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Treatment outcomes for tinea capitis in a skin of color population.
J Drugs Dermatol. 2012 Jul; 11(7):852-6.JD

Abstract

BACKGROUND

Tinea capitis periodically undergoes demographic shifts in causative dermatophyte and therapeutic response to oral anti-fungal therapy.

OBJECTIVE

To determine prevalent fungal species and response to standard antifungal therapy in inner-city children of color.

METHODS

An IRB-approved chart review of demographic, clinical, diagnostic, and therapeutic data was conducted for children and young adults (0 to 18 years of age) who had scalp fungal culture performed for scalp hyperkeratosis and/or alopecia over a 2.5 year time-period. Supplemental parental phone interview was performed for missing data points.

RESULTS

A total of 84 patients with final diagnosis of tinea capitis were identified-52% male, 60.6% African-American, 28.2% Hispanic, and 9.9% Caucasian. Complete resolution at 4 weeks was uncommon in all demographic groups (Hispanic: 11.7%, African-American: 41.3%). The Hispanic group and the youngest patients (aged less than 4 years) were less likely to respond to initial therapy, but the results were not significant. Of the 80 tinea capitis patients initially treated with griseofulvin, 41 out of 54 children (76%) had complete response to micronized suspension +/- crushed tablet (33% required shift to tablets from suspension) and 20 out of 26 (76.9%) cleared on crushed tablets alone. Of the 19 griseofulvin failures, 5 cleared on fluconazole suspension, 7 on terbinafine sprinkles, 3 on itraconazole therapy, and 4 were lost to follow-up. Of the 47 patients who could be evaluated long-term after a single course of oral griseofulvin at 6 weeks or greater, 38 had documented long-term mycological cure (80.8%) and 42 had long-term clinical cure (89%). Trichophyton tonsurans (n=40) was the most prevalent causative species identified on culture, followed by Alternaria species (n=10) and Microsporum canis (n=1).

LIMITATIONS

Retrospective chart review: patient population has a high rate of usage of over-the-counter antifungal creams and shampoos, affecting culture results.

CONCLUSIONS

Tinea capitis is still the most common cause of Trichophyton tonsurans in New York City. Response rates to griseofulvin are similar to rates seen in the 1970s, but require higher dosing and conversion to crushed tablets in partial responders. Usage of crushed ultramicronized griseofulvin, terbinafine sprinkles, itraconazole, and fluconazole are alternative regimens for those children whose tinea capitis does not clear on griseofulvin suspension.

Authors+Show Affiliations

St. Luke's-Roosevelt Hospital, New York, NY 10025, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22777228

Citation

Bhanusali, Dhaval, et al. "Treatment Outcomes for Tinea Capitis in a Skin of Color Population." Journal of Drugs in Dermatology : JDD, vol. 11, no. 7, 2012, pp. 852-6.
Bhanusali D, Coley M, Silverberg JI, et al. Treatment outcomes for tinea capitis in a skin of color population. J Drugs Dermatol. 2012;11(7):852-6.
Bhanusali, D., Coley, M., Silverberg, J. I., Alexis, A., & Silverberg, N. B. (2012). Treatment outcomes for tinea capitis in a skin of color population. Journal of Drugs in Dermatology : JDD, 11(7), 852-6.
Bhanusali D, et al. Treatment Outcomes for Tinea Capitis in a Skin of Color Population. J Drugs Dermatol. 2012;11(7):852-6. PubMed PMID: 22777228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment outcomes for tinea capitis in a skin of color population. AU - Bhanusali,Dhaval, AU - Coley,Marcelyn, AU - Silverberg,Jonathan I, AU - Alexis,Andrew, AU - Silverberg,Nanette B, PY - 2012/7/11/entrez PY - 2012/7/11/pubmed PY - 2012/12/10/medline SP - 852 EP - 6 JF - Journal of drugs in dermatology : JDD JO - J Drugs Dermatol VL - 11 IS - 7 N2 - BACKGROUND: Tinea capitis periodically undergoes demographic shifts in causative dermatophyte and therapeutic response to oral anti-fungal therapy. OBJECTIVE: To determine prevalent fungal species and response to standard antifungal therapy in inner-city children of color. METHODS: An IRB-approved chart review of demographic, clinical, diagnostic, and therapeutic data was conducted for children and young adults (0 to 18 years of age) who had scalp fungal culture performed for scalp hyperkeratosis and/or alopecia over a 2.5 year time-period. Supplemental parental phone interview was performed for missing data points. RESULTS: A total of 84 patients with final diagnosis of tinea capitis were identified-52% male, 60.6% African-American, 28.2% Hispanic, and 9.9% Caucasian. Complete resolution at 4 weeks was uncommon in all demographic groups (Hispanic: 11.7%, African-American: 41.3%). The Hispanic group and the youngest patients (aged less than 4 years) were less likely to respond to initial therapy, but the results were not significant. Of the 80 tinea capitis patients initially treated with griseofulvin, 41 out of 54 children (76%) had complete response to micronized suspension +/- crushed tablet (33% required shift to tablets from suspension) and 20 out of 26 (76.9%) cleared on crushed tablets alone. Of the 19 griseofulvin failures, 5 cleared on fluconazole suspension, 7 on terbinafine sprinkles, 3 on itraconazole therapy, and 4 were lost to follow-up. Of the 47 patients who could be evaluated long-term after a single course of oral griseofulvin at 6 weeks or greater, 38 had documented long-term mycological cure (80.8%) and 42 had long-term clinical cure (89%). Trichophyton tonsurans (n=40) was the most prevalent causative species identified on culture, followed by Alternaria species (n=10) and Microsporum canis (n=1). LIMITATIONS: Retrospective chart review: patient population has a high rate of usage of over-the-counter antifungal creams and shampoos, affecting culture results. CONCLUSIONS: Tinea capitis is still the most common cause of Trichophyton tonsurans in New York City. Response rates to griseofulvin are similar to rates seen in the 1970s, but require higher dosing and conversion to crushed tablets in partial responders. Usage of crushed ultramicronized griseofulvin, terbinafine sprinkles, itraconazole, and fluconazole are alternative regimens for those children whose tinea capitis does not clear on griseofulvin suspension. SN - 1545-9616 UR - https://www.unboundmedicine.com/medline/citation/22777228/Treatment_outcomes_for_tinea_capitis_in_a_skin_of_color_population_ DB - PRIME DP - Unbound Medicine ER -