxyl, ammonia, alkane, carbonate, and alcohol. Additionally, the GC-MS analysis identified 15 compounds, with xanthosine and decanoic acid being the predominant components. The methanolic extract of papaya fruits demonstrated potent antifungal activity: ZI = 37 mm, MIC = 1,000 µg/mL, MFC = 1900 µg/mL, MTT results indicated lower cytotoxicity of the fruit extract at concentrations of 20 µg/mL, 50 µg/mL, 100 µg/mL, 150 µg/mL, and 200 µg/mL, The IC50 revealed a significant decrease in cell viability with increasing extract concentration. Notably, papaya extract induced considerable alterations in the morphology of M. canis hyphae and spores. In animal tissue, improvements were observed among the group of rats which treated with Papaya extract. This study highlights the potential of C. papaya fruits as a natural antifungal agent, warranting further exploration for clinical applications. [ABSTRACT FROM AUTHOR]

Introduction: Tinea capitis (TC) is a common fungal infection of the scalp, especially in children. Trichoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the hair with the visualization of morphologic features that are often imperceptible to the naked eye. Aim: This study aimed to evaluate the usefulness of trichoscopy in clinical diagnosis and to study various clinico‑morphological patterns of TC. Materials and Methods: This cross-sectional, observational study included 140 clinically diagnosed cases of TC seen during a period of 1 year (April 2021 to March 2022). All patients were evaluated using a dermoscope (DermLite DL4 Multispectral 3 Gen, San Juan Capistrano, CA, USA,10×). Results: The prevalence rate of TC in this study was 2.69 per thousand population. The most common clinical variant was gray patch followed by kerion and black dot, and the most common etiological agent was Trichophyton tonsurans. The characteristic trichoscopic features were as follows: comma hairs (80%), followed by corkscrew hairs (68.6%), bent hairs (54.2%), zigzag hairs (35.7%), and morse code‑like hairs (15%). Other findings included scaling (89.2%), followed by black dot (67.1%), broken hairs (42.8%), and crusting and pustules (32.1% each). Comma and corkscrew‑shaped hairs were most common in the black dot type, whereas zigzag, bent hairs, and morse code hairs were common in the gray patch type of TC. There was a significant association between trichoscopic findings and type of TC. Conclusion: Trichoscopy can be considered a novel tool for rapid diagnosis and selection of the appropriate therapy and in the monitoring of treatment efficacy in TC. [ABSTRACT FROM AUTHOR]

Tinea capitis is a fungal infection of the scalp and hair caused by dermatophyte molds, that most often affects children and may also affect adults. Previous estimates suggest that between 3% and 11% of all tinea capitis cases worldwide occur in adults, although updated epidemiological studies are needed to reassess the prevalence of tinea capitis in adult populations specifically. Postmenopausal adult women are most often affected by tinea capitis, with African American or Black women particularly at risk. Adults who experience crowded living conditions, who live in close proximity to animals, who are immunosuppressed, and/or who live in households with affected children are at greatest risk of infection. Tinea capitis can be non-inflammatory or inflammatory in nature, and the subtype affects the extent and severity of clinical symptoms. Fungal culture and potassium hydroxide preparations are the most commonly used diagnostic tools. Trichoscopy, defined as dermoscopic imaging of the scalp and hair, is a useful adjunct to the physical examination. The mainstay of therapy is oral antifungal therapy, and topical therapy alone is not recommended. Since tinea capitis infection is uncommon in adults, there are no widely accepted treatment guidelines. Rather, the same medications used for tinea capitis infection among children are recommended for adults at varying doses, including griseofulvin, and terbinafine, and, less commonly, itraconazole and fluconazole. The prognosis for tinea capitis in adults is typically excellent when prompt and adequate treatment is administered; however, delayed diagnosis or inadequate treatment can result in scarring alopecia. Over the past decade, dermatophyte infections resistant to treatment with topical and oral antifungal agents have emerged. While tinea capitis infections resistant to antifungal therapy have been rarely reported to date, antifungal resistance is rising among superficial fungal infections in general, and antifungal stewardship is necessary to ensure that resistance to treatment does not develop among dermatophytes that cause tinea capitis. [ABSTRACT FROM AUTHOR]

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes. [ABSTRACT FROM AUTHOR]

