Tinea capitis is a common fungal infection caused by dermatophytes in children, but it is rare in infants. Although oral itraconazole has been widely used to treat tinea capitis, its use in infants is limited due to its low prevalence in this age group. A previous study reported the effectiveness of itraconazole continuous therapy in treating infantile tinea capitis caused by Microsporum canis. However, this approach has not been extended to tinea capitis caused by other fungi. In this study, we present four cases of infantile tinea capitis treated with continuous itraconazole oral solution therapy (5 mg/kg/day). Two patients were infected with M. canis, one patient with Nannizzia gypsea, and another with Trichophyton tonsurans. This study assesses the efficacy and safety of itraconazole oral solution continuous therapy, expanding our understanding by demonstrating its effectiveness for infantile tinea capitis caused by T. tonsurans and N. gypsea.

Infectious keratitis is a significant ocular disease that, if left untreated, can lead to blindness. Fungi are among the causative agents that can result in severe symptoms. Keratitis infections are prevalent globally, with a higher incidence reported in tropical and subtropical regions. The current research focused on the molecular diagnosis of fungal keratitis and its prevalence over a 3-year period in northeastern Iran. The study involved the collection of 38 corneal scraping specimens from the Eye Specialized Hospital of Khatam in Mashhad, northeastern Iran. These specimens were cultured on Sabouraud dextrose agar, and the isolates were identified using DNA-based techniques. Among the patients studied (n = 38), 22 (58%) cases were caused by Aspergillus species (A. flavus, n = 17, A. fumigatus, n = 3; A. terreus, n = 1; A. tubingensis, n = 1), seven (18%) by Neocosmospora species (N. falciformis, n = 4; N. solani, n = 3), three (7%) by Candida albicans, two (5%) by Fusarium annulatum, and one case each (2%) by Penicillium chrysogenum, Cladosporium cladosporioides, and Cytospora sp. In addition, one case had a combined infection of A. flavus and P. glabrum. The results indicate a higher incidence of fungal keratitis in males, particularly in the age range of 40-60 years. Aspergillus sp., and specifically A. flavus, had the highest prevalence. Cladosporium cladosporioides is reported for the first time in this area as causal agent of keratitis. Additionally, this is the first report of keratitis likely caused by Cytospora species.

A 50-year-old man, previously diagnosed with pulmonary tuberculosis and lung cavities, presented with symptoms including fever, shortness of breath, and cough. A pulmonary CT scan revealed multiple cavities, consolidation and tree-in-bud in the upper lungs. Further investigation through direct examination of bronchoalveolar lavage fluid showed septate hyphae with dichotomous acute branching. Subsequent isolation and morphological analysis identified the fungus as belonging to Aspergillus section Nigri. The patient was diagnosed with probable invasive pulmonary aspergillosis and successfully treated with a three-month oral voriconazole therapy. Phylogenetic analysis based on partial β-tubulin, calmodulin and RNA polymerase second largest subunit sequences revealed that the isolate represents a putative new species related to Aspergillus brasiliensis, and is named Aspergillus hubkae here. Antifungal susceptibility testing demonstrated that the isolate is resistant to itraconazole but susceptible to voriconazole. This phenotypic and genetic characterization of A. hubkae, along with the associated case report, will serve as a valuable resource for future diagnoses of infections caused by this species. It will also contribute to more precise and effective patient management strategies in similar clinical scenarios.

