Clinical and epidemiological profile of tinea capitis in central Tunisia. A 16-year retrospective study (1990-2005)

Background. The aim of the retrospective study reported here was to evaluate the real importance of tinea capitis (TC) among central Tunisian patients attending the Service of Dermatology in Sousse, Tunisia, and at assessing the dermatophytes that cause TC and their dynamics over a period of 16 years. Patients and methods. From 1990 to 2005, 1137 patients, aged between 1 and 75 years (median: 8.63 years) were referred to the laboratory of Parasitology-Mycology of Farhat Hached hospital by the Service of Dermatology in Sousse, for clinical suspicion of TC. All patients underwent a direct examination of hair specimens together with culture on Sabouraud dextrose agar medium. Results. Direct examination and culture confirmed to TC in 1137 patients. Out of 1048 whose age was known, 801 (76.4%) were younger than 10 years old. Sixty were adults with a median age of 34.5 years. The dermatophytes isolated were as follows: Trichophyton violaceum in 565 cases (53.4%), Microsporum canis in 395 cases (37.3%), T mentagrophytes in 37 cases (3.5%), T. schoenleinii in 26 cases (2.5%), T. ochraceum in 24 cases (2,3%), T rubrum in four cases (0,37%), M. gypseum in four cases (0.37%), M. langeronii in two cases (0.17%) and T. tonsurans in one case (0.09%). T violaceum was more frequently reported in females than M. canis. Out of 60 adults, 42 were females. The distribution of the causal species throughout the study period showed a dramatic decrease in favus, and a decreasing trend in T violaceum. In contrast, the incidence of M. canis steadily increased. Nearly all patients were treated with griseofulvin. A total of 1123 patients were cured by 6 to 12 weeks; while 14 showed a persistent alopecia. Conclusion. T. violaceum is still the leading species among central Tunisian patients with TC. The incidence of M. canis has been rising lasting recent decades. T ochraceum is evolving as a main causative agent of inflammatory TC. (C) 2010 Elsevier Masson SAS. All rights reserved.