Two Cases of Tinea in the Neonate Treated
Successfully with Griseofulvin William
DERMATOPHYTE
INFECTIONS in the rare. We have observed
newborn are quite 2 neonates with dermatophytosis beginning at age 7 days and 20 days respectively, who were successfully treated with griseofulvin. Case
Reports
Case 1. A black male infant was brought to the clinic at age 32 days with a scaling, annular, erythematous lesion of the frontal scalp, progressively enlarging since age 7 days. Broken hairs were present in the lesion and Wood’s lamp examination revealed no fluorescence. Growth and development of this child were within normal limits and previous treatment with antiseborrheic measures in the general clinic had failed. Potassium hydroxide (KOH) examination of the skin scrapings and hair revealed numerous hyphae. Culture of the hair grew A1icrosporum audouini. The infant was treated with ultrafine griseofulvin orally, 10 mg/kg per day, and tolnaftate solution applied topically twice daily. Follow-up examination 7 days later revealed almost complete clearing of the lesion and a KOH examination was negative. At 14 days the lesions were completely gone. Despite extensive investigation of the infant’s environment, no source of fungus was found.
From the Department of Dermatology, University of Medical Center, Denver, Co. Supported by NIH Dermatology Training Grant #5 T01 AM05527-06. Requests for reprints may be sent to E. George Thorne, M.D., Department of Dermatology, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, CO 80220.
Colorado
L.
Weston, M.D., E. George Thorne, M.D.
Case 2. A black male infant presented to our clinic at age 29 days with a scaling, annular, erythematous lesion on the left cheek and a similar lesion on the left parietal scalp. These lesions had been present since age 20 days. In the scalp lesion, broken hairs were present and Wood’s light examination revealed yellc~w-~reen fluorescence of the hair. KOH examination of the skin scrapings of the cheek and hair revealed numerous hyphae. Culture of the skin scrapings grew Microsporitin car~is. The patient was given ultrafine griseofuivin orally, 10 mg/kg per day. Follow-~~~ examination at 7 days revealed complete clearing of the lesion, which remained clear at 14 days.
dermatology
Discussion
Dermatophyte infections in newborns has reported on several occasions.k8 The youngest reported cases we have. found were those due to Microsporlim canÎ5.. in a 30day-old infant,2 and in a 21-day-old infant The earliest instance of 1l~~icra:s~a~r~urn audorcini
been
infection was in a 4-week-old infant.6 An instance due to Trichopliyton verrucosum has been reported in a 2-month-old infant. The infection by Microsporum c~udQUirai in a 7day-old infant recorded here appears to be the earliest report of dermatophyte infection in
infancy. ~Iinically, the dermatophyte the scalp of these two infants
infections of were similar to what is seen in older children. However, the age of the infants ruled out serious con-
601
Downloaded from cpj.sagepub.com at Monash University on June 15, 2015
dermatophyte infections by our pediatric colleagues. Experience with griseofulvin in infants, and neonates in particular, is quite limited. We were able to find two reported instances of successful treatment of infants with griseofulvin for infections of the scalp. 5-8 One for Microsporum cants, I0 mg/kg per day for 28 days, beginning at age 4 weeks, and another beginning at age 2 months for Trichophylon verrucosum. Both infants tolerated the griseofulvin without systemic effects and cleared themselves of the dermatophyte
though such therapy for the presshould be reserved for involvement of the scalp hair.
newborn,
sideration of
infection. There are scattered reports of the use of griseofulvin in infants aged 1 to 12 months, but information is scant. None of the infants on record had any side effects. We did not observe irritability, gastrointestinal upsets, morbilliform or urticarial skin eruptions, or leukopenia in either of our two infants. We believe the use of griseofulvin in carefully documented dermatophyte infections is safe, even in the
ent
References
1. Bereston, E. S., and Robinson, H. M.: Tinea capitis and corporis in an infant four weeks old. 2. 3. ‘
4. 5. 6.
7.
Arch. Dermatol. 68: 582, 1953. Huebner, L. F.: Tinea capitis in a 30-day-old infant. Arch. Dermatol. 76: 242, 1957. King, W. C., Walton, 1. K., and Livingood, C. S.: Superficial fungus infections in infants. Arch. Dermatol. 68: 664, 1953. Sharvill, D.: Ringworm: Infections in an adult scalp, a newborn infant and three nurses. Br. J. Med. 1: 415, 1955. Ross, C. M.: Ringworm of the scalp at four weeks. Br. J. Dermatol. 78: 524, 1966. Yesudian, P., and Kamalan, A.: E. floccosum infection in a three week old infant. Trans. St. Johns Hosp. Dermatol. Soc. 59: 66, 1973. Kelly, A. J. M., and MacKenzie, O. W. R.: Trichophyton verrucosum in a two months old infant. Trans. St. Johns Hosp. Dermatol. Soc. 52:
88, 1966.
8.
A.: Treatment of tinea capitis in children with griseofuivin. Am. J. Dis. Child. 100: 131, 1960.
