Tinea capitis is a scalp and hair follicle dermatophyte infection caused by Trichophyton sp. and Microsporum sp. that more commonly affects children than adults. Microsporum canis is the most common dermatophyte causing tinea capitis reported in Asia that respond well to griseofulvin. We report one case of an 8-year-old child with a history of patchy scaling lesion on the head, and itch heals well after being treated with griseofulvin for four weeks, diagnosis based on anamnesis, clinical, KOH examination, culture, and trichoscopy shows a diagnosis of Tinea capitis caused by Microsporum canis. The patient treated with griseofulvin for four weeks had excellent results.
An eight-year-old boy presented to the dermatology outpatient clinic of Dr. Soetomo General Hospital with chief complaint of scaling on the head, patchy alopecia, and pruritus. Two weeks before he came to the hospital, he went to a general practitioner and got steroid ointment and shampoo. However, there was no improvement, no one in the same household was experiencing any skin or scalp problems. The mother reported that their neighbor has a cat as a pet and frequently interacts with the child. Physical examination showed a normal body mass index and stable vital signs. Dermatological examination revealed multiple scaly erythematous macules, circular shape, sharply marginated, with a diameter of 2-6 cm, along with alopecia in each lesion, there was no palpable lymph node enlargement in the retroauricular region. Supportive examination using KOH preparation was performed, with the result of an ectothrix pattern in the hair shaft. Wood lamp examination showed positive yellow-green fluorescence. Trichoscopy of the lesions showed the pattern of diffuse scaling, perifollicular scaling, morse code-like hair, zigzag hair, black dot, broken hair, and comma hair. Fungal culture results revealed the species of Microsporum canis. Based on history taking, clinical manifestation, and supportive examination, the diagnosis of tinea capitis grey patch type was established. The patient was treated using griseofulvin 250 mg per day for four weeks with adjuvant treatment using ketoconazole 2% scalp solution and it shows real clinical improvement.
Tinea capitis, also known as ringworm, is a dermatophyte infection of the hair and the scalp. The clinical manifestation can be classified as non-inflammatory or inflammatory type. The non-inflammatory type is often uncomplicated with the presentation of one or more scaly patches of alopecia with black dots or grey patches. In contrast, the inflammatory type (kerion) usually takes the form of a painful pustule and plaques and is followed by scarring alopecia as a complication. The diagnosis of tinea capitis can be made with clinical suspicion. Supporting examinations are KOH Examination and Mushroom culture to determine their etiology. Mushroom culture is the standard of gold.
Microsporum canis is zoophilic; thus we might suspect the transmission came from the cat that frequently interacted with the patient. Cats and dogs may play a role as reservoir or source of infection of Microsporum canis. Transmission between humans is considered rare. Systemic antifungal drugs are required to treat Tinea capitis because topical agents do not penetrate well to hair shafts and follicles. Treatment with griseofulvin is considered the most effective therapy for Microsporum tinea capitis due to griseofulvin’s ability to concentrate in sweat. Since the location of the infection is ectothrix, in which the drug reaches the location well. Griseofulvin also has a good safety profile with lower adverse effects. Griseofulvin is effective for treating Tinea capitis caused by the fungus Microsporum canis. Diagnosis is needed with a thorough examination including anamnesis, clinical and supporting examinations to choose effective antifungal drugs.
Author: Dr.dr.Dwi Murtiastutik,Sp.KK(K)
Details of the research can be viewed on:
https://www.ijrp.org/paper-detail/2593
Successful Treatment of Tinea Capitis Caused by Microsporum canis Using Griseofulvin Brigita Ika Rosdiana, Yuri Widia, Linda Astari , Evy Ervianti , Dwi Murtiastutik
