Tinea infections in Children - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
The presentation depends upon the site of infection, age of the child and on the strain of fungus Tinea infections of children are superficial dermatophyte fungal infections involving the skin, hair and naisl. There are three causative genera. Genera Trichophyton cause skin, hair and nail infections. Genera Microsporum cause only skin and hair infections. While genera Epidermophyton causes skin and nail infections. The prevalence of tinea infections vary with age. For example Tinea capitis is common among children aged between 3 to 9 years while tinea corporis affects children of all age groups. ,,,,,,, The presentation depends upon the site of infection, age of the child and on the strain of fungus
Tinea infections of children are superficial dermatophyte fungal infections involving the skin, hair and naisl. There are three causative genera. Genera Trichophyton cause skin, hair and nail infections. Genera Microsporum cause only skin and hair infections. While genera Epidermophyton causes skin and nail infections. The prevalence of tinea infections vary with age. For example Tinea capitis is common among children aged between 3 to 9 years while tinea corporis affects children of all age groups. ,,,,,,,
Erythematous circular scaly rash Dermatophytes invade into the stratum corneum, and the inflammation they cause is a result of metabolic products of the fungus or delayed hypersensitivity. Usually, anthrophilic fungi cause lesions with minimal inflammation, while zoophilic fungi induce a more intense inflammation. ,,,,, Erythematous circular scaly rash
Dermatophytes invade into the stratum corneum, and the inflammation they cause is a result of metabolic products of the fungus or delayed hypersensitivity. Usually, anthrophilic fungi cause lesions with minimal inflammation, while zoophilic fungi induce a more intense inflammation. ,,,,,
Patchy alopecia Tinea capitis (scalp ringworm) commonly affects children. Tinea capitis is one of the commonest causes of hair loss in children. ,,, Patchy alopecia
Tinea capitis (scalp ringworm) commonly affects children. Tinea capitis is one of the commonest causes of hair loss in children. ,,,
Pruritus Is a common complaint in dermatophyte infections. Infants may present with disturbed sleep and crying. ,,, Pruritus
Is a common complaint in dermatophyte infections. Infants may present with disturbed sleep and crying. ,,,
Contact history Tinea infections are a contagious and communicable fungal infections. Therefore contact history with infected family member, classmate or sharing of clothes, bedlinen, pillows, towels, combs or animal contact may be positive in the history. ,,, Contact history
Tinea infections are a contagious and communicable fungal infections. Therefore contact history with infected family member, classmate or sharing of clothes, bedlinen, pillows, towels, combs or animal contact may be positive in the history. ,,,
History of immunesuppression Protection against fungal infection is mediated by cell mediated immunity [CMI]. Long term steroid therapy, Cushing' syndrome, HIV infection, malnutrition and specific immune deficient conditions are possible risk factors in the history. The incidence of fungal infections is increasing. This increase is related to the growing population of immunocompromised children. This results from the changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. ,,,, History of immunesuppression
Protection against fungal infection is mediated by cell mediated immunity [CMI]. Long term steroid therapy, Cushing' syndrome, HIV infection, malnutrition and specific immune deficient conditions are possible risk factors in the history. The incidence of fungal infections is increasing. This increase is related to the growing population of immunocompromised children. This results from the changes in medical practice such as the use of intensive chemotherapy and immunosuppressive drugs. ,,,,
Common among pre pubertal age group Due to physiological changes that occur with puberty sebum content of skin surface increases. Sebum which is rich in lipids provide a suitable media to growth of causative organisms. ,,,,, Common among pre pubertal age group
Due to physiological changes that occur with puberty sebum content of skin surface increases. Sebum which is rich in lipids provide a suitable media to growth of causative organisms. ,,,,,
History of living in tropical regions Warmth and humidity provides a suitable environment to pathogenic growth of causative organisms. ,,,,,, History of living in tropical regions
Warmth and humidity provides a suitable environment to pathogenic growth of causative organisms. ,,,,,,
More prevalent in the lower socio economic classes Overcrowding and poor social conditions are risk factors, for the spread of disease. More prevalent in the lower socio economic classes
Overcrowding and poor social conditions are risk factors, for the spread of disease.

