Tinea Capitis in an Immigrant Pediatric Community; A Clinical Signs-Based Treatment Approach

Tinea capitis is a common cutaneous infection of the scalp and hair follicles, typically diagnosed by direct examination and culture. Treatment with oral antifungals is usually withheld until mycology results are available. In Israel, African refugee children demonstrate higher susceptibility to Tinea capitis and generally fail to undergo follow-up evaluations. This study aimed to identify the clinical characteristics and treatment response of refugee children in Israel with Tinea capitis, in order to formulate a treatment plan, for primary care physicians. To this end, demographic, clinical and laboratory data were extracted from the electronic medical records of 76 refugee children presenting with Tinea capitis during 2016-2017. Scaling was the most common clinical finding. Cultures were positive in 64 (84%) and direct examination in 65 (85%) cases, with a positive correlation between the tests in 75% of cases. The most common fungal strain was T. violaceum. Fluconazole treatment failed in 27% of cases. Griseofulvin 50 mg/kg/day was administered to 74 (97%) of the children, and induced clinical responses. No side effects were reported. In African refugee children with suspected Tinea capitis, a culture, direct examination and empiric treatment with griseofulvin 50 mg/kg/day are recommended to prevent outbreak of an epidemic.