An eleven year old boy visited a clinician with a condition as shown in the picture below on his scalp. The most appropriate line of treatment is ?
A. Oral griseofulvin therapy.
B. Topical griseofulvin therapy.
C. Shaving of the scalp.
D. Selenium sulphide shampoo.
Ans:A. Oral Griseofulvin therapy.
The patient is having tinea capitis on his scalp as shown in the picture above. The most appropriate line of treatment is Oral griseofulvin.
- Ringworm of the scalp occurs in children exclusively.
- The disease is primarily caused by dermatophytes in the Trichophyton and Microsporum genera that invade the hair shaft.
- 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.
- It may appear as thickened, scaly, and sometimes boggy swellings, or as expanding raised red rings (ringworm). Common symptoms are severe itching of the scalp, dandruff, and bald patches where the fungus has rooted itself in the skin.
- Sometimes with a ‘black dot’ pattern (often with broken-off hairs), that may be accompanied by inflammation, scaling, pustules, and itching.It is easily spread by the sharing of hairbrushes.
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 lamp.
- 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 florescence.
- Favus: Causes crusting on the surface of the skin, combined with hair loss. Associated with Trichophyton schoenleini.
- Tiniea capitis may be difficult to distinguish from other skin diseases that cause scaling, such as psoriasis and seborrhoeic dermatitis; the basis for the diagnosis is positive microscopic examination and microbial culture of epilated hairs.
- The treatment of choice is Griseofulvin.This compound is fungistatic 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