Curing Ringworm Permanently
Griseofulvin has been the most widely used and the most prescribed treatment for tinea capitis and has served as a standard for the evaluation of any newer agent to be considered for this infection. New drugs being used against other fungal infections in adults, such as ketoconazole, itraconazole, terbinafine and fluconazole, are being considered more frequently for the treatment of tinea capitis. Sufficient pharmacological and pharmaceutical data exist on these five antifungal drugs to make them suitable for treating tinea capitis in children.16,17 In children with tinea capitis, which oral antifungal drug leads to high rates of cure with the fewest adverse events
The incidence of tinea pedis in industrialized countries has been estimated at 10 percent of the population. It has been estimated that in high-risk patients as many as 70 percent are affected. In the United States, 240 million per year is spent on products used to treat tinea pedis. Factors that predispose to infection include hot and humid climate, occlusive footwear, infrequent changes of socks or shoes, hyperhidrosis of the feet, conditions that lead to maceration of the feet, and repeated exposure of the feet to fungi combined with some form of minimal trauma. In high-risk groups, such as the elderly and immunocompromised patients, infections can become chronic and resistant to treatment and can disseminate. Tinea pedis can usually be prevented with proper hygiene. These measures include daily bathing and drying of feet, wearing absorbent socks and changing them daily, wearing shoes that breathe and changing them daily, wearing different footwear for sporting activities, and...
Tinea capitis is a dermatophyte infection of the scalp. It is most commonly seen in children, particularly African-American children. CLINICAL FEATURES Clinically one sees areas of alopecia with broken-off hairs and scale at the periphery. The alopecia is patchy and usually nonscarring ( Fig. 238-4). Occasionally, tinea capitis is associated with an intense inflammatory response. This is manifested as a boggy, tender, indurated plaque with superficial pustules and overlying alopecia. This is referred to as a kerion, and it may result in permanent scarring and alopecia. DIAGNOSIS Diagnosis is based on a positive potassium hydroxide preparation or positive fungal culture. A potassium hydroxide preparation of the hair is necessary scraping only the scalp rarely gives a positive KOH exam. Culture is often necessary to establish or confirm the diagnosis. Wood's light examination may be helpful as certain types of dermatophytes fluoresce under Wood's light examination.
Tinea capitis (scalp ringworm) is an infection of the scalp skin and hair caused by fungi (dermatophyte) mainly of the genera Trichophyton and Microsporum. The clinical hallmark is single or multiple patches of hair loss, sometimes with a black dot pattern (Figure 34.1), which may be accompanied by signs of inflammation such as scaling, pustules and itching.1,2 Figure 34.1 Tinea capitis Figure 34.1 Tinea capitis
There is good evidence to support the use of griseofulvin to treat tinea capitis caused by T. tonsurans, M. canis, T. mentagrophytes and T. violaceum. Overall, griseofulvin is considered to be safe in children. On the basis of the RCTs described, the recommended dosage regimen for children is continuous therapy with tablets or suspension, adjusted according to patient weight (10-20 kg 125 mg day 20-40 kg 250 mg day 40 kg 500 mg day) for 6-8 weeks, including microsized and ultramicrosized preparations. Other advantages of griseofulvin are that it is inexpensive and that the suspension allows accurate dosage in children. As far as I know it is licensed for tinea capitis in most countries.30
An example of introducing disease While working with sheep in Kosovo, a diagnosis was made of ringworm, a fungal infection of the skin. The disease had never been seen in the region prior to the introduction of a group of breeding rams from Kazakhstan. Contagious Ovine Foot Rot is a prime example of a purchased disease that requires close examination. A 30 45 day quarantine, including a zinc sulfate foot soak, must be intensively managed prior to introducing these sheep into the flock. Ovine progressive pneumonia (OPP) is a more subtle disease with no apparent clinical signs early in the course of the disease. The animals should have a negative serological test prior to entry and another negative test while in quarantine. Provide strict biosecurity between the quarantine facility and the existing flock, including separate boots and equipment. Always attend to the quarantine facility last in the daily routine. The diseases will vary with the specific locality, but the measures to...
