Clinical Review
The diagnosis and management of tinea
Cite this as:
BMJ
2012;345:e4380
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19 July 2012
With increased travel, especially of refugees from tropical areas we must be aware of differential diagnoses of tinea. In my first intern term I saw an aboriginal woman with "tinea" presenting as expanding discoloured area with a raised edge on her knee, that had failed to resolve after several different treatments by my predecessors. The clue was that it "felt different" and indeed was anesthetic. Biopsy showed leprosy, and on further inquiry, her sister had been isolated in a notorious leprosarium many years before. While such cases are uncommon, they may present long after the person has left the endemic area.
Competing interests: None declared
U of Calgary, Health Sciences Centre, Calgary, Alberta T2N 4N1
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13 July 2012
The reemergence of tinea infections in the UK as the authors stated is only part of a recent global reemergence of tinea particularly in developed urban environments in Europe, the US, as well as in Israel. This phenomenon of recent years is contributed at least in part by the influx of refugees fleeing from armed conflict-zones in Africa.
In fact, the largest reported tinea capitis outbreak due to Microsporum Canis in Israel in more than three decades was in Tel Aviv in 2009 (1). At the epicenter of this particular outbreak was one refugee family from Sudan, of which five of seven children had tinea capitis.
The most noticeable epidemiological fact of this outbreak, however, was that the pathogen identified was the zoophilic M. Canis, not a characteristic dermatophyte to Sudan, but once endemic in Israel. It is probably reemerging in such urban regions once again because of the prevalent proper conditions for its effective transmission, hence, poor living conditions such as overcrowded residences in urban African refugee communities.
Apart from investing in better urban infrastructure, griseofulvin treatment (still superior in Microsporum infections) and school screening programmes should be called once more unto the breach.
References:
1. Kopel E, Amitai Z, Sprecher H, Predescu S, Kaliner E, Volovik I. Tinea capitis
outbreak in a paediatric refugee population, Tel Aviv, Israel. Mycoses. 2012
Mar;55(2):e36-9. doi: 10.1111/j.1439-0507.2011.02127.x.
Competing interests: None declared
Tel Aviv, Israel
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