Bensel,
602
Downloaded from cpj.sagepub.com at Monash University on June 15, 2015
Successfully with Griseofulvin William
DERMATOPHYTE
INFECTIONS in the rare. We have observed
newborn are quite 2 neonates with dermatophytosis beginning at age 7 days and 20 days respectively, who were successfully treated with griseofulvin. Case
Reports
Case 1. A black male infant was brought to the clinic at age 32 days with a scaling, annular, erythematous lesion of the frontal scalp, progressively enlarging since age 7 days. Broken hairs were present in the lesion and Wood’s lamp examination revealed no fluorescence. Growth and development of this child were within normal limits and previous treatment with antiseborrheic measures in the general clinic had failed. Potassium hydroxide (KOH) examination of the skin scrapings and hair revealed numerous hyphae. Culture of the hair grew A1icrosporum audouini. The infant was treated with ultrafine griseofulvin orally, 10 mg/kg per day, and tolnaftate solution applied topically twice daily. Follow-up examination 7 days later revealed almost complete clearing of the lesion and a KOH examination was negative. At 14 days the lesions were completely gone. Despite extensive investigation of the infant’s environment, no source of fungus was found.
From the Department of Dermatology, University of Medical Center, Denver, Co. Supported by NIH Dermatology Training Grant #5 T01 AM05527-06. Requests for reprints may be sent to E. George Thorne, M.D., Department of Dermatology, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, CO 80220.
Colorado
L.
Weston, M.D., E. George Thorne, M.D.
Case 2. A black male infant presented to our clinic at age 29 days with a scaling, annular, erythematous lesion on the left cheek and a similar lesion on the left parietal scalp. These lesions had been present since age 20 days. In the scalp lesion, broken hairs were present and Wood’s light examination revealed yellc~w-~reen fluorescence of the hair. KOH examination of the skin scrapings of the cheek and hair revealed numerous hyphae. Culture of the skin scrapings grew Microsporitin car~is. The patient was given ultrafine griseofuivin orally, 10 mg/kg per day. Follow-~~~ examination at 7 days revealed complete clearing of the lesion, which remained clear at 14 days.
dermatology
Discussion
Dermatophyte infections in newborns has reported on several occasions.k8 The youngest reported cases we have. found were those due to Microsporlim canÎ5.. in a 30day-old infant,2 and in a 21-day-old infant The earliest instance of 1l~~icra:s~a~r~urn audorcini
been
infection was in a 4-week-old infant.6 An instance due to Trichopliyton verrucosum has been reported in a 2-month-old infant. The infection by Microsporum c~udQUirai in a 7day-old infant recorded here appears to be the earliest report of dermatophyte infection in
infancy. ~Iinically, the dermatophyte the scalp of these two infants
infections of were similar to what is seen in older children. However, the age of the infants ruled out serious con-
601
Downloaded from cpj.sagepub.com at Monash University on June 15, 2015
dermatophyte infections by our pediatric colleagues. Experience with griseofulvin in infants, and neonates in particular, is quite limited. We were able to find two reported instances of successful treatment of infants with griseofulvin for infections of the scalp. 5-8 One for Microsporum cants, I0 mg/kg per day for 28 days, beginning at age 4 weeks, and another beginning at age 2 months for Trichophylon verrucosum. Both infants tolerated the griseofulvin without systemic effects and cleared themselves of the dermatophyte
though such therapy for the presshould be reserved for involvement of the scalp hair.
newborn,
sideration of
infection. There are scattered reports of the use of griseofulvin in infants aged 1 to 12 months, but information is scant. None of the infants on record had any side effects. We did not observe irritability, gastrointestinal upsets, morbilliform or urticarial skin eruptions, or leukopenia in either of our two infants. We believe the use of griseofulvin in carefully documented dermatophyte infections is safe, even in the
ent
References
1. Bereston, E. S., and Robinson, H. M.: Tinea capitis and corporis in an infant four weeks old. 2. 3. ‘
4. 5. 6.
7.
Arch. Dermatol. 68: 582, 1953. Huebner, L. F.: Tinea capitis in a 30-day-old infant. Arch. Dermatol. 76: 242, 1957. King, W. C., Walton, 1. K., and Livingood, C. S.: Superficial fungus infections in infants. Arch. Dermatol. 68: 664, 1953. Sharvill, D.: Ringworm: Infections in an adult scalp, a newborn infant and three nurses. Br. J. Med. 1: 415, 1955. Ross, C. M.: Ringworm of the scalp at four weeks. Br. J. Dermatol. 78: 524, 1966. Yesudian, P., and Kamalan, A.: E. floccosum infection in a three week old infant. Trans. St. Johns Hosp. Dermatol. Soc. 59: 66, 1973. Kelly, A. J. M., and MacKenzie, O. W. R.: Trichophyton verrucosum in a two months old infant. Trans. St. Johns Hosp. Dermatol. Soc. 52:
88, 1966.
8.
A.: Treatment of tinea capitis in children with griseofuivin. Am. J. Dis. Child. 100: 131, 1960.
Bensel,
602
Downloaded from cpj.sagepub.com at Monash University on June 15, 2015
