Dermatológia pre prax 3/2020

Analysis of diagnosis and treatment of tinea in children - Tinea incognita (atypica)

Purpose: Dermatophytosis (tinea) has typical clinical manifestations. Due to the characteristics of the causative agent, the peculiarities of the affected person and unprofessional interventions in the treatment, we often observe atypical images called tinea incognita (atypica). The aim of the work is to point out the state of diagnosis and treatment of tinea in children, the importance of determining the etiological diagnosis, which will determine antifungal treatment. This avoids antimicrobial and anti-inflammatory hormonal treatments, which are ineffective and most significantly alter the typical clinical picture. Methods and patients: We used the method of analysis of data from medical records of hospitalized children in the years 2015 - 2019 for tinea. There were 89 children, 33 boys and 56 girls in the group. Most often, children were hospitalized for the diagnosis of tinea corporis alone and in combination with other localities. Scalp involvement was also common. Results: We found typical clinical manifestations in 40.45 percent. Of the atypical manifestations, we most often found more intense inflammatory changes (23.6%). We found changes in terms of numerous papules and pustules in 14.61%, flat less infiltrated deposits in 11.24%, we recorded rapid spread in 10.24% affected. We found the occurence of atopy in the affected and their families in the same way in 52.81 percent. We once found out that both parents were affected. We detected the occurrence of psoriasis 5 times. We noticed tinea of parents only 3 times and siblings 9 times. We found that 36 children were hospitalized within 3 weeks and up to 66 children within 5 weeks, which is up to 74.16 percent of the whole group. Only 23 (25.84%) patients were not treated before hospitalization. As many as 74.16% of children were treated by a pediatrician, dermatovenerologist, or both. Drugs with antifungal effects in 55.06%, with antimicrobial effects in 39.33%, corticoids and their combinations in 46.07%, and various drugs with non-hormonal anti-inflammatory and disinfectant effects in 44.94% were used for treatment. Systemic antibiotics were prescribed 16 times, antifungals 13 times, antihistamines 13 times and Isoprinosin 1 time. A total of 208 types of drugs were recorded. Microscopic mycological examination was performed on each hospitalized patient. It failed only 2 times. Culture examination was performed in 76 patients. 13 times the cultivation was done by a district dermatovenerologist. The most frequently isolated species was Trichophyton mentagrophytes (granulosum) followed by Microsporum canis. Contact with a cat was most often mentioned, followed by a guinea pig and a dog. Conclusion: In the diagnosis of tinea, a history, detailed clinical examination is important. Mycological examination is of particular importance to confirm the diagnosis and the corresponding treatment. Children with atopy are probably more prone to getting tinea. The causes of failure of outpatient antifungal therapy require a broader study.

Keywords: tinea in children, tinea atypica, atopy, polypragmasia, mycological examination