Tinea Capitis, Article Critique Example

Introduction

Tinea capitis is a fungal infection of the scalp; it is commonly known as ring worm-although it is really not a worm. The infection causes small patches of itchy, scaly skin on the scalp. It gets the name ring worm because of its circular marks. It is highly contagious and can be spread by sharing combs, towels, and other personal hygiene items. This infection is common to children, but can affect persons of any age. The fungus thrives on dead tissue, such as outer layers of skin. Poor hygiene and over crowded living conditions can cause an increase and spread of tinea capitis. The infection thrives in warm moist areas. Areas affected by the infection can become completely bald. If hair remains, it may become brittle and dry. Mild cases of the infection usually respond to antifungal products that can be applied directly to the affected areas. More severe cases may require antifungal pills to be taken for several weeks to eradicate the infection. These infections are often mistaken for other disorders. Consequently, it may go untreated for a period of time.  If left untreated the infection can cause permanent damage to the scalp.

Purpose Statement

The purpose of this study was to convey how to detect tinea capitis, discuss how the infection is spread, and present treatment options. This is very common infection. Many people believe it only affects children, but it can affect adults who come in contact with the infection. Often these people are in constant contact with small children. This infection is also commonly mistaken for other disorders. Black dot tinea is one disorder that is often mistaken for tinea capitis. The disorder has similar symptoms. However, this is an infection of the hair near the scalp, not the scalp itself. Instead of dry, itchy patches, this disorder is characterized by boggy, oozing, postural masses. Hair loss may also be a symptom. In its inflammatory stage, known as kerions, the masses can be mistaken for bacterial an abscess which leads to ineffective methods of treatment. Dermatitis, psoriasis, and seborrhea dermatitis also have common symptoms.

Research Questions/Hypotheses

The study sought to determine the appropriate evaluation of the index patient with tinea capitis and his/her contacts, discuss approved therapy and newer alternatives for patients with the infection, and to examine clinical findings of drugs that may be effective in treating the disorder. If a person is suspected of have the infection a culture sample should be collected and confirmed before treatment is started. Therapy can last several weeks, be quite costly, and possibly have adverse side effects for the patient. Being diagnosed could take up to two weeks. A culture can be taken without pain in one’s doctor’s office. A cotton applicator is used to remove a sample of skin. This type of infection requires systematic treatment. If topical agents are unable to destroy the infection, oral antifungal medication must be taken. Oral griseofulvan is the only oral medication approved by the FDA for the treatment of tinea capitis. Recent studies have proven that terbinafine, itraconazole, and fluconazole are also effective in treating this type of infection. They also may have the one advantage of shorter treatment time.

Study Design/Methodology

Several trials that studied the efficacy of several medications that is to treat tinea capitis. The study was performed to see which medication has the best treatment results of the disorder. Griseofulvin was introduced in the 1950s and is still widely used today in the treatment of tinea capitis. Seventy to 100 percent of people who used this drug were cured of the disorder. The success rate varied due to the pathogenic organism, dosage, and duration of therapy. Adults who took 25 mg per day were more likely to relapse, while children who took the same dosage were completely cured. Treatment typically occurred over a 6-8 week period. The common side effects were: headache and gastrointestinal discomfort.

Tebinafine is a tertiary allylamine. The recent study compared terbinafine and griseovulvin favored tebernafine if the duration of therapy was 12 weeks. A two week study showed that terbinafine had a cure rate of 60to 80 percent and 84 to 86 percent. Terbinafine seems to be just as effective as griseofulvin, but with a shorter therapy time. The standard dosage of terbinafine was 62.5 mg per day. This proves that higher dosage leads to higher cure rates. Terbinafine is not FDA approved. Common side effects are headache, gastrointestinal symptoms, and rash

Itraconazole is an antifungal that fights dermatophytes, candida, and some molds. Patients take the capsule for 4 weeks at 5 mg per day. They may be taken in capsules or oral solution. The capsules should be taken with food, but the oral solution should be taken on an empty stomach.

Fluconzole is also available in liquid and tablet form. The body absorbs more than 90 percent of the drug. Little evidence supports that this drug is effective in the treatment of tinea capitis. Six mg per day for 3 weeks is the recommended dosage. There is limited evidence of this drug being used for tinea capitis.

Terbinafine, itraconazole, and fluconazole have all been used in the United States for the treatment of tinea capitis, but neither of the three has been approved by the FDA.

Instrumentation

The article presented no information on what type of instrumentation was used. There was no reference to how data was collected or what type of tools was used. The only reference to a specific detail that was given was the fact that several mid-aged African-American women contracted the infection. The researchers speculated that it was contracted from small children that they were care-givers to. No information was provided as to how long the study took place or the age, ethnicity, etc of the subjects. There is also no information as to where the study took place (home, school, and controlled-environment.  The studies took place in the United States and the United Kingdom. There study took place starting in 1986 and concluded in 2004. There was no numbers given as to how many subjects participated at any given time. However, in some cases, subjects were followed up to two weeks after the completion of the administering of the drug to treat tinea capitis. It was also noted that in some cases mild to moderate cases of the infection required the repeat of therapy in 3-4 week intervals.

Analysis Plan

No plan for treatment or to avoid coming into contact with the infection was provided. However, one was reminded that tinea capitis is highly contagious. To avoid contracting the infection one should avoid contact with infected persons or their hygiene items.

Biases/Threats to Validity and Ethical Concerns

The validity of this report can not be confirmed. The authors did not present any documentation of the types of subjects that were used. It is impossible for one to know if the study was conducted on four people of four-hundred. No data was presented to back up the information that children respond better to a particular dosage than adults do. No information was presented to determine if sex, age, weight, or ethnicity plays a role in treatment. For many of the medications they discussed, it was stated that the medicine could remain in their systems for extended periods of time. If this is so, does that affect the person ability to be re-infected was not answered.

Results

According to the studies conducted, the authors have concluded that griseofulvin is the best drug to use to treat tinea capitis. The most important factor is that it is FDA approved. Also, it has limited, mild side effects. However, little evidence supports efficacy and safety of the other antifungal drugs. The short term evidence shows that terbinafine, itraconazole, and fluconazole are comparable in efficacy to griseofulvin. These drugs can be an alternative for people who have had adverse side effects to griseofulvin.

Recommendations for Further Research and Conclusion

This research should be done in a more controlled environment. Subjects need to be chosen from a variety of backgrounds. For example, subjects from different ethnicities need to documented. There needs to some type of comparison between how the four types of medicines are used in similar situations and the outcomes they produce. They could possibly use subjects from the same backgrounds and demonstrate how all four medicines were used and the results found.  This research is just not reliable because there is very limited documentation and evidence. The study was conducted over an extended period of time. Some type of correlation was noted in the effectiveness of griseovulvin.  Further research needs to be performed to determine if the strength of this drug has weakened over time, and what type of effect they may have had on the subjects.  With the information presented by the researchers, griseovulvin seems to be the most effective way to rid the body of tinea capitis, also known as ring worm. Anyone can be affected by this disease, but young children seem to be more prone to contracting this infection. The infection is highly contagious and can be contracted through direct contact with the person who is infected. Using items such as combs, brushes, and towels that belong to an infected person can put an uninfected person at risk of contracting the infection.  Care-givers of young children are at a heightened risk of contracting the disorder. The infection is prone in moist, warm environments. The infection can also spread from one area to another on the infected person by transfer (scratching).