Changing face of tinea capitis in Europe

The aim of this review is to update the latest epidemiological situation in Europe, explore recent issues in recognition and emerging opportunities in diagnosis and look at progressions in treatment. Papers reviewed have, in the main, been published within the last 2 years.

The predominantly responsible organism varies with country. Trichophyton tonsurans accounts for 50-90% of cases in the UK, Microsporum canis is commonest in Central and Southern Europe and T. violaceum in Greece and Belgium. Confirming the diagnosis of tinea capitis is best undertaken with more than one sampling method to include scraping of scalp, and either scalp massage brush, toothbrush, moistened cotton gauze swab or cytobrush to increase sensitivity. Advances in the speed of species identification is offered by the novel PCR-based detection/identification scheme, and although not yet commercially available, with potential turnaround times of <24 h this will offer a significant advance in the speed of diagnosis, allowing treatment to be organism tailored. Although griseofulvin remains the only licensed treatment in the UK and a meta-analysis confirms it is effective against the major tinea capitis pathogens, a new granule formulation of terbinafine has been shown to be more effective against T. tonsurans.

With the evolving organism profile across Europe, obtaining an accurate diagnosis and species identification is crucial. Using more than one sampling method followed by rapid species identification techniques will facilitate this. Although there are no changes in specific product license to include children, the production of a child-friendly formulation of terbinafine will contribute to improved compliance.