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Tinea capitis in an immigrant pediatric community; a clinical signs-based treatment approach
Riad Kassem1,2, Yahel Shemesh3, Orna Nitzan3,4
1Dermatology Department, Sheba Medical Center, Tel Aviv, Israel.
Background:
Tinea capitis is a common cutaneous infection of the scalp and hair follicles, typically diagnosed by direct examination and culture. Treatment with oral antifungals is usually withheld until mycology results are available. In Israel, African refugee children demonstrate higher susceptibility to Tinea capitis and generally fail to undergo follow-up evaluations.
Methods:
This study aimed to identify the clinical characteristics and treatment responses of refugee children in Israel with Tinea capitis, in order to formulate a treatment plan for primary care physicians. To this end, demographic, clinical and laboratory data were extracted from the electronic medical records of 76 refugee children presenting with Tinea capitis during 2016-2017. All measured variables and derived parameters are presented using descriptive statistics. The correlation between background clinical and demographic data and Tinea capitis diagnosis was assessed using the chi-squared and Wilcoxon tests. Correlations between demographic/clinical/laboratory characteristics and other types of fungi or other important findings were assessed using a T-test.
Results:
Scaling was the most common clinical finding. Cultures were positive in 64 (84%) and direct examination in 65 (85%) cases, with a positive correlation between the methods in 75% of cases. The most common fungal strain was T. violaceum. Fluconazole treatment failed in 27% of cases. Griseofulvin 50 mg/kg/day was administered to 74 (97%) children, and induced clinical responses. No side effects were reported.
Conclusions:
The key aim of this study was to emphasize the importance of diagnosis and treatment of these immigrant children by their primary pediatric doctor since it takes, an average of 4.3 months until they visit a dermatologist. During this critical time period, the scalp can become severely and permanently damaged, and the infection can become systemic or cause an outbreak within the entire community. In conclusion, we recommend to relate to scaly scalp in high-risk populations as Tinea capitis, and to treat with griseofulvin at a dosage of up to 50 mg/kg/day, starting from the first presentation to the pediatrician.
Insights
Tinea capitis, a common scalp infection in African refugee children, often requires prompt treatment. Griseofulvin is recommended for effective management, preventing long-term damage and community outbreaks.
Area of Science:
- Dermatology
- Mycology
- Pediatrics
Background:
- Tinea capitis is a prevalent scalp infection, particularly in African refugee children in Israel, who show increased susceptibility.
- Diagnosis typically involves direct examination and culture, with treatment often delayed pending mycology results.
- Refugee children frequently miss follow-up appointments, complicating management.
Purpose of the Study:
- To identify clinical characteristics and treatment responses of Tinea capitis in Israeli refugee children.
- To establish a treatment plan for primary care physicians to manage this condition effectively.
- To reduce diagnostic delays and prevent severe scalp damage or community spread.
Main Methods:
- Retrospective analysis of demographic, clinical, and laboratory data from 76 refugee children with Tinea capitis (2016-2017).
- Descriptive statistics were used for variable presentation.
- Chi-squared, Wilcoxon, and T-tests assessed correlations between clinical, demographic, and laboratory data.
Main Results:
- Scaling was the most frequent clinical presentation.
- Tinea violaceum was the predominant fungal strain identified.
- Fluconazole showed a 27% failure rate, while griseofulvin (50 mg/kg/day) demonstrated high efficacy with no reported side effects in 97% of treated children.
Conclusions:
- Prompt diagnosis and treatment by pediatricians are crucial for immigrant children with scaly scalps, considering Tinea capitis as a primary diagnosis.
- Griseofulvin at 50 mg/kg/day is recommended for initial treatment to prevent permanent scalp damage and systemic spread.
- Early intervention by pediatricians can mitigate long-term complications and prevent community outbreaks.
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