Tinea capitis dermatophytes: susceptibility to antifungal drugs tested in vitro and in vivo.
BACKGROUND
Tinea capitis is a worldwide-spread infection of the scalp caused by dermatophytes and is predominantly seen in children. The clinical manifestations range from mild scaling lesions to widespread alopecia or highly inflammatory suppurating lesions. Terbinafine and itraconazole seem to be promising therapies with shorter treatment durations than griseofulvin.


OBJECTIVE
The objective of the present study was to test the sensitivity of different species of dermatophytes towards terbinafine and itraconazole, and to compare the results with a retrospective study on 35 immunocompetent patients with tinea capitis who were treated with terbinafine (Lamisil(R)).


METHODS
Minimal inhibitory concentrations (MIC) were measured with an agar dilution method.


RESULTS
Each tested species of dermatophyte was sensitive to terbinafine and itraconazole at different concentration ranges. The MIC for terbinafine ranged from 0.005 to 0.5 microg/ml and for itraconazole from 40 to 80 microg/ml. Microsporum canis was the dermatophyte least sensitive to terbinafine. Our retrospective study showed that the cure rate was excellent for Trichophyton violaceum and T. soudanense, variable for T. mentagrophytes and poor for M. canis and M. langeronii.


CONCLUSIONS
(i) Regarding the results of susceptibility tests obtained with species involved in tinea capitis, clinical efficacy is not related to MIC measured in vitro; (ii) identification of the isolated dermatophyte from tinea capitis seems to be important for choosing the appropriate treatment.
Mock
M
M
Mycology Laboratory, Département Hospitalier Universitaire Romand de Dermatologie et Vénéréologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Monod
M
M
Baudraz-Rosselet
F
F
Panizzon
R G
RG
D000935:Antifungal Agents / Q000627:therapeutic use; D003883:Arthrodermataceae / Q000187:drug effects* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D003881:Dermatomycoses / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008864:Microsporum / Q000187:drug effects / Q000302:isolation & purification; D009281:Naphthalenes / Q000627:therapeutic use; D012189:Retrospective Studies; D013557:Switzerland / Q000453:epidemiology; D000077291:Terbinafine; D014006:Tinea Capitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D014249:Trichophyton / Q000187:drug effects / Q000302:isolation & purification
D000935:Antifungal Agents; D009281:Naphthalenes; D017964:Itraconazole; D000077291:Terbinafine