The value of direct microscopic examination in the diagnosis and evaluation of treatment efficacy in cases of tinea capitis

Objective: Tinea capitis is the most common dermatophyte infection of childhood, affecting the hair and scalp. Its higher frequency in certain populations increases the clinical importance of the disease in these regions. Direct microscopic examination, used especially in the diagnosis of fungal infections in dermatology, is a method that is easy to use and provides rapid results. In our study, we aimed to contribute to the literature by emphasizing the demographic and clinical characteristics of tinea capitis cases as well as direct microscopic findings during the diagnosis and treatment process. Materials and Methods: 45 pediatric cases who were clinically diagnosed with tinea capitis and applied to Yüzüncü Yıl University Dermatology Department were included in this study. Characteristics of the cases such as age, gender, clinical type of infection, location of the lesions, disease duration before admission, leukocyte and CRP levels at admission, family history, antifungal use before admission, animal contact, presence of tinea corporis, lymphadenopathy and presence of ID reaction were recorded. Wood's light examination was performed on the cases at the time of admission. Hair and scalp samples were taken from all cases at the first admission, after 4 week and after 8th week from the beginning of treatment, and the presence of fungal elements was investigated by direct microscopic examination. The results obtained were recorded and statistically analyzed. Results: The average age of the cases was found to be 6.36 and the male/female ratio was 2.75:1. The most common clinical type was tinea capitis profunda in 40 (88.9%) cases, while tinea capitis superficialis was seen in 5 (11.1%) cases. The average duration of illness of the cases before admission was 13.96 days. At admission, leukocytosis was observed in 44.4% of the cases and CRP elevation was observed in 77.8%, while higher CRP levels were detected in tinea capitis profunda cases. The most common lesion location was the parietal region (35.6%). There was a family history in 26.7% of the cases. While there was a history of animal contact in 38 (84.4%) cases, the most common species was ovine contact iv (35.6%). During clinical examination, the presence of tinea corporis was detected in 15.6% of the cases, lymphadenopathy in 35.6%, and id reaction in 17.8%. Fluorescence was detected in 14 (31.1%) cases during Wood's light examination. In the direct microscopic examination performed at the first admission, positive results were obtained in 41 (91.1%) cases, while ectothrix hair involvement was observed in 24 of them and endothrix hair involvement was observed in 17 cases. Although there are studies in our country that performed direct microscopic examination of tinea capitis cases, no comprehensive study classifying hair invasion as endothrix and ectothrix was found. The findings we obtained were predictable considering the hair invasion pattern of dermatophyte agents that were frequently detected in culture in previous studies in the region where our study was conducted. A significant relationship was found between direct microscopic findings and the results of animal contact and Wood examination of the cases (p<0.05). While positive results continued to be seen in 6 patients in the control microscopy performed at the end of 4 weeks following the start of treatment, positive results continued in 1 patient at the end of 8 weeks. Conclusion: The demographic and clinical characteristics of the cases in our study were found to be similar to the results of previous studies. When the microscopic findings obtained were evaluated together with the anamnesis, clinical and diagnostic findings of the cases, it allowed making predictions about the causative dermatophyte and predicting the treatment process. We think that the widespread use of direct microscopy in clinical practice will be beneficial in diagnosis and monitoring the clinical response of patients during treatment. Key words: Tinea capitis, tinea capitis profunda, tinea capitis superficialis, dermatophyte, microscopy, hyphae, spore.