Abstract Background Mucormycosis is a severe and fatal fungal infection in patients with coronavirus disease 2019 caused by Mucorales. Here we present a case of a 63-year-old man with coronavirus disease 2019 infection, along with rhinosinusitis mucormycosis caused by Rhizopus delemar. Case presentation A 63-year-old Iranian man suffering from a coronavirus disease 2019 infection with symptoms of cough, shortness of breath, and generalized body pain. On the basis of the clinical manifestations, such as headache, a history of black nasal discharge, nasal hypoesthesia, facial swelling, numbness, nasal obstruction, presence of necrotic lesions on the nasal passages on physical examination, and abnormal computed tomography scans of paranasal sinuses, the patient underwent surgical debridement. Direct microscopy of specimens obtained from the paranasal sinuses, and subsequent isolation and identification, revealed a rhinosinusitis mucormycosis caused by R. delemar. Despite therapeutic measures, such as sinus debridement surgery and antifungal therapy with amphotericin B injection (50 mg/day), the patient died after 35 days of hospitalization. Conclusion In this report, we present the first documented case of human infection with R. delemar in a patient with coronavirus disease 2019 infection, who also exhibited rhinosinusitis mucormycosis. R. delemar appears to be an emerging agent of rhinosinusitis mucormycosis in this region. Furthermore, prompt diagnosis and the exploration of alternative antifungal treatments, beyond amphotericin B, may be crucial for effectively managing patients with R. delemar infections.

Background:Hair loss is common in hypothyroidism patients. However, the link with alopecia areata (AA) and androgenetic alopecia (AGA) is unclear. Previous observational studies have presented completely opposite results. This study aims to causally link hypothyroidism with AA and AGA. Methods:A two-sample Mendelian Randomization (MR) study, utilizing data from FinnGen Consortium, investigated the causal link between hypothyroidism and AA and AGA. We employed Inverse Variance Weighted (IVW), MR-Egger, Weighted Median, Simple Mode, and Weighted Mode to assess the risk association. Results:The discovery samples included 13,429 hypothyroidism cases (94,436 controls), 767 alopecia areata cases (394,105 controls), and 220 androgenetic alopecia cases (219,249 controls). MR analysis showed a causal link between hypothyroidism and AA, with significant results from IVW (OR, 1.34; CI, 1.16-1.56; P = 0.0001), MR-Egger (OR, 1.56; CI, 1.09-2.23; P = 0.0240), and weighted median (OR, 1.34; CI, 1.06-1.69; P = 0.0140). However, no clear causal relationship was found between genetically predicted hypothyroidism and AGA risk (p > 0.05). Conclusion:The results show hypothyroidism causally associated with AA onset, but not AGA. These findings address contentious issues in observational studies. Comprehensive thyroid function assessments are crucial for AA patients, emphasizing thorough clinical examinations' importance.

Pityriasis versicolor, a common skin fungal infection, is typically observed on trunk and limb skin. Here, we highlight an unusual presentation: scalp involvement, often overlooked due to its asymptomatic, mildly scaly patches. We report four pediatric cases, emphasizing the potential underestimation of this scalp variant. This case series underscores the importance of considering this diagnosis in patients with unexplained scalp hypopigmentation, especially in males with short hair who may readily notice these subtle changes. The report contributes to the understanding of this variant's clinical presentation and emphasizes the need for awareness among clinicians to ensure accurate diagnosis and appropriate management.

Tinea capitis is a superficial fungal infection of the scalp and hair caused by Dermatophytes. It represents the most prevalent superficial fungal infection among preadolescent children worldwide, including in developing countries such as China. The highly contagious nature of tinea capitis can result in outbreaks within communal settings for children. Furthermore, pustular lesions associated with this condition can lead to permanent scarring and hair loss, imposing a significant psychological burden on affected children and their parents. This article aims to provide a comprehensive literature review encompassing the susceptible person, epidemiological characteristics, trends, etiology, modes of transmission, clinical manifestations, treatment, and prevention strategies of tinea capitis. The ultimate objective is to raise awareness, implement effective prevention and control measures, interrupt the transmission cycle, and ultimately reduce the incidence of tinea capitis in the pediatric population.

