الفهرس 
Acknowledgment
Treatment of Tinea capitisOnly 14 pages are availabe for public view
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Abstract
Tineacapitis (TC) is a dermatophyte infection of the scalp hair follicles and intervening skin (Elewski, 2000 ; Gupta and Summerbell, 2000). It is the most common cutaneous mycosis in children but is uncommon in adults (Rebollo et al., 2008).
Tineacapitis always requires systemic treatment because topical antifungal agents do not penetrate the hair follicle. Topical treatment is only used as adjuvant therapy to systemic antifungal(Fuller et al., 2003).
The aim of this study was:
• To determine type of dermatophyte species that causetineacapitis in Assuit, Upper Egypt.
• To asses the efficacy (clinical and myocological cure) and safety of oral antifungal drugs (terbinfine, itraconazole, fluconazole) for treatment of tineacapitis in children in Assuit.
Subjects and Methods:
The study was conducted over the period from May 2015 to September 2016 inAssuit University Hospital and El-Qusia Central Hospital.
Inclusion criteria:
Patients with Tineacapitis from different sex and age groups ranges(4-18 years).
Exclusion criteria:
1-Patients with other scalp conditions such as psoriasis, head lice, or seborrheic dermatitis.
2-Patients use any previous treatment for tineacapitis either topical (2weeks) or systemic (one month).
3-Patients with signs and symptoms of hypersensitvity after the start of therapy will be excluded .
4-Patients with any history of chronic or active liver disease.
METHOD:
The whole study was explained to eligible patient and their parents or guardians, they are completely free to let their child be included in the study or not.
All patients were subjected to:
1- History taking: Demographic data (e.g. name, age, sex, weight, residence and family history) and previous therapy were recorded for each patient.
2-Clinical assessment (through clinical examination including type and duration of the disease, site, shape, size and number of the lesions).
3-Mycological study by KOH examination and culture on Sabouraud’s agar media was done at first visit, and after second, fourth, sixth and eight weeks.
4-The patients will be devided into 3 groups:
A- group A patients will receive terbinafine as follows:
10–20 kg: 62.5 mg⁄day
20–40 kg: 125 mg⁄day
>40 kg: 250 mg⁄day
B- group B patients will receive fluconazole as follows:
Weekly dosing: 8 mg⁄kg once weekly
C-group C patients will receive itraconazole as follows:
Daily dosing: 5 mg⁄kg⁄day
5- Patients have received treatment until complete clinical (hair regrowth) and myocological cure (negative culture) up to maximum 8 weeks.
6-Follow up was done for each patient every 2weeks and include clinical, photographic and mycological examination.
Results:
The present study was carried on 91clinically diagnosed tineacapitis child patients. Sixty patients completed the study(20 patients in each group: Terbinafine, Itraconazole and Fluconazole groups),7 patients were excluded from the study as they were negative mycologically while 24 patients did not complete the study. The age of those patients ranged from 4 -13 years with a mean ± SD of 7.65 ± 2.59 years. The number of male patients was 53 (88.3%) while 7 (11.7%) were females. Scaly ringworm was the predominant type of tineacapitis (56/60) among studied patients. T. violaceum was the most common detected organism followed by M.canis.
Improvement in mycological cure started after 4 weeks of treatment, where terbinafine group showed the highest number of improved cases. After eight weeks of treatment, mycological cure rates were 90% for terbinafine, 75% for itraconazole and 70% for fluconazole.
As regards clinical cure at the end of the study, patients treated with Terbinafine showed the most significantly improved clinical cure (90%),whereas in patients treated with Itraconazole and Fluconazole,the clinical cure rates were 60%and 65% respectively. On prolonged treatment more than 8 weeks the clinical cure rates were 95% for terbinafine, 70% for itraconazole and 65% for fluconazole.
Complete cure after 8 weeks of treatment was 90% for terbinafine, 60% for itraconazole and 55% for fluconazole.
With regard to treatment failure at the end of the study13/60 cases (21.67%) were not cured mycologically and there was resistance to treatment (10% of terbinafine group, 25% of itraconazole group and 30% of fluconazole group), while 17 cases (28.3%) were not cured clinically and showed resistance to treatment, (10% of terbinafine group,40% of Itraconazole group and 35% of Fluconazole group).
There was highly statistically significant difference in mycological and clinical cure between first versus last visit of patients in the three studied groups.