Discussion
The amount of fungistatic saturated fatty acids in sebum increases at
puberty and therefore dermatophyte colonization of the scalp disappears
in this age9. This is thought to explain the rarity of
tinea capitis in adults. Although the disease was once thought to be
rare in adulthood, studies have been increasingly reporting tinea
capitis among adults especially in immunocompromised patients,
menopausal and elderly women2 34. Our patient was a 75-year-old menopause female, but
not immunocompromised. In most of the reported cases, including our
case, the diagnosis was delayed. This delay is probably due to both the
rarity of this infection in adults and its atypical clinical
presentation. The disease may resemble bacterial folliculitis,
folliculitis decalvans, dissecting cellulitis, pityriasis amiantace and
its related etiologies, and scaring alopecia like lupus
erythematosus10. In many studies the correct diagnoses
were established by tissue culture23. Although, for some authors, griseofulvin remains
the treatment of choice for tinea capitis in children and adults, both
terbinafine and itraconazole are considered acceptable
alternatives2 3 4.
Due to the numerous reports describing treatment-resistant
dermatophytosis, which has emerged as a global public health
threat,11 12 1314 we started the treatment with high dose
itraconazole as 400 mg daily. Also, we prescribed prednisone 15mg daily
at the first month because of the severe inflammation. Our patient
responded well to this treatment and there was complete clearance of the
lesions with acceptable hair regrowth.
We reviewed tinea capitis case reports in adults indexed in PubMed
between 2018 and 2023. To be included in the review, articles had to be
available in the English language. Inclusion criteria included patient
age ≥18 years, diagnosis of tinea capitis, no history of
immunosuppression or receiving any immunosuppressant drugs, no history
of other medical conditions or history of other dermatophytosis
infection in other parts of the skin, no history of gardening,
pet-keeping, contact with domestic animals or other individuals with the
same manifestations or dermatophytosis infection and no history of
contact with objects containing fomites, including brushes, combs,
bedding, clothing, toys, furniture, and telephones (Table 1).
We found a total of 11 cases. Of these cases, the prevalence was higher
in women (8/11) and the average age was 48.36. Three cases did not have
a mycological culture and didn’t mention the dermatophyte isolated.
Trichophyton tonsurans was the most common dermatophyte, followed by
Trichophyton violaceum. Most cases were treated with oral terbinafine
250 mg daily. One patient was treated with oral griseofulvin 500 mg
every 12 hours and another one with oral itraconazole 200 mg twice
daily. Most patients received combination therapy consisting of oral and
topical antifungal agents. All patients reported were cured successfully
without any side effects. Two cases had disseminated lesions on the
face15, extremities and nails1516 years after the scalp manifestations. One case
caused by Trichophyton tonsurans suffered subsequent herpes zoster
infection, which shows that tinea capitis may be a risk factor for
varicella zoster virus reactivation17.