Successful internal and external parasite control programs depend on an understanding of the parasites involved and developing a strategic plan to control these pests. Some of the most common parasites of sheep include stomach worms, liver flukes, tapeworms, coccid-ia, nose bots, lice, keds, and ringworm.
Differential diagnoses usually considered include ectoparasitism, dermatophytosis, food allergy and herpes infection. Various food trials are usually unhelpful, and evidence for the other differentials is frequently not found. There may be secondary bacterial and yeast infections readily demonstrated with skin cytology. The histological changes in skin biopsies include acanthosis, crusting, hydropic degeneration of basal cells and occasional dyskeratotic keratinocytes including the follicular epithelium. An intense mixed superficial dermal infiltrate accompanies the epidermal changes.
Page JC, Abramson C, Wei-Li L, et al Diagnosis and treatment of tinea pedis A review and update J Am Podiatr Med Assoc 81 304, 1991. 7. McBride A, Cohen BA Tinea pedis in children. Am J Dis Child 146 844, 1992. 8. Evans EG Tinea pedis Clinical experience and efficacy of short treatment. Dermatology 194 (suppl 1) 3, 1997. 9. DelRosso JQ Advances in the treatment of superficial fungal infections Focus on onychomycosis and dry tinea pedis. J Am Osteopath Assoc 97 339, 1997. 10. Tausch I, Decrois J, Gwiezdzinski Z, et al Short-term itraconazole versus terbinafine in the treatment of tinea pedis or manus. Int J Dermatol 37 140, 1998.
Miliary dermatitis is a cutaneous reaction pattern a response to a variety of stimuli that induce self trauma and overlicking. The principal differential diagnosis is flea-bite hypersensitivity other allergic causes include food allergy, atopy and possibly intestinal parasite hypersensitivity, although the latter is considered exceptionally rare. Infectious causes include dermatophytosis and bacterial folliculitis. Parasitic causes may include lice, Cheyletiella, Otodectes and trombiculid mites. Rare causes include EFA deficiency and hypereosinophilic syndrome.
The major risk factor for developing differentiated thyroid carcinoma is exposure to low-level external radiation. Enlargement of the thymus, scalp ringworm, recurrent tonsillitis, cervical adenopathy, facial acne and other head and neck disorders were commonly treated with 100-1500 cGy of external radiation from 1940 until the late 1960s. A dramatic increase in the diagnosis of differentiated thyroid carcinoma, predominately papillary carcinoma, resulted from these treatments and displayed an average latency period of 5 years from exposure to diagnosis. Young patients exposed between the ages of 5 and 15 seem to be at highest risk for developing radiation-associated thyroid carcinoma.6 This risk, which is increased after radiation exposure of as little as 10 cGy, is highest at 20 years after exposure and declines gradually thereafter. These same observations have been seen in Hiroshima and Nagasaki after the atomic bomb, in Nevada and in the Marshall Islands after atomic bomb testing...
Bifonazole, econazole nitrate or miconazole nitrate gave a RR of 2-25 (CI 1 -44 to 3-52, n 520). All the creams were similarly effective whether used for 4 or 6 weeks. Over-the-counter antifungal creams are very effective in the treatment of athlete's foot when compared with placebo controls. Patel et ai.w found exactly the opposite effect in a smaller but similar trial (n 104). They compared 1 week of terbinafine cream with 4 weeks of clotrimazole cream in people with interdigital tinea pedis. Terbinafine was found to more effective after 1 week (RR 1-51, CI 1-16 to 1-98) but there were no differences in effectiveness for outcomes assessed at later times. Schopoff et al,12 compared terbinafine cream used for 1 week with clotrimazole cream for 4 weeks in 429 people with interdigital tinea pedis and found no differences in the effectiveness at any time during the trial.
