Treatment of Trichophytosis and Microsporosis

A patient with an isolated affection of the smooth skin (superficial trichophytosis, microsporosis) may be cured by external treatment alone: a 2 per cent iodine tincture is applied in the morning, and ointment with 10 per cent sulphur and 3 per cent salicylic acid or a 10-15 per cent sulphur-tar ointment in the evening. This treatment is continued for two or three weeks, after which the skin is painted with 2 per cent iodine tincture for three or four weeks.

In superficial or chronic trichophytosis and microsporosis of the scalp, multiple or solitary foci on the smooth skin but with involvement of the downy hair in the process, the antibiotic griseofulvin is of high therapeutic value. It is dispensed in 0.125 g tablets. It penetrates the blood and tissues well and is adsorbed by the horny layer of the epidermis, hair, and nails. It is prescribed in a daily dose of 21-22 mg/kg. The daily dose is divided into three portions taken during a meal. The drug is washed down with a teaspoonful of vegetable or cod-liver oil for better absorption in the intestine. Griseofulvin is given daily until two tests for fungi are negative, then it is given every other day until three tests made at intervals of two or three days yield negative results after which it is taken twice a week for two weeks.

Polyvitamins of the B complex are given for the whole period of griseofulvin therapy to prevent hypovitaminosis. Griseofulvin is more effective in trichophytosis than in microsporosis.

Griseofulvin is contraindicated in diseases of the blood, liver, and kidneys, porphyrin disease, and malignant new growths.

External treatment is applied together with griseofulvin therapy. The lesions on the scalp are painted with a 2 per cent iodine tincture in the morning and a 10-15 per cent sulphur-tar or Wilkinson's ointment is applied to them in the evening (the hairs are shaved once in seven to ten days to remove the viable spores). The hair may be washed two or three times a week. Similar external therapy is applied in multiple foci on the smooth skin.

Patients who fail to respond to griseofulvin or are intolerant should be treated with an alternative treatment regimen:

DRUG	DOSE
Fluconazol	6mg/kg/day for 20 days
Itroconazole	3-5 mg/kg/day for 4-6 weeks
Terbinafine	3-6mg/kg/day for 4 weeks (infections by M.canis may require up to 8 weeks of terapy)

When treatment is completed hairs taken mostly from the affected areas are examined with the microscope three times at intervals of seven to ten days. The examination is repeated during the second and third months. A child is allowed to attend children's collective if three successive tests prove negative and on condition that a cap is worn and terminal disinfection has been conducted at home. A follow-up period of three months (beginning with first control microscopy) provides grounds for considering the patient to be cured.

Infiltrative-suppurative trichophytosis of the scalp and smooth skin is managed by different methods because it is marked by a tendency to spontaneous cure. In an acute course (the deep form), wet dressings (10 per cent ichthammol solution, 2 per cent boric acid solution, 0.1 per cent ethoxydiaminoacridine lactate) and manual removal of the hairs with eyelid forceps are resorted to first. When the acute symptoms abate, a 10-15 per cent sulphur-tar Wilkinson's ointment is prescribed. The infiltrative and superficial forms of zooanthropophilic trichophytosis are treated from the onset with ointments without the preliminary application of wet dressings. In such cases an attempt may be made first to cause an exacerbation of the process which would enhance the therapeutic effect of iodine and ointments applied later.

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