Wednesday, 19 February 2014

Friday Meetings: Friday 28/3/2014

Friday 28/3/14 1:30 pm Cairo Time Google Plus Hangout

One-topic meeting:

An update on the management of alopecia areata 

Free talks via Google Hangout on Fridays have been arranged. These Friday Meetings have been audiovisual online meetings where we have typed, talked and screen shared. The Handouts, when available, can be emailed on request unless they become out-of-date. 

Similarly, Thursday Meetings have been developed to discuss Rook's Textbook of Dermatology on Google Hangout. 

Monday, 10 February 2014

Scaly tinea capitis

Whereas all three genera attack the skin, Microsporum does not infect nails and Epidermophyton does not infect hair. Tinea capitis in general is predominantly an infection of children, although adult cases are occasionally seen. Tinea capitis may also be seen in adults with AIDS.

The clinical appearance of tinea capitis is most variable,
depending on the type of hair invasion, the level of host resistance and the degree of inflammatory host response. The appearance therefore may vary from a few dull grey, broken-off hairs with a little scaling, detectable only on careful inspection, to a severe, painful, inflammatory mass covering most of the scalpItching is variable. In all types, the cardinal features are partial hair loss with inflammation of some degree.

It should be noted that the phenomenon of producing a characteristic fluorescence by hair infected by certain dermatophytes on Wood's light examination has been attributed to some substance produced by the interaction of the fungus and the growing hair. Its chemical nature has not been defined, and the suggestion that it may be a pteridine has been challenged.

Tinea capitis is treated systemically; additional topical application of an antifungal may reduce transmission.
A topical antifungal can also be used to treat asymptomatic carriers of tinea capitis. There is evidence that ketoconazole shampoo may reduce the incidence of positive cultures.

Griseofulvin is used for tinea capitis in children and adults, it is effective against infections caused by both Trichophyton species and Microsporum spp. Terbinafine is an alternative for certain infections such as those caused by Trichophyton species. The role of terbinafine in the management of Microsporum infections is uncertain. (Griseofulvin for at least 6 weeks - Terbinafine for at least 4 weeks). Fluconazole or itraconazole are alternatives in the treatment of tinea capitis. The appropriate length of treatment with either itraconazole or fluconazole is not established.

In severely inflammatory forms, there has been some argument in favour of using systemic steroids to inhibit the inflammatory response. While this view has its supporters, all cases should generally be reviewed early after the institution of antifungal therapy, and only systemic steroids are used in severe cases with widespread ide reactions.

When treatment failure occurs certain points should be checked e.g. diagnosis, interactions, HIV, co-pathogens, antifungal
resistance and reinfection.

In small-spored ectothrix infections (scaly tinea capitis),
griseofulvin for at least 6 weeks is usually adequate.

This page was last updated in February 2014.

Main Works of Reference List (The first eight are my top favourites)

  • British National Formulary
  • British National Formulary for Children
  • Guidelines (BAD - BASHH - BHIVA - Uroweb)
  • Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health
  • Oxford Handbook of Medical Dermatology
  • Rook's Textbook of Dermatology
  • Simple Skin Surgery
  • Weedon's Skin Pathology
  • A Concise Atlas of Dermatopathology (P Mckee)
  • Andrews' Diseases of the Skin
  • Andrology (Nieschlag E FRCP, Behre M and Nieschlag S)
  • Bailey and Love's Short Practice of Surgery
  • Davidson's Essentials of Medicine
  • Davidson's Principles and Practice of Medicine
  • Fitzpatrick's Colour Atlas and Synopsis of Clinical Dermatology (Klaus Wolff FRCP and Richard Allen Johnson)
  • Fitzpatrick’s Dermatology in General Medicine
  • Ganong's Review of Medical Physiology
  • Gray's Anatomy
  • Hamilton Bailey's Demonstrations of Physical Signs in Clinical Surgery
  • Hutchison's Clinical Methods
  • Lever's Histopathology of the Skin
  • Lever's Histopathology of the Skin (Atlas and Synopsis)
  • Macleod's Clinical Examination
  • Martindale: The Complete Drug Reference
  • Oxford Handbook of Clinical Examination and Practical Skills
  • Oxford Textbook of Medicine
  • Practical Dermatopathology (R Rapini)
  • Sexually Transmitted Diseases (Holmes K et al)
  • Statistics in Clinical Practice (D Coggon FRCP)
  • Stockley's Drug Interactions
  • Treatment of Skin Disease: Comprehensive Therapeutic Strategies
  • Yen & Jaffe's Reproductive Endocrinology