Profile of Tinea Capitis in Skin and Gender Poly

at RSUD Dr. Rm Djoelham Binjai Periode

1 Januari 2014 – 1 September 2018

Hervina

Department of Dermatology and Venereology Medical Faculty Muhammadiyah University Of North Sumatera

Keywords: Tinea Capitis, risk factors

Abstract: Introduction: Tinea capitis ( ringworm of the scalp) is a disorder of the skin and the hair of the head caused

by a species of dermatophyte. This disorder is characterized by scaly lesions, reddish tint, alopecia to

kerion.

(1)

Tinea capitis usually occurs, especially in children, although there are also cases in adults are

usually infected with Trichophyton tonsurans. Tinea capitis can also be seen in adults with AIDS.

(2)

Objective: To determine the overall incidence of Tinea Capitis in the general hospital, Dr. RM.

DJOELHAM THE CITY OF BINJAI

Research method: This research uses a descriptive method with a

retrospective approach. Data obtained from the medical records of patients of Tinea Capitis the period 1

January 2014 – 1 November 2018

Result : On 1 January 2014 – 1September 2018 in the polyclinic of the

health of the skin and venereal Hospital DR RM DJOELHAM the City of Binjai an incident the highest

incidence of Tinea Capitis at the age of 1-20 years (52,4%), and to incidence of most common of Tinea

Capitis occurs in women that is of 66.7% compared to men of 33.3%, based on the work, student / school

have a high risk factor to be exposed to Tinea Capitis i.e. 61,9%. Conclusion: Based on the results of the

research overview of the incidence of Tinea Capitis in the Polyclinic of the Health of the Skin and Venereal

Hospital DR. RM DJOELHAM the City of Binjai much happens in women that is of 66.7% compared to

men of 33.3%, at the age of 1-20 years (52,4%), based on the work, student/school have a high-risk factor to

be exposed to Tinea Capitis 61,9%.

1 INTRODUCTION

Tinea capitis ( ringworm of the scalp) is a disorder

of the skin and the hair of the head caused by a

species of dermatophyte. This disorder is

characterized by scaly lesions, reddish tint, alopecia

to kerion (Budimulja et al, 2016). Tinea capitis is a

disorder on the scalp caused by fungi

dermatophytes. Tinea capitis usually occurs,

especially in children, although there are also cases

in adults are usually infected with Trichophyton

tonsurans. Tinea capitis can also be seen in adults

with AIDS (Verma et al, 2008).

Tinea capitis can be divided into different types,

namely: gray patch ringworm → papule billion

around the estuary of the hair, hair easily is broken,

leaving alopecia brown. Black dot ringworm →

fungal infection in the hair (endotriks) or outside a

hair (ektotriks), the hairs break off, leaving a

macular blackish brown. Kerion → .the skin of the

head seen small ulcers with squama. Tinea Favosa

→ red spots yellowish covered crusting cup-shaped

(skutula), foul-smelling (mousy odor), the hair on

top of it broken up and easily removed (Siregar,

2014).

The spread of infection of tinea capitis can be

spread by species zoophilic, geophilic, and

anthropophilic. Species zoophilic generally found in

the body of an animal but is transmitted to the

human body. Animals and pets are the primary

sources of infection in urban areas (for example, M.

canis in dogs and cats). Transmission can occur

through direct contact with animals that are specific

or indirectly when the hair of infected animals

carried in a shirt or contained in the building or

contaminated food. The area exposed such as the

scalp, beard, face, and hands. Dermatophytes are

inflamed usually caused by an infection caused the

organism zoophilic (Verma et al, 2008).

As for the treatment of tinea can be given a

topical therapy in the form of selenium sulfide,

Hervina, .

Proﬁle of Tinea Capitis in Skin and Gender Poly at RSUD Dr. Rm Djoelham Binjai Periode 1 Januari 2014 – 1 September 2018.

DOI: 10.5220/0009991304490454

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 449-454

ISBN: 978-989-758-469-5

449

povidone-iodine, or ketoconazole, or systemic

therapy with griseofulvin (Verma et al, 2008;

Siregar, 2014).

Based on the background above, with the number

of incidence of Tinea Capitis, the researcher

interested in doing research about the profile of the

incidence of Tinea Capitis in the Clinic of Skin and

Venereal HOSPITAL DR RM Djoelham the City of

Binjai in the period of 1 January 2014 – 1

September 2018.