目的 比较口服特比萘芬与伊曲康唑治疗儿童头癣的疗效.方法 2021年1-12月北京儿童医院皮肤科门诊头癣患儿53例,采用随机数字表法分为特比萘芬治疗组(体重＜20 kg,剂量62.5 mg/d;体重20～40 kg,剂量125 mg/d;体重＞40 kg,剂量250 mg/d)和伊曲康唑治疗组(3～5 mg·kg-1·d-1).使用SPSS23.0软件进行统计分析,组间计数资料比较采用x2检验或Fisher确切概率法.结果 特比萘芬治疗组27例(白癣17例、脓癣10例),治愈14例(51.85％),其中白癣5例,脓癣9例.伊曲康唑治疗组26例(白癣17例、脓癣9例),治愈25例(96.15％),其中白癣16例,脓癣9例.伊曲康唑组的疗效显著高于特比萘芬组,x2=13.37,P＜0.001.结论 伊曲康唑治疗儿童白癣的效果优于特比萘芬,但两药治疗儿童脓癣的疗效相当.

A 3-year-old girl presented to our outpatient clinic with a bee sting on her neck. One hour earlier, a honeybee had landed on her neck, and she had swatted it, resulting in a painful sting. The patient did not exhibit any symptoms of fever, cough, cold, nausea, vomiting, breathlessness, chest pain, palpita-tions, blackouts, or loss of consciousness, but she did report pain in the area where she was stung. On examination, we observed a foreign body on the right side of the patient ’ s neck (Figure 1A). Dermoscopy revealed that the foreign body was the residue of the honeybee ’ s body (Figure 1B). We removed the stinger by scraping it with a credit card (Figure 1C), and no residual stinger was observed on dermoscopy (Figure 1D). After treatment with 0.1% mometasone furoate cream, the lesion completely resolved within 1day.

Journal Article Facial Skin Lesions in a Boy With Wiskott-Aldrich Syndrome Get access Ya Bin Zhou, Ya Bin Zhou Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Shan Wang, Shan Wang Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Lin Ma, Lin Ma Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Li Wei Li Wei Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China Correspondence: Li Wei, Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nan Lishi Rd, Xicheng District, Beijing, China (bellewli@qq.com). Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 77, Issue 4, 15 August 2023, Pages 659–661, https://doi.org/10.1093/cid/ciac955 Published: 19 April 2023

BACKGROUND:Tinea capitis is an infection of the scalp and hair shaft caused by dermatophytes that predominantly occurs in children. Skin fungal infections have been found to be associated with alterations in the overall bacterial and fungal communities. However, the scalp microbiome in tinea capitis have not been fully investigated.OBJECTIVES:To investigate and compare the scalp bacterial and fungal microbiomes between children with tinea capitis and healthy children and between children and adults.METHODS:Skin samples were collected from the scalp. Bacterial and fungal community compositions were analysed by amplification sequencing of the V3-V4 of 16S rDNA and ITS1-5F, respectively.RESULTS:The predominant fungi detected using amplicon sequencing were consistent with the culture- or real-time PCR-positive pathogens in most samples. Children with tinea capitis had lower fungal and higher bacterial Shannon diversity than healthy children. A higher relative abundance of pathogenic fungi and significant alterations in the bacterial community in the lesional sites of tinea capitis than healthy scalps. Compared with adults, healthy children were characterised by higher Shannon diversities with significantly lower relative abundances of Malassezia and Cutibacterium and higher relative abundances of Candida and Streptococcus.CONCLUSIONS:We demonstrated that tinea capitis was characterised by significant alterations in both fungal and bacterial communities and amplicon sequencing could be a complementary method for pathogen identification.

