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Tinea Capitis

Disease Details

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Description: Tinea capitis, also known as scalp ringworm, is a fungal infection of the scalp and hair shafts, characterized by itchy, scaly, and bald patches.
Type: Tinea capitis is a fungal infection and does not involve genetic transmission. It is caused by dermatophytes, a type of fungus, and is typically transmitted through direct contact with infected individuals, animals, or contaminated objects.
Signs And Symptoms: Tinea capitis, commonly known as scalp ringworm, is a fungal infection of the scalp.

Signs and symptoms include:
- Itchy scalp
- Red, scaly patches or bald spots on the scalp
- Small black dots on the scalp where hair has broken off
- Dry, brittle hair that may break easily
- Swelling of the lymph nodes in the neck
- Pus-filled sores (in severe cases)

It primarily affects children but can also occur in adults. Early diagnosis and treatment are important to prevent spreading and complications.
Prognosis: The prognosis for tinea capitis is generally good with appropriate treatment, which typically includes antifungal medications. Most patients recover fully without long-term complications, although untreated cases may lead to permanent hair loss or scarring. Early diagnosis and adherence to treatment are essential for optimal outcomes.
Onset: Tinea capitis, also known as scalp ringworm, typically has an onset that can range from a few days to several weeks after exposure. The initial symptoms often include itching, redness, and scaling on the scalp. As the infection progresses, patients may develop round patches of hair loss, with the exposed scalp sometimes appearing inflamed or scaly. In severe cases, there may be pustules or kerion formation, which is a painful, swollen inflammatory response.
Prevalence: Tinea capitis, also known as scalp ringworm, is a common fungal infection, particularly affecting children. The prevalence can vary widely depending on geographic location and population. In some areas, particularly in urban settings and developing countries, the prevalence in school-aged children can be as high as 10-20%.
Epidemiology: Tinea capitis caused by species of Microsporum and Trichophyton is a contagious disease that is endemic in many countries. Affecting primarily pre-pubertal children between 6 and 10 years, it is more common in males than females; rarely does the disease persist past age sixteen. Because spread is thought to occur through direct contact with affected individuals, large outbreaks have been known to occur in schools and other places where children are in close quarters; however, indirect spread through contamination with infected objects (fomites) may also be a factor in the spread of infection. In the US, tinea capitis is thought to occur in 3-8% of the pediatric population; up to one-third of households with contact with an infected person may harbor the disease without showing any symptoms.The fungal species responsible for causing tinea capitis vary according to the geographical region, and may also change over time. For example, Microsporum audouinii was the predominant etiological agent in North America and Europe until the 1950s, but now Trichophyton tonsurans is more common in the US, and becoming more common in Europe and the United Kingdom. This shift is thought to be due to the widespread use of griseofulvin, which is more effective against M. audounii than T. tonsurans; also, changes in immigration patterns and increases in international travel have likely spread T. tonsurans to new areas. Another fungal species that has increased in prevalence is Trichophyton violaceum, especially in urban populations of the United Kingdom and Europe.
Intractability: Tinea capitis, also known as scalp ringworm, is not considered intractable. It is typically treatable with antifungal medications, such as oral terbinafine or griseofulvin. Treatment duration can vary but generally lasts several weeks. Early diagnosis and adherence to the prescribed treatment regimen usually lead to successful resolution of the infection.
Disease Severity: Tinea capitis, also known as scalp ringworm, varies in severity. It can range from mild to severe, with symptoms including scaling, itching, hair loss, and, in severe cases, painful inflammation and abscesses.
Healthcare Professionals: Disease Ontology ID - DOID:4337
Pathophysiology: From the site of inoculation, the fungus grows down into the stratum corneum, where it invades keratin. Dermatophytes are unique in that they produce keratinase, which enables them to use keratin as a nutrient source. Infected hairs become brittle, and after three weeks, the clinical presentation of broken hairs is evident.There are three types of infection:
Ectothrix: Characterized by the growth of fungal spores (arthroconidia) on the exterior of the hair shaft. Infected hairs usually fluoresce greenish-yellow under a Wood's lamp (blacklight). Associated with Microsporum canis, Microsporum gypseum, Trichophyton equinum, and Trichophyton verrucosum.
Endothrix: Similar to ectothrix, but characterized by arthroconidia restricted to the hair shaft, and restricted to anthropophilic bacteria. The cuticle of the hair remains intact and clinically this type does not have fluorescence. Associated with Trichophyton tonsurans and Trichophyton violaceum, which are anthropophilic.
Favus: Causes crusting on the surface of the skin, combined with hair loss. Associated with Trichophyton schoenleini.
Carrier Status: Carrier status for tinea capitis refers to individuals who harbor the causative fungi on their skin or hair without showing symptoms. These carriers can spread the infection to others, especially in close-contact environments. Carrier states are clinically significant as they can perpetuate outbreaks, particularly in communal settings like schools.
Mechanism: Tinea capitis, also known as scalp ringworm, is a fungal infection of the scalp primarily caused by dermatophyte fungi such as Trichophyton and Microsporum species.