Tinea capitis is a contagious, scalp-involving dermatophyte infection, with a high prevalence among pre-pubertal children. This present study aims to isolate and characterize (obtaining the sequences of the internal transcribed spacer (ITS) of the genome DNA with the PCR method using universal primers for molecular identification and phylogenetic analyses) of opportunistic mycoses pathogens associated with Tinea capitis. Scalp-scrapping were obtained from head lesions of 136 pupils with 85 boys (62.5%) and 51 girls (37.5%) from three primary schools in Somolu local government, Lagos state. One hundred and thirty-three yield fungal growth, of which are twelve fungal species were identified based on their morphological characteristics and nucleotide sequencing of polymerase chain reaction (PCR) using primers targeting the internal transcribed spacer (ITS) regions (ITS1 and ITS4). The identified fungi include: Aspergillus sydowii, Aspergillus niger, Canidida orthopsilosis, Canidida parapsilosis, Chaetomium globosum, Neopestalotiopsis sp and Talaromyces islandicus. The utilization of a pairwise nucleotide differentiation, disparity among species was observed, ranging from 394 to 538 base pair (bp). The data reported here is to provide a basis for further improvement on the available mycoses agents (oral/topical) in order to combat opportunistic human pathogenic fungi associated with Tinea capitis infection in children. This has become a necessity as this group of fungi pathogens are always present (contribute) at the site of this infection. [ABSTRACT FROM AUTHOR]

Key Clinical Message In examining any scalp itch or skin lesions, especially in children with long hair, fungal lesions under the hair may not be diagnosed in a timely manner. Additionally, fungal infection of the scalp, known as tinea capitis, is considered a chronic condition and if left untreated, it can lead to alopecia (hair loss) and permanent scarring. Abstract Tinea capitis (TC) is a common cutaneous fungal infection in childhood. In this report, we describe the case of an 8‐year‐old child presenting with erythematous scalp lesions accompanied by hair loss. Upon examination, palpation revealed a swollen and tender left parotid gland. Notably, the frontal region of the scalp exhibited erythematous lesions and scaly red plaques resembling yellowish paste‐like dough. Subsequent clinical evaluation and culture analysis confirmed the diagnosis of TC. The patient received treatment with Terbinafine 125 mg for a duration of 8 weeks. Follow‐up examinations conducted after 3 months showed no signs of recurrence. Accurate diagnosis and timely treatment, along with adherence to medication regimens, are crucial in cases of TC, and differential diagnoses should be considered. Treatment should commence promptly upon diagnosis to prevent complications such as scalp baldness and transmission to others. This case report underscores the significance of establishing a precise diagnosis and effective treatment for this dermatophytosis to mitigate the risk of recurrences or therapeutic shortcomings, particularly in infants.

Introduction: Tinea capitis (TC) is a common fungal infection of the scalp, especially in children. Trichoscopy is a noninvasive technique that allows rapid and magnified in vivo observation of the hair with the visualization of morphologic features that are often imperceptible to the naked eye. Aim: This study aimed to evaluate the usefulness of trichoscopy in clinical diagnosis and to study various clinico-morphological patterns of TC. Materials and Methods: This cross-sectional, observational study included 140 clinically diagnosed cases of TC seen during a period of 1 year (April 2021 to March 2022). All patients were evaluated using a dermoscope (DermLite DL4 Multispectral 3 Gen, San Juan Capistrano, CA, USA,10×). Results: The prevalence rate of TC in this study was 2.69 per thousand population. The most common clinical variant was gray patch followed by kerion and black dot, and the most common etiological agent was Trichophyton tonsurans. The characteristic trichoscopic features were as follows: comma hairs (80%), followed by corkscrew hairs (68.6%), bent hairs (54.2%), zigzag hairs (35.7%), and morse code-like hairs (15%). Other findings included scaling (89.2%), followed by black dot (67.1%), broken hairs (42.8%), and crusting and pustules (32.1% each). Comma and corkscrew-shaped hairs were most common in the black dot type, whereas zigzag, bent hairs, and morse code hairs were common in the gray patch type of TC. There was a significant association between trichoscopic findings and type of TC. Conclusion: Trichoscopy can be considered a novel tool for rapid diagnosis and selection of the appropriate therapy and in the monitoring of treatment efficacy in TC.