Clinicals - Examination

Fact Explanation
Round, scaling area of alopecia with diffuse scaling on the scalp Dermatophyte infection of the scalp is known as Tinea capitis. This is the commonest tinea infection of children. Anthrophilic organisms cause bald and scaly areas with minimal inflammation. Zoophilic organisms induce an intense inflammation causing red, boggy kerion formation. ,,,,,, Round, scaling area of alopecia with diffuse scaling on the scalp
Dermatophyte infection of the scalp is known as Tinea capitis. This is the commonest tinea infection of children. Anthrophilic organisms cause bald and scaly areas with minimal inflammation. Zoophilic organisms induce an intense inflammation causing red, boggy kerion formation. ,,,,,,
Single or numerous erythematous, annular plaques with scaling on the trunk and limbs Tinea infections of the trunk and limbs is Tinea corporis. This is the second commonest tinea infection in children. The lesions expand slowly and the healing center leaves a typical ring like pattern. The erythema is most pronounced at the periphery. ,,,, Single or numerous erythematous, annular plaques with scaling on the trunk and limbs
Tinea infections of the trunk and limbs is Tinea corporis. This is the second commonest tinea infection in children. The lesions expand slowly and the healing center leaves a typical ring like pattern. The erythema is most pronounced at the periphery. ,,,,
Sharply demarcated area in the groin with elevated, scaling, serpiginous borders Tinea infections involving the groin are known as Tinea cruris. The eruption is unilateral or bilateral and asymmetrical. Can spread to the upper inner thigh. ,,, Sharply demarcated area in the groin with elevated, scaling, serpiginous borders
Tinea infections involving the groin are known as Tinea cruris. The eruption is unilateral or bilateral and asymmetrical. Can spread to the upper inner thigh. ,,,
Interdigital maceration, diffuse scaling on soles and side of the feet Tinea infections of the feet are known as Tinea pedis (athlete's foot). Trichophyton rubrum, Trichophyton mentagrophytes and Epidrmophyton floccosum are the common causative organisms. ,,, Interdigital maceration, diffuse scaling on soles and side of the feet
Tinea infections of the feet are known as Tinea pedis (athlete's foot). Trichophyton rubrum, Trichophyton mentagrophytes and Epidrmophyton floccosum are the common causative organisms. ,,,
Diffuse dry scaling, usually affects only one palm Tinea infections affecting hand are known as Tinea manuum. The characteristic feature is powdery scaling along the creases of the palm. Trichophyton rubrum is the common causative organism. ,,, Diffuse dry scaling, usually affects only one palm
Tinea infections affecting hand are known as Tinea manuum. The characteristic feature is powdery scaling along the creases of the palm. Trichophyton rubrum is the common causative organism. ,,,
Slightly scaling, erythematous patches and plaques on the face Tinea infections involving the face is kown as Tinea faciale. The border of the lesion may be not well demarcated. ,,, Slightly scaling, erythematous patches and plaques on the face
Tinea infections involving the face is kown as Tinea faciale. The border of the lesion may be not well demarcated. ,,,
Subungual debris with separation of the nail bed. Tinea infections of the nail is known as Tinea unguium. The initial changes occur at the free edge of the nail as this becomes yellow and crumbly. ,,, Subungual debris with separation of the nail bed.
Tinea infections of the nail is known as Tinea unguium. The initial changes occur at the free edge of the nail as this becomes yellow and crumbly. ,,,

Investigations - Diagnosis

Fact Explanation
Woods light examination Uses ultraviolet light to observe skin closely. It reveals some of epidermophytes with green fluorescence. Some causative fungi do not fluorescence. ,,, Woods light examination
Uses ultraviolet light to observe skin closely. It reveals some of epidermophytes with green fluorescence. Some causative fungi do not fluorescence. ,,,
Light microscopic examination Skin scrapings should be taken from the scaly margin of a lesion, with a small curette or a scalpel blade and clippings or scrapings from the most crumbly part of the nail. Broken hair should be plucked with with a tweezers. The specimens are cleared in pottassium hydroxide prior to microscopy. Branching hyphae and spores can easily be seen. ,,,,, Light microscopic examination
Skin scrapings should be taken from the scaly margin of a lesion, with a small curette or a scalpel blade and clippings or scrapings from the most crumbly part of the nail. Broken hair should be plucked with with a tweezers. The specimens are cleared in pottassium hydroxide prior to microscopy. Branching hyphae and spores can easily be seen. ,,,,,
Culture Culture should be carried out in a mycology or bacteriology laboratory. A transport medium is not necessary, and specimens can be sent in folded black paper and dry petri dish. The report may take as long as a month: microscopy is much quicker. ,,, Culture
Culture should be carried out in a mycology or bacteriology laboratory. A transport medium is not necessary, and specimens can be sent in folded black paper and dry petri dish. The report may take as long as a month: microscopy is much quicker. ,,,

Investigations - Management

Fact Explanation
Follow up visits To see the response to treatment and to assess complications of the disease. Weighing children in follow up visits is important to adjust the dose of systemic therapy.,,,. Follow up visits
To see the response to treatment and to assess complications of the disease. Weighing children in follow up visits is important to adjust the dose of systemic therapy.,,,.
Periodic monitoring In patients prescribed systemic anti fungals there is a possibility of serious hepatotoxicity and occurrence of other side effects, including thrombocytopenia and derangement of liver enzymes. Periodic monitoring of liver function tests and full blood count is important. ,,,. Periodic monitoring
In patients prescribed systemic anti fungals there is a possibility of serious hepatotoxicity and occurrence of other side effects, including thrombocytopenia and derangement of liver enzymes. Periodic monitoring of liver function tests and full blood count is important. ,,,.

