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A 6-year-old boy with multiple pustules on his head and hair loss for more than a month, what is the cause?
Case Profile
The child had no obvious cause of hair loss spots on the top of the head 1 month ago, and there was a guinea pig who had been raised for 6 months at home, and according to the clinical manifestations and laboratory tests, the tinea capitis caused by Microsporum canis was finally diagnosed, and the tinea capitis was relieved after oral itraconazole and topical terbinafine.
Tinea capitis (TC)
TC is a disease caused by dermatophyte infection of the scalp and hair, which is common in children aged 3-10 years, and is highly contagious, which may lead to permanent hair loss and have a greater impact on the physical and mental health of children. In recent years, with the popularity of family pets, the incidence of tinea capitis in children caused by Microsporum canis infection has increased significantly.
Clinical presentation
Tinea capitis is a disease caused by dermatophyte bacteria infecting the scalp and hair, which can be clinically divided into jaundice, vitiligo, tinea melitosis and pyophyllum according to the different pathogenic species and host responses.
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diagnosis
The diagnosis of tinea capitis is based on clinical findings and laboratory tests.
Laboratory tests
Fungal microscopy and fungal culture are the classic methods for diagnosing tinea capitis.
➤ Fungal microscopy: The presence of a fungal infection can be determined simply and quickly, but not the species.
➤ Fungal culture: Identification of strains based on the colonies grown by the fungus and the morphological characteristics of the hyphae and spores under the microscope.
treat
Tinea capitis is mainly treated orally plus topically.
Oral therapy
➤ Griseofulvin: The recommended dose is 15-20mg/(kg·d), the course of treatment is long, generally 6-8 weeks;
< 㼡: 20mg 1:62.5mg/d;5000 20-400mg:125mg/d;>40mg 1:250mg/d;24-600mg;
➤ Itraconazole: The recommended dose is 3-5mg/(kg·d), taken immediately after meals, and the course of treatment is 4-6 weeks;
➤ Fluconazole: The recommended dose is 6 mg/(kg·d) for 4-6 weeks.
Topical treatments
➤ Liniment: external application of antifungal drugs, such as 5% sulfur ointment, 5% salicylic acid ointment, 2% miconazole cream, 1% bifonazole cream, 1% terbinafine cream, butinaphene cream, clotrimazole cream, liranathylate cream, sertathylate cream, etc., pyotra can be topically coated with a combination of antifungal agents and hormones, and patients with bacterial infection can add 2.5% iodine tincture, 2 times/day.
➤ Wash: Wash your hair with soap, sulfur soap, 2% ketoconazole lotion, 2.5% selenium sulfide antifungal drug shampoo, 1-2 times/day.
➤ Shaving: If the skin lesion area is larger, the haircut is once a week, and the diseased hair on the skin lesion is removed with tweezers, and the diseased hair is incinerated for treatment.
➤ Disinfection: Boil, disinfect or sterilize the daily necessities that the child has come into contact with, such as hairdressing utensils, combs, towels, hats, pillowcases, bed sheets, etc., once a week to avoid indirect infection.
Bibliography:
[1] Wei S, Wang H, Li A, et al. Kerion Celsi caused by Microsporum gypseum in a Chinese child, a case report. Medicine (Baltimore). 2022 Apr 1; 101(13):e28936.
[2]https://www-uptodate-com-s--cams1.du2022.top/contents/zh-Hans/tinea-capitis?
Skin Diseases and Sexually Transmitted Diseases,2022,44(03):222-225.
[4] Yu Jin, Zhu Min.Guidelines for the diagnosis and treatment of tinea capitis in China (2018 revised edition)[J].Chinese Journal of Mycology,2019,14(01):4-6.
Bulletin of Dermatology,2017,34(05):522-530+3.