Journal of the European Academy of Dermatology and VenereologyVolume 36, Issue 9 p. e727-e729 Letter to the Editor Cutaneous pilus migrans on the back of a 6-year-old boy Bei Li, Bei Li Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, ChinaSearch for more papers by this authorLin Ma, Lin Ma Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, ChinaSearch for more papers by this authorYa Bin Zhou, Corresponding Author Ya Bin Zhou [email protected] orcid.org/0000-0001-5775-3861 Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, ChinaCorrespondence: Y. B. Zhou. E-mail: [email protected]Search for more papers by this author Bei Li, Bei Li Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, ChinaSearch for more papers by this authorLin Ma, Lin Ma Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, ChinaSearch for more papers by this authorYa Bin Zhou, Corresponding Author Ya Bin Zhou [email protected] orcid.org/0000-0001-5775-3861 Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, ChinaCorrespondence: Y. B. Zhou. E-mail: [email protected]Search for more papers by this author First published: 23 May 2022 https://doi.org/10.1111/jdv.18250Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Xie H, Zhang RZ, Zhu WY. A new site of cutaneous pili migrans in a 6-month-old infant. Indian J Dermatol Venereol Leprol 2012; 78: 498– 499. 2Kim YH, Kim JI, Hwang SH et al. Cutaneous pili migrans. Ann Dermatol 2014; 26: 534– 535. 3Liu X, Yao ZY. Cutaneous pili migrans: a case confirmed by dermoscopy and reflectance confocal microscopy. Indian J Dermatol Venereol Leprol 2021; 87: 244– 246. 4Luo DQ, Liu JH, Huang YB, He DY, Zhang HY. Cutaneous pili migrans: a case report and review of the literature. Int J Dermatol 2009; 48: 947– 950. 5Khare S, Sengar SS. Cutaneous pili migrans: a creeping eruption like condition easy to diagnose and cure. Med J Armed Forces India 2016; 72: 97– 98. 6Franbourg A, Hallegot P, Baltenneck F, Toutain C, Leroy F. Current research on ethnic hair. J Am Acad Dermatol 2003; 48(6 Suppl): S115– S119. 7Neri I, Bianchi F, Medri M, Bardazzi F. Cutaneous pili migrans in a 3-year-old child. Pediatr Dermatol 2004; 21: 612– 613. Citing Literature Volume36, Issue9September 2022Pages e727-e729 ReferencesRelatedInformation

Yuan Yuan Xiao, Ya Bin Zhou A 3 year old girl presented with a one month history of progressive skin discoloration on the index finger of her right hand.Her parents denied any injury or insect bite anddid notmentionpain, itching, or paraesthesia. The parents reported that their daughter habitually rubbed her scalp with this finger. Physical examination showed a brown patch on the fingertip (fig 1). The other fingers and nails and oral mucosa, teeth, and eyes showed no discoloration. Sweat and urine were reported to be clear. Range of movement in the finger joint was normal. The pigmentation was unaffected by 75% ethanol, excluding exogenous staining. A complete blood cell count was normal.

Tinea capitis is the most common pediatric dermatophytosis of the scalp and hair follicles that require oral antifungals therapy. It usually occurs in children between 3 and 7 years old, whereas it is rarely reported in children under 2 years old. Although oral terbinafine has been broadly used to treat tinea capitis, it is not approved for pediatric patients under 2 years old. Previous studies reported that a doubled oral terbinafine dose could improve the cure rates of tinea capitis due to Microsporum canis. However, the doses are all not strictly weight-based. Here, we report four pediatric tinea capitis patients under 2 years of age who were treated with a high, strictly weight-based dose of oral terbinafine therapy (10 mg/kg/day). We determine the efficacy and safety of this novel oral terbinafine therapy schedule. It may be a promising therapy to treat pediatric tinea capitis under 2 years old.

目的 了解儿童脓癣的致病菌、临床类型以及治疗方法.方法 回顾性分析2011年4月-2021年8月北京儿童医院皮肤科脓癣患儿的致病菌、临床特点、治疗方案及预后情况.结果 148例脓癣患者中表现为单个痈样脓肿型38例,多个小脓肿融合成大片型38例,毛囊性脓疱性红斑块型41例,毛囊炎样损害型31例.4种脓癣临床类型中犬小孢子菌均为主要致病菌,其中在毛囊炎样损害型和毛囊性脓疱性红斑块型脓癣中犬小孢子菌占比最高,分别为70.97％和56.10％.须癣毛癣菌复合体则更易形成单个痈样脓肿型(26.32％).所有脓癣患者均采用口服特比萘芬抗真菌治疗,同时联合抗炎治疗.根据脓癣不同临床类型,抗炎治疗方案分别为应用糖皮质激素(口服或者外用)或者口服复方甘草酸苷治疗,所有患儿治疗8周后有效率为97.97％.结论 儿童脓癣的致病菌以犬小孢子菌为主,但须癣毛癣菌复合体引起的脓癣炎症反应常更强烈.临床抗真菌治疗的同时,联合抗炎治疗可获得较好的疗效.应根据脓癣的不同类型,制定相应的抗炎治疗方案.