2 MATERIAL AND METHODS

RESEARCH

This research uses a descriptive method with a

retrospective approach. Data obtained from the

medical records of patients of Tinea Capitis the

period 1 January 2014 – 1 September 2018. By

using the examination of KOH 10%.

2.1 Definition

Tinea capitis ( ringworm of the scalp) is a

disorder of the skin and the hair of the head

caused by a species of dermatophyte. This

disorder is characterized by scaly lesions,

reddish tint, alopecia to kerion

(Budimulja et al,

2016

)Tinea capitis is a disorder on the scalp

caused by fungi dermatophytes. Tinea capitis

usually occurs, especially in children, although

there are also cases in adults are usually

infected with Trichophyton tonsurans. Tinea

capitis can also be seen in adults with AIDS.

(Verma et al, 2008). Tinea Capitis is a superficial

fungal infection that affects the scalp and hair.

(

Siregar, 2014).

2.2 Etiology

Infection on the scalp by the dermatophytes is

usually the result of transmission from person to

person. These organisms remain alive on combs,

brushes, couches, and sheets for a long time. Species

of dermatophytes only specific endemic in parts of

the world sure In general, M. Audouinii is the

causative agent of classical in Europe and America

and M. Ferrugineum most common in Asia, T

violaceum also is common in Romania, Italy,

Portugal, Spain, and the former Soviet Union, as

well as in Yugoslavia. In Africa, T violaceum, T

schoenleinii, and M canis is commonly isolated.

(6)

T. violaceum and M. canis is the agent that is

prevalent in Asia. T schoenleinii is common in Iran

and Turkey, while M canis is common in Israel.

Epidermophyton floccosum and T concentricum not

attack the skin of the head of hair. Trichophyton

rubrum, which is the dermatophyte most commonly

isolated in the whole world, is not a common cause

of tinea capitis On infections ectothrix,

fragmentation of the mycelium into spores occurs

just below the cuticle. Different from infection

endothrix, the destruction of the cuticle occurs. This

type of infection is caused by T verrucosum, T

mentagrophytes, and all species of

Microsporum.(Kondo et al, 2006)

2.3 Epidemiology

The incidence of tinea capitis is still unknown, but it

is usually found in children aged 3 - 14 years, rarely

occurs in adults. Tinea capitis is found in many

children of African descent, the Transmission

increases with reduced hygiene personal, the area of

residence are dense, and low socioeconomic status.

Patients with a carrier symptomatic often found, and

this causes tinea capitis challenging to eradicate.

(2,4)

2.4 Risk Factors

1. Age

Tinea capitis often appears in children between the

ages of 3-14 years. But in adults rarely occur due to

changes in the PH of the scalp and an increase in

fatty acids that are useful as protection against fungi.

(Verma et al, 2008;Welsh et al,2006)

2. Gender

Tinea capitis is often encountered in children than

adults. (Verma et al, 2008;N Rebollo et al,2008)

3. Environment

Hygiene poor, population density, and low

socioeconomic increase transmission of the fungi.

(Verma et al, 2008;N Rebollo et al,2008)

2.5 Diagnosis

1. Anamnesis

a. Grey patch ringworm

Tinea capitis, usually caused by the genus

Microsporum and are often found in children. The

cause in the form of the organism anthropophilic

ektotric such as M. audounii or M. canis. Form of

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

450

tinea capitis is also known as a form of seborrheic

dermatitis of the squama that stands out.

Inflammation is minimal. The infected hair becomes

gray and dull in the sheath arthroconidia, and hair

breaking off at the top of the scalp (Verma et al,

2008;James et al.,2006)

Figure 1: Grey patch ringworm

b. Kerion celcii

Is the reaction of inflammation weight in tinea

capitis, in the form of swelling which resembles a

honeycomb with inflammation of the dense

surrounding. When the cause is Microsporum canis

and Microsporum gypseum, the formation of a

kerion is often seen. Reduced when the cause

Trichophyton tonsurans, and fewer when the cause

is Trichophyton violaceum. This type is as a result

of the reaction of hypersensitivity to infection. The

spectrum of inflammatory diseases can occur

ranging from folliculitis postular up to a kerion,

which gives the picture such as "mud," the

inflammatory with a sprinkling of damaged hair and

orifice follicular that secrete pus. Inflammatory

lesions usually pruritic, and may also pain, the

presence of lymphadenopathy cervical posterior,

fever, and lesions on the scalp that are bald. .(Verma

et al, 2008;James et al.,2006)

Figure 2: kerion

c. Black dot ringworm

Mainly caused by the Trichophyton tonsurans and

Trichophyton violaceum. At the beginning of the

disease, the clinical picture resembles the

abnormalities caused by the genus Microsporum.