Management - Supportive

Fact Explanation
Educate parents Inform that Tinea infections are common superficial fungal infection that can be treated successfully. ,,, Educate parents
Inform that Tinea infections are common superficial fungal infection that can be treated successfully. ,,,
Advise regarding hygiene Advise families not to share clothes, towels,bedlinen, combs,pillows etc. Advise regarding importance of daily bathing and wearing clean dry clothes to reduce recurrence. After bathing, children should be towel-dried.,,,,,, Advise regarding hygiene
Advise families not to share clothes, towels,bedlinen, combs,pillows etc. Advise regarding importance of daily bathing and wearing clean dry clothes to reduce recurrence. After bathing, children should be towel-dried.,,,,,,
Preventive measures for immune compromised children Immune compromised children must advised to practice hand washing as a habit and not to go walk bare-foot in public places, such as shower rooms and swimming pools. Selenium sulphide shampoo and topical antifungals can be used prophylactically. ,,,,,, Preventive measures for immune compromised children
Immune compromised children must advised to practice hand washing as a habit and not to go walk bare-foot in public places, such as shower rooms and swimming pools. Selenium sulphide shampoo and topical antifungals can be used prophylactically. ,,,,,,
Advise to treat infected family members/pets Tinea infections are contagious and communicable fungal infections, treating infected family members and infected pets prevents infection of the children. ,, Advise to treat infected family members/pets
Tinea infections are contagious and communicable fungal infections, treating infected family members and infected pets prevents infection of the children. ,,

Management - Specific

Fact Explanation
Local imidazole preparations An imidazole containing preparation (such as miconazole, econazole and clotrimazole) used twice daily for 3-4 week period is usually adequate. Imidazoles interfere with fungal oxidative enzymes to cause lethal accumulation of hydrogen peroxide. They also reduce the formation of ergosterol, an important constituent of fungal cell wall which thus becomes permeable to intracellular constituents. When topical treatment has failed systemic drugs needs to be considered. Systemic therapy given according to the body weight of the child. When prescribing systemic therapy must refer BNF for Childrens' for dosing according to body weight. ,,,,,, Local imidazole preparations
An imidazole containing preparation (such as miconazole, econazole and clotrimazole) used twice daily for 3-4 week period is usually adequate. Imidazoles interfere with fungal oxidative enzymes to cause lethal accumulation of hydrogen peroxide. They also reduce the formation of ergosterol, an important constituent of fungal cell wall which thus becomes permeable to intracellular constituents. When topical treatment has failed systemic drugs needs to be considered. Systemic therapy given according to the body weight of the child. When prescribing systemic therapy must refer BNF for Childrens' for dosing according to body weight. ,,,,,,
Topical nail preparations Children may refuse systemic treatment. For nail infections a nail lacquer containing amorolfine is worth a trial. Ciclopirox is a alternative available in the USA. , Topical nail preparations
Children may refuse systemic treatment. For nail infections a nail lacquer containing amorolfine is worth a trial. Ciclopirox is a alternative available in the USA. ,
Terbinafin Has now largely superseded griseofulvin. It acts by inhibiting fungal squalane epoxidase and does not interact with cytochrome p-450 system. It is fungicidal and so cures chronic dermatophyte infections more quickly and more reliably than griseofulvin. ,,,,,, Terbinafin
Has now largely superseded griseofulvin. It acts by inhibiting fungal squalane epoxidase and does not interact with cytochrome p-450 system. It is fungicidal and so cures chronic dermatophyte infections more quickly and more reliably than griseofulvin. ,,,,,,
Griseofulvin Was for many years drug of choice for chronic dermatophyte infections, but is now largely reserved for treatment of tinea capitis. Griseofulvin prevents fungal growth by inhibiting mitosis. The therapeutic efficacy of griseofulvin depends on its capacity to bind to keratin. ,,,,,, Griseofulvin
Was for many years drug of choice for chronic dermatophyte infections, but is now largely reserved for treatment of tinea capitis. Griseofulvin prevents fungal growth by inhibiting mitosis. The therapeutic efficacy of griseofulvin depends on its capacity to bind to keratin. ,,,,,,
Itraconazole Is now preferred to Ketoconazole, which occasionally damages the liver, and is a reasonable alternative to terbinafin if this is contraindicated. Fungistactic rather than fungicidal, it interfere with cytochrome P-450 system, so a review of any other medication being taken is needed before a prescription is issued. ,,,,,, Itraconazole
Is now preferred to Ketoconazole, which occasionally damages the liver, and is a reasonable alternative to terbinafin if this is contraindicated. Fungistactic rather than fungicidal, it interfere with cytochrome P-450 system, so a review of any other medication being taken is needed before a prescription is issued. ,,,,,,
Ketoconazole This drug should be reserved for patients with severe and resistant disease because of the possibility of serious hepatotoxicity and occurrence of other side effects, including rashes, thrombocytopenia and gastrointestinal disturbances . ,,,,, Ketoconazole
This drug should be reserved for patients with severe and resistant disease because of the possibility of serious hepatotoxicity and occurrence of other side effects, including rashes, thrombocytopenia and gastrointestinal disturbances . ,,,,,

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