**Mechanism:**
1. **Infection Route:** The infection often begins with the fungi invading the keratinous tissues of the hair shaft and scalp.
2. **Spore Adhesion:** Fungal spores adhere to the keratinized surface of the hair and scalp.
3. **Follicular Penetration:** The fungi then penetrate the hair follicle, producing enzymes like keratinases that degrade keratin proteins in the hair and skin.
4. **Colonization and Proliferation:** Once inside the follicle, the fungi proliferate, leading to hair breakage and the formation of characteristic lesions.

**Molecular Mechanisms:**
1. **Keratinase Production:** Dermatophytes produce specific proteolytic enzymes such as keratinases that digest keratin, allowing the fungus to access nutrients from the host's tissue.
2. **Evasion of Immune Response:** The fungi have mechanisms to evade the host's immune response. They can modify their cell wall components to reduce recognition by immune cells and produce molecules that inhibit immune responses.
3. **Host Inflammatory Response:** Fungal components, like cell wall mannans, can trigger inflammatory responses in the host, leading to symptoms like itching, redness, and swelling.
4. **Genetic Variability:** Dermatophytes exhibit genetic variability that may influence their virulence and the host's susceptibility to infection. Different strains have varying abilities to produce enzymes and evade the immune response.
5. **Antioxidant Defense:** Some dermatophytes can produce antioxidants to protect themselves from reactive oxygen species generated by the host immune response.

These mechanisms collectively contribute to the establishment and progression of tinea capitis in the affected individual.
Treatment: The treatment of choice by dermatologists is a safe and inexpensive oral medication, griseofulvin, a secondary metabolite of the fungus Penicillium griseofulvin. This compound is fungistatic (inhibiting the growth or reproduction of fungi) and works by affecting the microtubular system of fungi, interfering with the mitotic spindle and cytoplasmic microtubules. The recommended pediatric dosage is 10 mg/kg/day for 6–8 weeks, although this may be increased to 20 mg/kg/d for those infected by T. tonsurans, or those who fail to respond to the initial 6 weeks of treatment. Unlike other fungal skin infections that may be treated with topical therapies like creams applied directly to the affected area, griseofulvin must be taken orally to be effective; this allows the drug to penetrate the hair shaft where the fungus lives. The effective therapy rate of this treatment is generally high, in the range of 88–100%.
Other oral antifungal treatments for tinea capitis also frequently reported in the literature include terbinafine, itraconazole, and fluconazole; these drugs have the advantage of shorter treatment durations than griseofulvin. A 2016 meta-analysis of randomized controlled trials found that terbinafine, itraconazole and fluconazole were at least equally effective as griseofulvin for children infected with Trichophyton, and terbinafine is more effective than griseofulvin for children with T. tonsurans infection. However, concerns have been raised about the possibility of rare side effects like liver toxicity or interactions with other drugs; furthermore, the newer drug treatments tend to be more expensive than griseofulvin.On September 28, 2007, the U.S. Food and Drug Administration stated that Lamisil (Terbinafine hydrochloride, by Novartis AG) is a new treatment approved for use by children aged 4 years and older. The antifungal granules can be sprinkled on a child's food to treat the infection. Lamisil carries hepatotoxic risk, and can cause a metallic taste in the mouth.
Compassionate Use Treatment: Tinea capitis, a fungal infection of the scalp primarily caused by dermatophyte fungi such as Trichophyton and Microsporum species, is generally treated with antifungal medications. When considering compassionate use, off-label, or experimental treatments, it is important to consult a healthcare provider for the most appropriate and effective options.