A 6-year-old girl presented with recurrent skin rash at the initial stage, recent joint pain, and neutrophilia was found during a routine blood test. After a multidisciplinary case discussion, she was diagnosed with chronic neutrophil leukemia, and the symptoms were relieved after hydroxyurea and luxolitinib treatment. She received the allogeneic hematopoietic stem cell transplantation subsequently. At present, she is in stable condition and under follow-up. Chronic neutrophil leukemia is a rare disease, which rarely occurs in children. It is more difficult to diagnose in patients with skin rash as the first manifestation. The diagnosis and treatment of this case reflects the important role of multidisciplinary cooperation in the diagnosis and treatment of difficult and rare diseases.

Chronic neutrophilic leukemia (CNL) is a rare BCR-ABL negative myeloproliferative neoplasm that usually affects older adults with a poor prognosis. Leukemia cutis is an extramedullary manifestation of leukemia and may be misdiagnosed by dermatologists. Here, we describe a case of CNL in a 6-year-old Chinese girl with leukemia cutis as the first manifestation. Her skin rashes failed to attract the attention of dermatologists in early stages. The diagnosis was confirmed by peripheral smear, bone marrow studies, genomic analysis and skin biopsy.

Background Tinea capitis is the most common dermatophytosis in children. Due to many factors, the types of pathogenic fungi of tinea capitis vary all over the world, and the pathogenic fungi of tinea capitis may change over time even in the same region. Objectives To investigated the epidemiological characteristics and pathogenic strains distribution of tinea capitis in children in Beijing and adjacent regions. Patients/Methods Through retrospective study and epidemiological analysis, we investigated the epidemiological characteristics of tinea capitis in children in Beijing and adjacent regions over 15 years. Results A total of 1739 children with tinea capitis were retrospectively investigated from January 2006 to December 2020, including 1100 boys and 639 girls. A total of 67.4% of tinea capitis patients were between 1 and 5 years of age. A decreasing trend in tinea capitis was observed before 2009, while for the following 12 years, the incidence rate of tinea capitis fluctuated little. Zoophilic isolates (primarily Microsporum canis ) were responsible for 88.4% of tinea capitis. Males are at greater risk for M. canis infection ( p = 0.02). Conclusion Zoophilic species were responsible for approximately nine-tenth of the tinea capitis cases. The incidence of tinea capitis decreased before 2009.

What is the diagnosis? Answer Tinea capitis, a common dermatophyte infection of the scalp and hair that mostly occurs in children.1 Black dot tinea capitis represents endothrix infection (where fungal spores invade the hair shaft) from species such as Trichophyton tonsurans, Trichophyton soudanense, Trichophyton violaceum, and Microsporum audouinii.1 It is characterised by patches of alopecia with hair shafts broken off at scalp level, leading to a “black dot” appearance on the scalp.2 This fungal infection is highly contagious,1 and family members in the same household are often infected.3 Screen family members and close contacts and treat accordingly.2 Failure to treat infected contacts may result in recurrence.1 Endothrix infections usually cause pityriasiform scaling of the scalp because of the location of the spores within the hair shaft.1 Asymptomatic individuals may transmit the infection.1 Topical antifungal drugs are unable to sufficiently penetrate the hair shaft to clear the infection and used alone are not suitable.1 Treatment requires a combination of oral and topical antifungal drugs.1 4 Learning points • Consider tinea capitis when the scalp has a black dot appearance on a patch of alopecia. • Screen familymembers and treat all infected individualswith a combinationof topical andoral antifungals.