Abstracts
Adults & Dandruff
Adults
Tinea capitis in adults is supposed to be rare; we have recently observed a significant increase in cases.
Eight cases were observed: 6 were women, 4 never traveled and 5 had an underlying immunosuppressive disease. Scalp scaling and alopecia were the most frequent clinical features. A zoophilic dermatophyte was recovered in 50% of cases.
These cases represent 11% of all tinea capitis observed in the same period of time (higher than the 3-5% observed in the literature). Secretion of sebum and colonization by Pityrosporon orbiculare are supported to protect the scalp against dermatophytic invasion after puberty, but an immune defect may also facilitate hair invasion.
Cremer G et al., Tinea capitis in adults: misdiagnosis or reappearance? Dermatology, 1997, 194:1, 8-11.
Allergy to Fenugreek
Allergy to Fenugreek
Allergic reactions after consumption of spices are well-known. In Asia, fenugreek seeds are consumed as spices and also as medicines. Literature survey carried out does not reveal reports of allergic reactions to fenugreek. In our survey carried out on patients with food allergy, we found two cases of severe allergy to fenugreek.
Skin scratch tests for the patients revealed strong sensitivity to fenugreek and chickpeas. None of the controls showed such response with fenugreek extract.
Patil SP et al., Allergy to fenugreek (Trigonella foenum graecum). Ann Allergy Asthma Immunol, 1997 Mar, 78:3, 297-300.
Children & Dandruff
Children
Described trends in tinea capitis incidence among California children and to determine subpopulations at increased risk.(California, 1984 through 1993.)
California Medi-Cal provider data for first-time prescriptions of oral griseofulvin suspension were used to estimate annual incidence of tinea capitis and calculate risk ratios.
From 1984 through 1993, the incident rate for prescriptions of oral griseofulvin suspension increased by 84.2% for all children, 140.4% for white children, and 209.7% for African-American children. In 1993, incidence rates (per 10,000 enrolled) were 252.1 claimants for African-American children, 23.1 for white, 17.5 for Hispanic, and 14.3 for Asian/Pacific Islander. The highest rate by location was San Francisco County (172.2). In age groups < 5 years and 5 to 9 years, African-American children were 13.1 and 17.6 times more likely to be prescribed griseofulvin than Hispanic children. Since 1987, incidence rates for children 5 to 9 years of age were higher compared with children ages < 5 years.
Tinea capitis is epidemic among California children with higher rates in the northern counties studied. African-American children are the most affected by this epidemic; however, white children have also experienced increased rates.
Lobato MN et al., Tinea capitis in California children: a population-based study of a growing epidemic. Pediatrics, 1997 Apr, 99:4, 551-4.
Melaleuca
Melaleuca
The in vitro antifungal activity of tea oil, the essential oil of Melaleuca alternifolia, has been evaluated against 26 strains of various dermatophyte species, 54 yeasts, among them 32 strains of Candida albicans and other Candida sp. as well as 22 different Malassezia furfur strains.
Tea tree oil was found to be able to inhibit growth of all clinical fungal isolates.
Both C. albicans strains and the other strains belonging to the genus Candida and Trichosporon appeared to be slightly less susceptible to tea tree oil in vitro.
The in vivo effect of tea tree oil ointment in the therapy of fungal infections of the skin and mucous membranes as well as in the treatment of dandruff, a mild form of seborrheic dermatitis, may be at least partly due to an antifungal activity of tea tree oil.
Nenoff P et al., Antifungal activity of the essential oil of Melaleuca alternifolia (tea tree oil) against pathogenic fungi in vitro. Skin Pharmacol, 1996, 9:6, 388-94.
Newborn & Dandruff
Newborn
Tinea capitis is a common infection of childhood. There have been several reports of tinea capitis in newborns.
The patient was successfully treated with oral griseofulvin.
Ungar SL & Laude TA: Tinea capitis in a newborn caused by two organisms. Pediatr Dermatol, 1997 May-Jun, 14:3, 229-30.
Patient Education (Dandruff)
Patient Education
Dandruff is the excessive production of small flakes of dead "skin" on the scalp. It is a normal process because the cells of the outer layer of scalp skin (the epidermis) die and are replaced constantly, like all other cells in the body. Dandruff is a common, normal condition that carries no risk to health whatsoever. It is not contagious and does not cause "baldness". It seems to be made worse by a variety of factors such as emotional "stress", poor diet, poor hygiene (including rarely washing or shampooing the hair), "allergies", various chemicals and cosmetics applied to scalp. The "skin inflammation" called seborrheic "dermatitis" is considered to be a most important cause of dandruff. "Hormone" imbalance is thought to be a factor because it runs a similar course to "acne". It is rare under the "age" of 12, is most common in adolescence and worse around age 20. There is usually evidence of skin disorders on other parts of the body. Many suitable shampoos exist but no one particular shampoo suits everyone.