1. **Compassionate Use Treatments:**
Compassionate use treatments are typically reserved for severe cases where standard therapies have failed. There are no widely recognized compassionate use treatments specifically for tinea capitis at present.

2. **Off-Label Treatments:**
- **Itraconazole:** Although not specifically approved for tinea capitis, itraconazole has been used off-label and may be effective, especially in cases where first-line treatments are not suitable or effective.
- **Fluconazole:** Similar to itraconazole, fluconazole is sometimes used off-label for tinea capitis. It may be considered in cases resistant to conventional treatments.

3. **Experimental Treatments:**
Experimental treatments are usually assessed in clinical trials and are not widely available outside of these settings. Current research often focuses on new antifungal agents or formulations, but specific promising experimental treatments for tinea capitis have not yet gained widespread recognition.

It's essential to prioritize standard treatments such as oral griseofulvin or terbinafine, as they are well-documented in their efficacy and safety for treating tinea capitis. Always consult a healthcare professional before considering non-standard treatment options.
Lifestyle Recommendations: For tinea capitis, lifestyle recommendations include:

1. **Maintain Hygiene:** Regularly wash your hair with medicated shampoo as recommended by a healthcare provider.
2. **Avoid Sharing Personal Items:** Do not share combs, brushes, hats, pillows, or towels.
3. **Clean Environment:** Regularly clean and disinfect household items and surfaces to prevent the spread of the infection.
4. **Limit Close Contact:** Avoid close contact with infected individuals to reduce the risk of contagion.
5. **Follow Treatment Protocols:** Adhere strictly to prescribed antifungal treatments and complete the full course of medication.
6. **Healthy Scalp Care:** Keep your scalp dry and clean, and avoid excessive use of hair products that can irritate the scalp.
Medication: Tinea capitis is a fungal infection of the scalp. Treatment typically involves oral antifungal medication such as griseofulvin or terbinafine. Topical antifungal shampoos, such as those containing ketoconazole or selenium sulfide, may also be used to reduce fungal load and prevent spread, but they are not effective as sole treatment.
Repurposable Drugs: Tinea capitis, a fungal infection of the scalp, primarily affects children and can cause hair loss and inflammation. Some repurposable drugs for treating tinea capitis include:

1. **Griseofulvin:** Traditionally used for fungal infections, including tinea capitis.
2. **Terbinafine:** An antifungal that is effective and often used off-label for this condition.
3. **Itraconazole:** Another antifungal sometimes repurposed for tinea capitis, especially in refractory cases.

NAN (Not Applicable/Not Available) indicates that information for the specific query might not be available or relevant in this context.
Metabolites: Tinea capitis, also known as scalp ringworm, is a fungal infection of the scalp caused by dermatophyte fungi. Information specifically related to metabolites in the context of tinea capitis is not well-documented in general medical literature because the primary focus is on the fungal organism and its treatment. However, the fungi responsible for tinea capitis, such as Trichophyton and Microsporum species, may produce various secondary metabolites that could potentially influence the infection process. Detailed studies on specific metabolites in tinea capitis might require targeted research articles or specialized scientific sources.
Nutraceuticals: Nutraceuticals are not commonly used in the standard treatment of tinea capitis. This fungal infection of the scalp primarily requires antifungal medications such as oral griseofulvin or terbinafine. Topical treatments may be used as adjunct therapy. Nutraceuticals like vitamins and dietary supplements are not typically effective in eradicating the fungus responsible for tinea capitis. Always consult a healthcare professional for proper diagnosis and treatment recommendations.
Peptides: Tinea capitis, also known as scalp ringworm, is primarily treated with oral antifungal medications rather than peptides. Current first-line treatments involve drugs like griseofulvin and terbinafine. Nanotechnology-related treatments are an emerging research area, focusing on improving drug delivery and effectiveness, but are not yet standard practice.