There are three main types of tinea pedis. The most common type of tinea pedis is the interdigital type. This type manifests as maceration and scale in the web spaces between the toes. Ulceration may even be present in severe cases with secondary bacterial and candidal infection ( Fig 239-2). FIG. 239-2. Ulcerative interdigital tinea pedis. Secondary bacterial and or candida infection complicate this case of interdigital tinea pedis. This eruption is quite painful and debilitating. The second type, which is seen in tinea manuum as well, presents as chronic, dry scales with little, if any, inflammation on the palmar or plantar surfaces. It often extends to the medial and lateral aspects of the feet but not the dorsal surface. When present on the feet in this distribution, it is often described as a moccasin distribution. Polycyclic or annular patterns may be seen. Maceration between the toes is common. Onychomycosis may be present with numerous, but usually not all, nails having...
In addition to the infections mentioned above, numerous other infections can occur on the face. In children, impetigo on the face is common, as is dermatophyte infections (tinea faciei and tinea barbae). Staphylococcal folliculitis is also seen on the face. The face and scalp are also a common site of involvement in secondary syphilis in which individuals develop moth-eaten alopecia, scaly or moist papules around the nose and at the angles of the mouth. Flat warts are frequently seen in males as a result of spreading the virus by shaving. Numerous molluscum contagiosum on the face of an adolescent or adult are suggestive of HIV. Patients with this disorder should be tested for HIV.
Zoonotic fungal infections are occasionally acquired by humans. The most common of these infections is a dermatophytosis from Microsporum canis. It is estimated that up to 30 percent of human dermatophytoses have a zoonotic origin.52 Treatment is often with topical antifungals or griseofulvin.
The diagnosis of pityriasis rosea is made by the clinical appearance. It can be confused with viral exanthem, drug eruptions, syphilis, and seborrheic dermatitis. Potassium hydroxide preparation of skin scrapings will serve to distinguish pityriasis rosea from tinea corporis. A serologic test for syphilis must be done to exclude that diagnosis.
Colonizes mucocutaneous and gastrointestinal surfaces and is a part of the normal human flora the dermatophytes are a group of specialized fungi causing localized infections of skin, nails and hair by virtue of their ability to utilize keratin and the dimorphic fungi grow as saprophytic molds in soil or vegetation but can transform at 37 C into parasitic yeast forms well-adapted for survival in susceptible mammalian hosts. In addition to causing localized and systemic infections, fungi can trigger immune-
To identify studies where oral treatments -itraconazole (continuous and pulse), fluconazole, terbinafine (continuous and pulse) and griseofulvin - were used to treat adults with toenail or fingernail onychomycosis caused by dermatophytes, we searched Medline (1966-2002) for randomised controlled trials (RCTs). The reference sections of the published reports were also examined for potential studies not listed in the database. Figure 33.1 This patient is a 47-year-old non-diabetic male exhibiting an infection of the left great toenail with no other health problems. He gave a history of approximately 15-year duration of nail abnormality that may be related to previous nail trauma. The thickened nail had large areas of yellowish-white discoloration typical of fungal nail infection. Culture revealed infection with the dermatophyte fungus, Trichophyton rubrum. Figure 33.1 This patient is a 47-year-old non-diabetic male exhibiting an infection of the left great toenail with no other health...
The diagnosis is usually fairly straightforward once one has observed the involvement of the claw beds of several feet. The other clinical signs may lead to some confusion with dermatophytosis and cats receive therapy for such disease until more typical signs appear, including pustules on the pinnae or the caseous exudate from the feet. Some cats are also treated with antibiotics for paronychia. This is based on cyto-logical examination of the exudate and or a positive
It can be acquired through contact with people, animals or objects carrying the fungus. The presence of fungi within the scalp may not be sufficient to result in tinea capitis (carrier state). Approximately eight dermatophyte species are characteristically associated with tinea capitis. Infections due to Trichophyton tonsurans predominate from Central America to the United States and in parts of Western Europe. Microsporum canis infections are mainly seen in South America, Southern and Eastern Europe, Africa and the Middle East. Reported cases of kerion (inflammatory tinea capitis) are rare outside Africa.