Hair exposed to the infection of the broken right on

the estuary of the follicle, and what's left is the ends

of the hair which is full of spora.(Verma et al,

2008;James et al.,2006)

Figure 3: Black dot ringworm

d. Tinea favus

Tinea favus is an infection of the clinical

dermatophytes of the head, the skin is no hair, and or

nails, characterized crusting dry and thick hair

follicles that cause scarring alopecia. Tinea favus

generally suffered before the adults continued adults,

and is associated with malnutrition and poor

nutrition. The most common cause is T. scholeinii,

occasionally T. violaceum, and M. gypseum.

.(Verma et al, 2008;James et al.,2006)

Figure 4: Tinea Favus

Proﬁle of Tinea Capitis in Skin and Gender Poly at RSUD Dr. Rm Djoelham Binjai Periode 1 Januari 2014 – 1 September 2018

451

3 INVESTIGATIONS

- Ray Wood

Flouresensi positive infected by Microsporum

audouinii, Microsporum canis, Microsporum

femgineum, Microsporum distorturn, and

Trichophyton schoenleinii. In a room that is dark

skin under the lights, this flouresensi slightly blue.

Dandruff is generally a bright bluish-white. The

infected hair flouresensi bright green or greenish-

yellow while the organisms endotrik, Trichophyton

tonsurans does not seem flouresensi.(Verma et al,

2008;Siregar,2014)

- KOH 10%

Visible hyphae or spores and mycelium. Preparation

directly from the hair can be visible hyphae or

spores inside a hair (endotriks) or outside a hair

(ektotriks). (Siregar,2014)

Positive results there are 2 possibilities:

1.Ektotrik: looks arthroconidia small or large form a

layer surrounding the outside of the hair shaft.

2.Endotrik: looks arthroconidia in the hair

shaft.(Verma et al, 2008)

3.1 Culture Examination

Speciation of fungi is based on the characteristics of

the microscopic, macroscopic, and metabolism of

the organism. Sabouraud Dextrose Agar (SDA)

media is the most common insulation used.

(Siregar,2014)

3.2 Pathogenesis

Infection endotrik and ektotrik except arthroconidia

still contained in the hair shaft, replacing the keratin

intrapilari, and reduce the intake with the cortex. As

a result, hair is easily broken and separated on the

surface of the head whereby the walls of the

follicular does not support, leaving a small black

dot. (Verma et al, 2008)

3.3 Pathofisiologi

The period of incubation of tinea capitis antropofilik

is 2 to 4 days, Hyphae growing towards the follicle,

the hair surface, and hyphae intrafollicular broken

down into a chain of spores. The period of the

deployment (4 days to 4 months) occurred during

the lesions enlarge and appear new lesions. Three

weeks hair started off a few millimeters above the

surface of the skin. In the hair, hyphae into the top of

the zone keratogenous and on the zone this is

Adamson's "fringe" is formed day 12. There are no

new lesions appear during a refractory period (4

months to several years). (Verma et al, 2008;Welsh

et al,2006)

3.4 Differential Diagnosis

1. Alopecia areata (with the shape of the black dot),

usually the skin looks slippery and brown.

2. Dermatitis Seboroika (with the form of tinea

favosa), the hair looks oily, the skin of the head

seemed covered squama oily.

3. Psoriasis ( with a form of tinea favosa), scales

(squama) thick, white, shiny and are kronik residif.

(Siregar,2014)

3.5 Therapy

Systemic :

Griseofulvin with a dose of 0.5 – 1g for adults and

0.25 to 0.50 g for the children a day or 10-25 mg/kg.

Given 1-2 times/day with long pengebotan

depending on the location, cause and clinical, healed

continue treatment for up to 2 weeks.

Ketoconazole 200 mg/day for ten days to 2

weeks the morning after a meal. Replace

ketoconazole with itraconazole 2x 100-200 mg/ day.

Terbinafine for 2-3 weeks, doses of 62.5 mg – 250

mg/day depending on weight.

(Budimulja et al,

2016).