Zeyu Huang,1 Mingyan Chen,1 Yang Peng,1 Ruzhi Zhang2 1Department of Dermatology, The Third Affiliated Hospital of Soochow University, Changzhou, People’s Republic of China; 2Department of Dermatology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, People’s Republic of ChinaCorrespondence: Ruzhi Zhang, Department of Dermatology, The Second Affiliated Hospital of Wannan Medical college, No. 10 Rehabilitation Road, Jinghu District, Wuhu, 241101, People’s Republic of China, Tel +86 18761161826, Email zhangruzhi628@163.comAbstract: Tinea capitis, a common cutaneous fungal infection, shows an increasing prevalence with the increasing number of pets. We present tinea capitis in a 4-year-old girl presenting without typical symptoms such as alopecia or hair breakage. After a comprehensive evaluation including dermoscopy, Wood’s light, direct KOH fluorescent staining, scanning electron microscopy, fungal culture and mass spectrometry analysis, a diagnosis of tinea capitis infected Microsporum canis carried by domestic cats was made. We preliminarily explored the two modes of hair erosion by tinea capitis fungi and analyzed the possibility of the feature in this case. This case highlights the importance of accurate diagnosis and appropriate therapeutic intervention in cases of paediatric tinea capitis, particularly in households with resident pets.Keywords: dermoscopy, microsporum canis, scanning electron microscopy, mass spectrometry, tinea capitis

The etiology of tinea capitis changes over time, mainly due to trends in migration. We report 19 cases of tinea capitis caused by Microsporum audouinii , an uncommon agent in South America, all of them confirmed by molecular methods. All patients were male. The average age was 6.1 years. Fifteen patients were residents of Rio de Janeiro city and four were from neighboring cities. Among the patients submitted to follow-up, griseofulvin was prescribed for eight of them. Due to medication shortages, terbinafine was prescribed for five patients, needing to be switched in three cases, with a bigger total average time until clinical improvement. The study reaffirms the emergence of a new etiological agent in Rio de Janeiro, Brazil. [ABSTRACT FROM AUTHOR]

Introduction: When performed by a skilled provider appropriately, induced abortion is a very safe medical procedure. However, a series of complications such as uterine perforation can still occur rarely. Case presentation: We present a case of tinea coli evisceration through a uterine perforation that occurred during a manual vacuum aspiration (MVA) procedure for uterine evacuation. The case presented with crampy lower abdominal pain 2 days after she had an MVA procedure for an incomplete abortion. The diagnosis of uterine perforation was considered on ultrasonography (USG) examination. Explorative laparoscopy was subsequently done and a posterior uterine wall perforation of ~2 cm was identified. A tinea coli of the sigmoid colon was seen sucked into the uterus through the perforation but no wall of the colon was lacerated or sucked in. The tinea coli was pulled out and the uterine defect was repaired laparoscopically. Conclusion: This unique case, the first of its kind to be reported to our knowledge, could be a reminder to consider tinea coli evisceration in suspected uterine perforation but without typical manifestations of bowel injury. [ABSTRACT FROM AUTHOR]

Tinea capitis is a common disease in children but rare in newborns younger than 1 month of age. Only 29 cases of tinea capitis in newborns have been described in indexed literature from 1990 until now. While antifungal agents can be used topically and systemically, systemic antifungal therapy is generally accepted as the treatment of choice for tinea capitis due to limited penetration of topical agents into the hair follicle. However, there is a lack of data on the use of systemic antifungal agents in newborns, and there are reports of successful treatment of tinea capitis in newborns using only topical therapy. In this paper, we present a case of tinea capitis in a 29‐day‐old female baby and review the previous 29 reported cases. [ABSTRACT FROM AUTHOR]

There is increasing evidence of clinically resistant cutaneous fungal infections. The use of combination oral antifungals is described in adults but not in paediatric patients. We present seven paediatric cases of clinically resistant fungal infections treated successfully with combination oral antifungal therapy after inadequate response to a single agent. [ABSTRACT FROM AUTHOR]

