XXXX : epidemiology, diagnosis and management strategies.

@entity1 @entity1665 @entity8974 @entity3101 @entity2380 @entity344 @entity364 @entity3100 @entity18519 @entity2059 @entity288
@entity3100 is a common superficial @entity364 of the scalp in @entity1 , particularly in those of African descent. Trichophyton tonsuran, an anthropophilic dermatophyte, is responsible for the majority of cases in North America. The clinical presentations are variable and include: (i) a "seborrheic" form that is scaling, often without noticeable hair loss; (ii) a pustular, crusted pattern, either localized or more diffuse; (iii) a "black dot" variety characterized by small black dots within areas of @entity1665 ; (iv) a kerion, which is an inflammatory mass; and (v) a scaly, annular patch. Most experts still consider @entity3101 to be the drug of choice, but recommend a higher dosage of 20-25 mg/kg/day for 8 weeks because of the increase in treatment failures. Despite a history of having an excellent tolerability profile, the long treatment course and higher doses required for @entity3101 have led to consideration of new antifungal agents for this infection. @entity8974 , @entity2059 , and @entity2380 compartmentalize in skin, hair, and nails, thereby allowing shorter treatment courses of < or =4 weeks. All have generally been shown to be effective in the treatment of @entity3100 and appear relatively well tolerated, with @entity344 being the most common adverse effect. Monitoring for liver enzyme elevations is generally unnecessary if therapy is limited to </=4 weeks. As more data regarding efficacy, tolerability, and dose administration becomes available, one or more of these new antifungal agents may become first-line therapy for @entity3100 . For now, we recommend their use in cases of treatment failure or recurrent noncompliance. Our personal preference in the younger @entity1 is @entity2380 . It has a favorable tolerability profile and is available in liquid form. In the older @entity1 who can take a tablet, @entity8974 is recommended. More data is available on this drug in the treatment of @entity3100 than the other two, and it is the least expensive. Although the oral antifungal agents are the most important aspect of therapy, adjunctive therapy may be beneficial. Sporicidal shampoos, such as @entity18519 , can aid in removing adherent scales and hasten the eradication of viable spores from the scalp in the hope of decreasing the spread of this infection. The use of corticosteroids for the treatment of kerions is controversial. Many of the studies have design flaws or show variable results. We recommend either a short burst of oral @entity288 or topical corticosteroids in @entity1 with the most severe disease.