"Dandruff: patient education." Murtagh, J. Aus. Fam. Phys. 1994 July 7; 23: 1351.
Psoriasis (Dandruff)
Psoriasis
The recent discovery that human epidermal cells themselves make and secrete the components necessary to avoid colonization by molds and other organisms. It also helps clarify the mechanisms underlying clinical and laboratory findings seen in chronic mucocutaneous "candidiasis", dandruff and "psoriasis". Psoriasis seems best explainable as a visible, late stage of the "inflammatory" sequelae of activation of the alternative complement pathway in the epidermis.
"Psoriasis is a visible manifestation of the skin's defense against micro-organisms." Rosenbeg, E.W.; Noah, P.W.; Skinner, R.B. Jr. J. Dermatol. 1994 Jun; 21(6): 375-81.
Seborrheic Dermatitis
Seborrheic Dermatitis
Seborrheic dermatitis is a common condition that usually appears as simple dandruff. It may affect the scalp, the central part of the face and the "anterior" portion of the chest, as well as flexural creases of the arms, legs and groin. It occurs most often in infants and in adults between 30 and 60 years of age. Patients with acquired immunodeficiency syndrome may have particularly resistant cases of seborrheic dermatitis. Diagnosis of this condition is generally straightforward, but the differential diagnosis includes a variety of conditions, such as "psoriasis vulgaris" (sebopsoriasis), "atopic dermatitis", "tinea capitis" and candidiasis, as well as other, more rare conditions. Seborrheic dermatitis may be associated with or caused by a variety of underlying disorders. Treatment is generally topical. "Steroid" creams, "selenium", "salicylic acid" and coal tar preparations, and pyrithione "zinc" are frequently used to treat this condition.
Seborrheic dermatitis. Janniger-CK; Schwartz-RA. Am-Fam-Physician. 1995 Jul; 52(1): 149-55, 159-60.
Tinea Capitis (Dandruff)
Tinea Capitis
A prospective, randomized, nonblinded clinical trial to determine whether an over-the-counter shampoo (containing 1% selenium sulfide) would have sporicidal activity equal to that of a (2.5% selenium sulfide) prescription lotion in the adjunctive treatment of tinea capitis "infection".
Both the 2.5% selenium sulfide and 1% selenium sulfide preparations were superior to the nonmedicated control shampoo in terms of the time required to eliminate shedding of viable spores. When compared with each other, there was no difference between the 2.5% selenium sulfide and 1% selenium sulfide preparations in time required to produce a negative culture.
Commercially available 1% selenium sulfide shampoo is an equally effective yet less expensive alternative sporicidal therapy in the adjunctive treatment of tinea capitis infection.
Comparison of 1% and 2.5% selenium sulfide in the treatment of tinea capitis. Givens-TG; Murray-MM; Baker-RC. Arch-Pediatr-Adolesc-Med. 1995 Jul; 149(7): 808-11.
Treatment (Pharmaceuticals)
Treatment (Pharmaceuticals)
Reviewed the epidemiology, pathogenesis, mycology, clinical presentation, and pharmacotherapy of tinea capitis.
Griseofulvin is the drug of choice in the treatment of tinea capitis. Newer agents with greater efficacy or shorter treatment durations continue to be explored. Ketoconazole, the first azole studied for efficacy in tinea capitis, has not demonstrated any clinical advantage over griseofulvin in several controlled clinical trials. Itraconazole is effective, but the available data are limited to case reports and a single uncontrolled study. Terbinafine similarly has shown promise in the treatment of tinea capitis, but the oral formulation was only recently approved in the US. Existing studies reflect the results in infection with pathogens not seen in the US. Both itraconazole and terbinafine achieve high concentrations in the hair and stratum corneum that persist for several weeks following drug administration. This may enable shorter courses of therapy; however, comparative studies need to be conducted in the US.
Tinea capitis remains the most common dermatophyte infection in young urban children. Oral antifungal therapy is required for effective treatment, often for several months. The combination of griseofulvin with a selenium sulfide shampoo continues to be the mainstay of therapy until more experience is gained with the newer antimycotics.
Abdel-Rahman SM & Nahata MC: Treatment of tinea capitis. Ann Pharmacother, 1997 Mar, 31:3, 338-48.
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