314
11.
12.
13.
14.
15.
16. 17.
Pediatric Dermatoiogy Vol. 9 No. 3 September 1992
study of the four main types of ichthyosis after 1 month's treatment with Ro-10-9359. In: Orfanos CE et ai, eds. Retinoids: advances in basic research and therapy. New York: Springer-Verlag, 1981:303-306. Cunliffe WJ. Use of isotretinoin in the ichthyosis. In: Cunliffe WJ, Miller AJ, eds. Retionoid therapy: a review of clinical and laboratory research. Lancaster: MTP Press, 1984:321-325. Van der Schroeff JG, Van Rhee HJ. The treatment of children with etretinate. In: Cunliffe WJ, Miller AJ, eds. Retinoid therapy: a review of clinical and laboratory research. Lancaster: MTP Press, 1984:39-43. Blanchet-Bardon C, Nazzaro V, Rogrim C, Geiger JM, Puissant A. Acitretin in the treatment of severe disorders of keratinization. J Am Acad Dermatol 1991;24:982-986. Atherton DJ, Welis RS. Etretinate in the ichthyosiform erythrodermas. In: Cuniiffe WJ, Miiler AJ, eds. Retinoid therapy: a review of clinical and laboratory research. Lancaster: MTP Press, 1984:63-71. Tamayo L, Ruiz-Maldonado R. Long-term follow-up of 30 children under oral retinoid Ro 10-9359. In: Orfanos CE et al, eds. Retinoids: advances in basic research and therapy. New York: Springer-Verlag, 1981:287-294. Glover MT, Peters AM, Atherton DJ. Surveillance for skeletal toxicity of children treated with etretinate. Br J Dermatol 1987;116:609-614. Ruiz-Maldonado R, Tamayo L. Retinoids in disorders of keratinization: their use in children. Dermatologica 1987;175(suppl 1): 125-132. MALLIKA NAYAR, MBBS (STORE), MRCP GIAM YOKE CHIN, M.MED (PAED), FAAD National Skin Centre Singapore
AN EPIDEMIC OF SUPERFICIAL DERMATOPHYTOSIS CAUSED BY TRICHOPHYTON TONSURANS IN 23 VILLAGE CHILDREN To the Editor: Mycotic infections are common at every age, but in an epidemic form they occur mostly in children. From September to November of 1990, in the district of Przemysl in southeast Poland, 23 cases of superficial dermatophytosis were fotmd in one rural commune. The children (9 girls, 14 boys) were between 3 and 15 years old (mean 9 yrs). Lesions were typical erythematous ringworms, 2 to 5 cm iti diameter, with single, peripheral vesicles and itching (Fig. 1). In 17 children, mycotic foci were single, in 6 double. Lesions occurred on the lower limbs in nine patients, trunk in nine, upper limbs in six, face in four, neck in two, and localized on the border of the face and scalp in one. They lasted for one to eight weeks (mean 3 wks) from initial appearance to
their discovery by our medical team. In addition
Figure 1. A large mycotic tesion of the neck.
to physical examination, a Wood's lamp examination was done for each child, all with negative results. Mycologic inoculations on Sabouraud's medium grew fast-growing, white- to creamy-tinged colonies in all cases. These had a suede-like depression in the center and folded edges. Microscopically, multicellular mycelia with 2 to 10 cellular, fusiform macroconidia and numerous microconidia on the ends of hyphae were seen. In addition, inoculations on Christensen medium and thiamine medium were made. Finally, Trichophyton tonsurans was identified. Each child was treated with 1% clotrimazole cream applied three times daily. In all patients, complete healing was obtained after 10 to 70 days of treatment (mean 24 days). In view of the decreasing numbers of T. tonsurans infections reported in Poland over the years 1952-1988 from 5.6% to 3.6% (1-8), the epidemic among these children from a rural commune of 3000 inhabitatits is of particular interest. The children had contact with each other as siblings, neighbors, and classmates, indicating the probable routes of infection. Most of the mycotic foci were localized on exposed or potentially exposed parts of the body, supporting this theory of the means of spread. Unfortunately, it was not possible to establish where
Correspondence 315 the epidemic had originated. When the first cases came to the attention of the medical service, all school children in the locality were examined immediately, and 16 cases of previously untreated dermatophytosis were found in one day. Apart from this epidemic, about 20 cases of dermatophytosis are seen in this locality every year, but these are caused mainly by zoophilic fungi because of the rural character of the area. Although in the literature T. tonsurans has been reported as causing mycoses of the scalp, only one of our patients had lesions in this area, and then only partially, another lesion being localized to his back. Since all the children were infected by the same strain of dermatophyte, the efficacy of treatment with clotrimazole could be evaluated, and was 100%. The length of treatment required for cure did not depend on the child's sex or course of previous infection, but was shorter in younger children (average 20 days for those
11.
12.
13.
14.
15.
16. 17.
