| Background:Tinea capitis is a disease caused by dermatophytes infecting the scalp and hair.It can be divided into different types according to the types of pathogenic bacteria and host reaction,whether there is inflammation in clinical manifestations,the way pathogens invade hair and the different pathogenic bacteria.The current incidence of tinea capitis is on the rise,with a prevalence rate of more than 40%in some areas.The types of pathogens causing tinea capitis vary from region to region.In turn,the types of pathogens may vary over time,especially as new organisms migrate or migrate.At present,griseofulvin is still used as the first-line treatment of tinea capitis at home and abroad.It has good activity against dermatophytes and has long-term safety.However,what are the factors that affect the efficacy of griseofulvin in the treatment of tinea capitis?at present,there are few related studies at home and abroad.Objectives:The effects of age,sex,clinical types and bacteria on the efficacy of griseofulvin were analyzed.At the same time,to explore the adverse reactions after oral administration of griseofulvin;to clarify the demographic characteristics of patients with tinea capitis in Wuhan and its surrounding areas;to understand the differences of tinea capitis pathogens in this area;and to speculate the main sources of infection of patients with tinea capitis in this area.Methods:Selected patients with tinea capitis diagnosed from January 2019 to August 2020,regardless of age and sex,long-term residence in Wuhan and surrounding cities;and fungal microscopic examination and mycological culture positive or both positive;patients who have not been given oral antifungal drugs within one month and have not taken oral antifungal drugs within half a year;those who are voluntarily treated with oral griseofulvin and can be followed up on time.The collected patients were investigated by questionnaire（including name,sex,age,place of long-term residence,basic diseases,history of animal contact,other superficial mycosis with patients,superficial mycosis with close contacts,etc.）.The results of fungal microscopic examination,fungal culture,blood routine,liver function and renal function were recorded.According to the Chinese guidelines for diagnosis and treatment of tinea capitis（2018 revised edition）,the oral dose of griseofulvin is 15～25mg·kg-1·d-1in children and 1g/d in adults.Oral griseofulvin is given twice,and the first visit is made after 3 weeks of continuous treatment.Combined with clinical manifestations and fungal microscopic examination results,if the clinical manifestations disappear completely and fungal microscopic examination is negative,oral griseofulvin treatment will be stopped.The results of fungal microscopic examination,blood routine examination,liver function,renal function test and adverse reactions were recorded.If the patients were revisited every 2 weeks,and the fungal microscopic examination was negative for 3consecutive times,they were considered to be cured.If the clinical manifestation of the revisit does not disappear completely or the fungal microscopic examination is positive,continue the treatment for 1 week and then revisit again,also combined with the clinical manifestation and the fungal microscopic examination results,if the clinical manifestation disappears completely and the fungal microscopic examination is negative,then stop oral griseofulvin treatment.If the clinical manifestation has not completely disappeared or the fungal microscopic examination is positive after the revisit,revisit the patient again after one week of treatment until the end of the 18th week of treatment.If it is not cured after 18 weeks,consider replacing other systemic antifungal drugs.All patients were treated with topical antifungal drugs such as bifonazole,ketoconazole and Sertaconazole at the same time.Results:In this study,a total of 69 patients with tinea capitis were collected,including 19 male patients and 50 female patients.According to the age group（according to the Chinese age standard of 2021）,there were 43 cases（62.32%）of tinea capitis in childhood（0～6 years old）and 21 cases（30.43%）in juvenile period（7～17 years old）,There were 1 case（1.45%）of tinea capitis in adolescent age（18～40 years old）,4 cases（5.80%）in middle age（41～65 years old）,and no tinea capitis patients were collected in senile period（>65 years old）.According to the statistics of the clinical types of tinea capitis,there were 17 cases of tinea alba（24.64%）,39 cases of black-dot tinea（56.52%）and 13 cases of kerion（18.84%）.No patients with favus type were found.According to the different pathogens,there were 25 cases（36.23%）of tinea capitis of Microsporum canis,39 cases（56.52%）of tinea capitis of Trichophyton purpurea,3 cases（4.35%）of tinea capitis of Trichophyton tonsurans,and 2 cases（2.90%）of negative mycological culture.Of all patients with tinea capitis,3（4.35%）had other superficial mycosis,18（26.09%）had superficial mycosis among their close contacts,and 10（14.49%）had a history of close contact with animals,including puppies,kittens,rabbits and hamsters.Among the 69 patients treated with griseofulvin,64 patients actually completed the follow-up observation,and the other 5 patients stopped taking the drug on their own during the treatment.62 patients（96.88%）were cured during the 18-week observation period（including 18 weeks）.Among them,14 patients were cured in 3weeks（21.88%）,38 patients were cured in 4 weeks（59.38%）,2 patients were cured in 6 weeks（3.13%）,1 patient was cured in 7 weeks（1.56%）,1 patient was cured in 8weeks（1.56%）,5 patients were cured at 12 weeks（7.81%）and 1 patient was cured at13 weeks（1.56%）.Another 2 cases（3.13%）were not cured at the end of 18-week observation period,including 1 case of kerion from Microsporum canis and 1 case of black-dot tinea from Trichophyton tonsurans.The treatment was changed to oral itraconazole and has been cured.Among all the patients,2 cases（2.90%）had digestive tract adverse reactions,mainly loss of appetite,5 cases（7.25%）had mild abnormal blood routine,and 5cases（7.25%）had mild abnormality of liver function（4 cases showed mild abnormality of liver enzyme and 1 case showed mild abnormality of alkaline phosphatase）,but it did not affect the continuation of treatment.The curative effect of griseofulvin was reflected by cure weeks.62 patients cured by griseofulvin were analyzed by multiple regression analysis with SPSS23.0.The results showed that there was no significant difference in the efficacy of griseofulvin in the treatment of tinea capitis among different ages,genders,clinical types and infectious bacteria,P>0.05.The average cure weeks of griseofulvin were used to reflect the curative effect of griseofulvin.The average cure weeks of 62 patients cured by griseofulvin were calculated and compared with SPSS23.0.The results showed that the average cure weeks of all patients were（4.74±2.61）weeks,and there was no significant difference in the efficacy of griseofulvin in the treatment of tinea capitis among different ages,genders,clinical types and infectious bacteria,P>0.05.Conclusions:Griseofulvin is effective in the treatment of tinea capitis,but there is no significant difference in age,sex,clinical type,strain and other factors on the efficacy of griseofulvin in the treatment of tinea capitis.The course of treatment of tinea capitis with griseofulvin is（4.74±2.61）weeks,and it is safe for tinea capitis.In Wuhan and its surrounding areas,there are fewer male than female patients with tinea capitis,and the ratio of male to female is close to 1:2.6;and tinea capitis patients mainly occur in childhood（0～6 years old）;the dominant pathogen of tinea capitis in this area is Trichophyton purpurea,the second is Microsporum canis,and the source of infection may be related to superficial mycosis and close animal contact. |
PDF Full Text Request