Topical

Wash the head and hair with shampoo disinfectant

antimikotik such as a solution of salicylic acid,

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

452

benzoic acid, and sulfur presipitatum. Derivatives of

imidazole 1-2% in cream or solution can cure,

ketoconazole cream 2 %.(Siregar,2014)

4 RESULT

Figure 4.1 The incidence of tinea capitis is based on age

On 1 January 2014 – 1 September 2018 in the

Polyclinic of the Health of the Skin and Venereal

Hospital DR. RM. Djoelham the City of Binjai, the

highest incidence of Tinea Capitis, are in the age

range 1-20 years (52,4%), then at the age of 21 - 40

years (23,8%), aged 41-60 years (of 19.0%), and

ages 61 - 80 (of 4.8%). This is in accordance with

the theory described by Siregar, where the incidence

of Tinea Capitis a lot happens before the age of 20

years. (Siregar,2014)

Figure 4.2 Occurrence of Tinea Kapitis based on work

The incidence of Tinea Capitis seen based on the

work in getting that student/school have risk factors

the risk of developing Tinea Capitis this is affected

by the dirty environment and the air hot and humid,

the results obtained,(61,9%) compared to farmers

(14.3 %), civil servants (14.3 %), retired (4.8 %),

and schools (4.8 %).

Figure 4.3 The incidence of tinea capitis by sex

Based on the diagram 4.3 the incidence of

Tinea Capitis in a poly skin and venereal

HOSPITAL DR. RM DJOELHAM the CITY of

BINJAI more common in women (66,7%) than men

(33,3%), for the year 2014, and in 2016 more

common in men (28,6 %), and women (9.5 percent)

and for years the incidence of tinea capitis is

suffered by many women. This statement is

inversely proportional to the research that has been

done by Siregar in the study also found that men

more often suffer from Tinea Capitis than females

(3)

. On the poly skin and venereal in hospital, Dr.

RM DJOELHAM the CITY of BINJAI encountered

many patients of Tinea Capitis sex women seeking

treatment than men, and this is because women

usually tend to be more worried about the change of

the pigmentation of their skin and the impact on

their social life.

Proﬁle of Tinea Capitis in Skin and Gender Poly at RSUD Dr. Rm Djoelham Binjai Periode 1 Januari 2014 – 1 September 2018

453

5 DISCUSSION

In a study done at the polyclinic the health of the

skin and venereal HOSPITAL DR. R. M.

DJOELHAM the CITY of BINJAI in the Years

2014-2018 the patients with Tinea Capitis most in

the age range 1-20 years, with female gender and

employment status as a student/school. The same

thing obtained in the research carried out in RSUP

Sanglah Denpasar to get age group the highest in the

5-14 years (45,45%), while in RSU dr. Soetomo

Surabaya age group the highest at the age of under

14 (93,33%).(Putu et al,2008;Suyoso et al,2008)

Research in Spain gain of 0.33% of school

children with culture-positive tinea capitis in 1994

and in London reported a prevalence of 2.5 % in

1995. The prevalence of tinea capitis in the United

States ranged from 3% to 8% in the child population

.(Mohrenschlager et al,2005) from Indonesia that

comes from RSUP Sanglah Denpasar to get to

0.32% of patients with tinea capitis were treated

during the period January 2004 to December 2006.

(

Putu et al,2008) Other Data in the poly

Dermatomikosis Unit Outpatient Skin and Venereal

HOSPITAL dr. Soetomo Hospital Surabaya, there is

0,31-1,55% of new cases of tinea capitis between the

years 2001-2006.(Suyoso et al,2008)

6 CONCLUSION

Tinea capitis ( ringworm of the scalp) is a disorder

of the skin and the hair of the head caused by a

species of dermatophyte. This disorder is

characterized by scaly lesions, reddish tint, alopecia

to kerion.

(Budimulja et al, 2016) The cause of the

tinea capitis is a dermatophyte fungus. Tinea capitis

usually occurs, especially in children, although there

are also cases in adults are usually infected with

Trichophyton tonsurans the most common cause

Verma et al, 2008) incidence of Tinea capitis in the

Polyclinic of the Health of the Skin and Venereal

HOSPITAL DR. RM DJOELHAM the CITY of

BINJAI In the year 1 January 2014 - 1 November

2018 more common in women that is of 66.7%

compared to men of 33.3%, achieved the number of

patients of Tinea Capitis as many as 50 people, with

the age group is the largest 1 -120 of the year

amounted to 52.4%, and a lot of students/school

(61,9%).

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