Pediatric Dermatoiogy Vol. 9 No. 3 September 1992
study of the four main types of ichthyosis after 1 month's treatment with Ro-10-9359. In: Orfanos CE et ai, eds. Retinoids: advances in basic research and therapy. New York: Springer-Verlag, 1981:303-306. Cunliffe WJ. Use of isotretinoin in the ichthyosis. In: Cunliffe WJ, Miller AJ, eds. Retionoid therapy: a review of clinical and laboratory research. Lancaster: MTP Press, 1984:321-325. Van der Schroeff JG, Van Rhee HJ. The treatment of children with etretinate. In: Cunliffe WJ, Miller AJ, eds. Retinoid therapy: a review of clinical and laboratory research. Lancaster: MTP Press, 1984:39-43. Blanchet-Bardon C, Nazzaro V, Rogrim C, Geiger JM, Puissant A. Acitretin in the treatment of severe disorders of keratinization. J Am Acad Dermatol 1991;24:982-986. Atherton DJ, Welis RS. Etretinate in the ichthyosiform erythrodermas. In: Cuniiffe WJ, Miiler AJ, eds. Retinoid therapy: a review of clinical and laboratory research. Lancaster: MTP Press, 1984:63-71. Tamayo L, Ruiz-Maldonado R. Long-term follow-up of 30 children under oral retinoid Ro 10-9359. In: Orfanos CE et al, eds. Retinoids: advances in basic research and therapy. New York: Springer-Verlag, 1981:287-294. Glover MT, Peters AM, Atherton DJ. Surveillance for skeletal toxicity of children treated with etretinate. Br J Dermatol 1987;116:609-614. Ruiz-Maldonado R, Tamayo L. Retinoids in disorders of keratinization: their use in children. Dermatologica 1987;175(suppl 1): 125-132. MALLIKA NAYAR, MBBS (STORE), MRCP GIAM YOKE CHIN, M.MED (PAED), FAAD National Skin Centre Singapore
AN EPIDEMIC OF SUPERFICIAL DERMATOPHYTOSIS CAUSED BY TRICHOPHYTON TONSURANS IN 23 VILLAGE CHILDREN To the Editor: Mycotic infections are common at every age, but in an epidemic form they occur mostly in children. From September to November of 1990, in the district of Przemysl in southeast Poland, 23 cases of superficial dermatophytosis were fotmd in one rural commune. The children (9 girls, 14 boys) were between 3 and 15 years old (mean 9 yrs). Lesions were typical erythematous ringworms, 2 to 5 cm iti diameter, with single, peripheral vesicles and itching (Fig. 1). In 17 children, mycotic foci were single, in 6 double. Lesions occurred on the lower limbs in nine patients, trunk in nine, upper limbs in six, face in four, neck in two, and localized on the border of the face and scalp in one. They lasted for one to eight weeks (mean 3 wks) from initial appearance to
their discovery by our medical team. In addition
Figure 1. A large mycotic tesion of the neck.
to physical examination, a Wood's lamp examination was done for each child, all with negative results. Mycologic inoculations on Sabouraud's medium grew fast-growing, white- to creamy-tinged colonies in all cases. These had a suede-like depression in the center and folded edges. Microscopically, multicellular mycelia with 2 to 10 cellular, fusiform macroconidia and numerous microconidia on the ends of hyphae were seen. In addition, inoculations on Christensen medium and thiamine medium were made. Finally, Trichophyton tonsurans was identified. Each child was treated with 1% clotrimazole cream applied three times daily. In all patients, complete healing was obtained after 10 to 70 days of treatment (mean 24 days). In view of the decreasing numbers of T. tonsurans infections reported in Poland over the years 1952-1988 from 5.6% to 3.6% (1-8), the epidemic among these children from a rural commune of 3000 inhabitatits is of particular interest. The children had contact with each other as siblings, neighbors, and classmates, indicating the probable routes of infection. Most of the mycotic foci were localized on exposed or potentially exposed parts of the body, supporting this theory of the means of spread. Unfortunately, it was not possible to establish where
Correspondence 315 the epidemic had originated. When the first cases came to the attention of the medical service, all school children in the locality were examined immediately, and 16 cases of previously untreated dermatophytosis were found in one day. Apart from this epidemic, about 20 cases of dermatophytosis are seen in this locality every year, but these are caused mainly by zoophilic fungi because of the rural character of the area. Although in the literature T. tonsurans has been reported as causing mycoses of the scalp, only one of our patients had lesions in this area, and then only partially, another lesion being localized to his back. Since all the children were infected by the same strain of dermatophyte, the efficacy of treatment with clotrimazole could be evaluated, and was 100%. The length of treatment required for cure did not depend on the child's sex or course of previous infection, but was shorter in younger children (average 20 days for those
![[Extensive inflammatory and childhood dermatophytosis caused by Trichophyton rubrum].](/assets/img/hold.png)