Dermatophytosis Microsporum canis ( 90 ), Trichophyton mentagro-phytes and M. gypseum are the most commonly isolated dermatophytes from infected cats (Wright, 1989). Trichophyton infections may reflect exposure to rodents and M. gypseum to contaminated soil. Many other species of Trichophyton, Microsporum and Epidermophyton may rarely cause sporadic disease. Dermatophytosis has been called one of the great pretenders because there are so many potential kinds of presentation. The classic signs include alopecia and scale with central healing. One can also see just alopecia, (nasal facial) folliculitis and furunculosis, onychomycosis and granulomas. Paronychia may be the only sign in some cats. Occasionally one may see a pustular form that may appear like a bacterial pyoderma or even mimic pemphigus foliaceus or erythematosus (Plate 6.12). subsequent culture. Hairs can retain positive fluorescence for long periods but be culture negative. It is possible for dermatophytes to be seen in...
Another RCT enrolled 60 patients with culturally proven dermatophytosis (47 patients) or cutaneous candidosis (13 patients) in a doubleblind, randomised study to compare the efficacy and tolerability of flutrimazole 1 cream with ketoconazole 2 cream, applied once daily for 4 weeks. Both groups of patients and distribution of target lesions were similar. The clinical results at the end of treatment were similar in both groups. The proportion of patients with negative microscopy and culture after 4 weeks of treatment was 70 in the flutrimazole group and 53 in the ketoconazole group seven
Infectious diseases can complicate and confuse the clinical presentation, including dermatophytes and Malassezia (Mason, 1997 Bond et al, 1997), and occasionally bacteria. Hair plucks for fungal culture and impression smears for skin cytology are routine diagnostic tests to consider in a standard work-up.
Regarding oral antifungal therapy, Stengel et al. compared fluconazole, 150 mg once weekly, with ketoconazole, 200 mg daily, in an RCT of 158 patients who had different forms of dermatophytosis, including a few with cutaneous candidiasis. Cure rates were similar in the patients with cutaneous candidiasis (fluconazole three of three, ketoconazole two of three).21
Various topical antifungal agents are available for the treatment of candida and the dermatophytic infections. The imidazole and polyene classes of agents are the most commonly used in outpatient medicine. Members of the imidazole class include clotrimazole, miconazole, and ketoconazole, while the polyenes are represented by nystatin and amphotericin B. Generally, the imidazoles are effective against yeasts and dermatophytes, whereas the polyenes are useful only in the treatment of candidal infections. In that diagnostic confusion that may arise in the fungal etiology of the superficial infection, polyene agents are best avoided imidazole agents will treat all such superficial fungal infections. Dermatophytic and yeast infections should be treated for prolonged periods to reduce the possibility of recurrence in general, a two- to four-week period of therapy is advised. In cases involving significant discomfort, combination agents composed of imidazole and corticosteroid agents reduce...
Cutaneous mycoses are the most common fungal infections found in humans, and are caused by fungi known as dermatophytes, which are able to utilise the keratin of skin, hair or nails by secreting the enzyme keratinase. Popular names for such infections include ringworm and athletes' foot. They are highly contagious, but not usually serious conditions.
One of the most important aspects of the past medical history, is whether the patient has received head or neck irradiation in childhood. Between 1940 and 1960, radiation was used as a treatment for thymic enlargement, recurrent tonsillitis, adenoiditis, otitis media, hemangiomas, ringworm, acne and dermatologic conditions. This therapy has now clearly been associated with an increased incidence of both benign and malignant nodules. If a patient with a solitary nodule has a history of radiation, the prevalence of cancer is 30-50 .2 Other factors to examine in the
The initial reports of FeLV and FIV infection associated with dermatitis and abscesses were lacking in clear evidence of a causal link between viral infection leading to the skin infection and the type of dermatitis. There have also been associations with otitis externa and notoedric mange. There is more likely to be a direct link between retrovirus infection and chronic dermatophytosis, mycobacterial infection and demodicosis, where immune suppression could promote persistent skin disease. It is prudent to evaluate cats with chronic infectious skin disease, including cowpox infection, for underlying immune suppression due to retrovirus infection.