BackgroundTinea capitis (T. capitis), commonly known as scalp ringworm, is a fungal infection affecting the scalp and hair. Among the causative agents, Microsporum canis (M. canis) stands out, often transmitted from cats to humans (zoonotic disease). In this study, we investigated the efficacy of Carica papaya (C. papaya), fruit extract against dermatophytes, particularly M. canis, both in vitro and in vivo. Additionally, we aimed to identify the active compounds responsible for suppressing fungal growth and assess the toxicity of C. papaya on human cells.MethodologyIt conducted in two parts. First, In Vitro Study include the preparation of C. papaya fruit extract using methanol as the solvent, Phytochemical analysis of the plant extract including Gas chromatography–mass spectrometry (GC–MS) and Fourier-transform infrared spectroscopy (FTIR) was conducted, Cytotoxicity assays were performed using HUH-7 cells, employing the MTT assay (1-(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide), Antimicrobial activity against M. canis was evaluated, including: Zone of inhibition (ZI), Minimum inhibitory concentration (MIC), Minimum fungicidal concentration (MFC), M. canis cell alterations were observed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Second, In Vivo, Albino Wistar male rats were included.ResultsThe phytochemical analysis of the methanolic extract from papaya revealed several functional groups, including hydroxyl, ammonia, alkane, carbonate, and alcohol. Additionally, the GC–MS analysis identified 15 compounds, with xanthosine and decanoic acid being the predominant components. The methanolic extract of papaya fruits demonstrated potent antifungal activity: ZI = 37 mm, MIC = 1,000 μg/mL, MFC = 1900 μg/mL, MTT results indicated lower cytotoxicity of the fruit extract at concentrations of 20 μg/mL, 50 μg/mL, 100 μg/mL, 150 μg/mL, and 200 μg/mL, The IC50 revealed a significant decrease in cell viability with increasing extract concentration. Notably, papaya extract induced considerable alterations in the morphology of M. canis hyphae and spores. In animal tissue, improvements were observed among the group of rats which treated with Papaya extract. This study highlights the potential of C. papaya fruits as a natural antifungal agent, warranting further exploration for clinical applications.

Introduction. A differential diagnostic search is a crucial method for making a final clinical diagnosis. Lack of clinical thinking leads to tactical errors, both in making a diagnosis and in choosing a therapy algorithm. The problem of iatrogeneses especially often arises at the initial stages of patient management.Case descriptions. The paper demonstrates the difficulties of verifying the diagnosis of patients with dermatological pathology on the example of clinical cases. The stages of differential diagnostic search are covered in detail. Practicing physicians stress the importance of timely correct diagnosis and, consequently, the choice of therapy. The study involved a detailed analysis of clinical cases and mistakes causing a delay in diagnosis and wrong choice of therapeutic tactics at the outpatient stage. A clinical case with designated diagnosis is presented and analyzed as an illustrative example. Special attention was given to a complex evaluation of subjective, objective and diagnostic data, the significance of analyzing the development of dermatoses.Conclusion. Careful adherence to diagnostic algorithms will avoid iatrogenic errors and thereby improve the quality of medical care and the quality of life of dermatological patients.

Key Clinical Message While the initial lesions of tinea capitis are often overlooked due to their small size and numerous hairs emerging from the follicle, it is crucial not to dismiss the partial presence of comma or harpin hairs and black spots.

Tinea capitis is a dermatophyte scalp infection with a marked prevalence among the pediatric population. However, in the last few years, its epidemiology has changed due to increasing population migration worldwide. Host-specific and environmental factors contribute to the pathogenesis of tinea capitis. Clinically, tinea capitis may present as a subtle hair loss accompanied by scalp scaling, alopecia with scaly patches, or alopecia with black dots. A more severe form of tinea capitis is represented by kerion celsi, which clinically presents as a tender plaque covered by pustules and crusts. If left untreated, this dermatophytic infection may resolve with permanent scarring and alopecia. The pathological changes found in tinea capitis are reflected by a spectrum of clinical changes. Zoophilic infections typically prompt an extensive inflammatory reaction, while anthropophilic dermatophytoses often lack inflammation and result in more persistent lesions. Tinea capitis typically requires systemic antifungal therapy. Griseofulvin, terbinafine, itraconazole, and fluconazole are the main antifungal agents used. Currently, the duration of antifungal therapy varies based on the clinical presentation and type of dermatophyte involved. Through the reported cases and literature review, we aim to emphasize the importance of the early recognition of atypical variants of tinea capitis in immunocompetent children for the prompt initiation of systemic antifungal therapy, minimizing the need for prolonged treatment. Additionally, we emphasize the importance of regular laboratory testing during systemic antifungal therapy, particularly liver enzyme tests, to prevent adverse events, especially in cases requiring long-term treatment. [ABSTRACT FROM AUTHOR]

Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections. [ABSTRACT FROM AUTHOR]

Background: Tinea capitis (TC), a fungal infection that occurs in children, is primarily caused by dermatophytes such as Trichophyton and Microsporum species. For Trichophyton species, treatment with terbinafine is considered more effective than griseofulvin treatment. Specific populations, such as refugee children, are more susceptible to TC. Objective: This study aimed to describe and compare the response to treatment among Israeli and refugee children with TC. Patients/Methods: We retrospectively reviewed data collected on refugee and Israeli children with TC between January 2004 and January 2020. Results: Overall, 3358 children with TC (refugees: 1497; Israelis: 1861) were identified. Among these, 86% of the refugee children had TC caused by Trichophyton violaceum, 65% of the Israeli children had TC caused by Microsporum canis and 83% of all children were treated with griseofulvin. Overall, 14% of the refugees showed a partial response to a griseofulvin dose of ≤25 mg/kg/day; however, they showed a complete response upon increasing the dose to ≥30 mg/kg/day. No significant adverse effects were observed. Conclusion: The over‐crowded day care centres and dense living make refugee children more susceptible to TC than the general population, and griseofulvin dosage adjustment is necessary. TC, due to Trichophyton species, could benefit from receiving an increased dose of griseofulvin in a suspension form, which is cheaper than terbinafine. [ABSTRACT FROM AUTHOR]

Tinea capitis is a common dermatophyte infection associated with pupils of primary school age group. Dermatophytosis is relatively common in tropical and sub-tropical regions where warm and humid climates provide a favorable environment for the fungal to thrive. Prevalence in many of these regions are unknown and shift in etiology has frequently been observed. Hence the objective of this paper was to carry out a survey of Tinea capitis among primary school pupils in Sapele and Ethiope West Local Government Areas in Delta State, Nigeria using standard procedures and estimating its prevalence on the scalp of primary school pupil. Pupils (5,876) aged 4-13 years in government-owned primary schools located in urban and rural areas of Sapele and Ethiope West Local Government Areas, were physically screened for hair-scalp fungal infection. Mycological examination revealed Microsporum audouinii (24%) as the most implicated dermatophyte in these local government areas. Boys; 190 (65%) were more infected than girls 103 (35%) and prevalence was among children between 4-7 years old (51%). Thus male pupil are affected by Microsporum audouinii in these local government areas under study [ABSTRACT FROM AUTHOR]

The dermatological canvas, often considered the storyteller of human health, is imbued with narratives that intertwine with the very essence of the natural world. A mesmerizing facet of this narrative is found in "animals eponyms" -- enigmatic skin conditions christened after animals whose traits mimic the intricate nuances of these dermatological tales. Delving into this realm unveils a tapestry where medicine and nature dance in synchrony, encapsulating both the artistry and science of dermatology. Animals eponyms offer a unique bridge between dermatology and the natural world. They serve as memorable tools for recognizing and diagnosing dermatological conditions while embodying the fascinating connection between humans and the animal kingdom. By examining these eponyms, dermatologists gain a deeper understanding of the intricate relationship between medicine and nature, ultimately enhancing patient care through enhanced diagnostic acumen. [ABSTRACT FROM AUTHOR]

Tinea capitis is a common dermatophyte infection of the scalp in children. It is an uncommon infection in adults and usually affects postmenopausal women and immunocompromised patients. We report an immunocompetent elderly female with inflammatory tinea capitis caused by Trichophyton violaceum and review the literature for the past 5 years to describe the disease, its epidemiologic characteristics, dermatophyte species involved and treatment options used. The total number of cases was 11, including 8 women and 3 men, with an average age of 48.36. The most commonly isolated dermatophyte was Trichophyton tonsurans, and most cases were treated successfully with oral terbinafine with no side effects. In our case, the diagnosis was established by direct examination, culture and histological examination. Remedy with itraconazole and prednisolone was very successful. Early diagnosis of tinea capitis in adults is necessary to provide early treatment and minimize sequelae of the disease. [ABSTRACT FROM AUTHOR]