British Association of Dermatologists' guidelines for the management of tinea capitis 2014

Abstract

The overall objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of tinea capitis. This document aims to update and expand on the previous guidelines by (i) offering an appraisal of all relevant literature since January 1999, focusing on any key developments; (ii) addressing important, practical clinical questions relating to the primary guideline objective, i.e. accurate diagnosis and identification of cases; suitable treatment to minimize duration of disease, discomfort and scarring; and limiting spread among other members of the community; (iii) providing guideline recommendations and, where appropriate, some health economic implications (tinea capitis is a common problem in resource-poor settings and therefore treatments that are more easily and cheaply available and applicable to these settings have been factored in); and (iv) discussing potential developments and future directions. This guideline is presented as a detailed review with highlighted recommendations for practical use in the clinic (see Section 12), in addition to the production of a patient information leaflet [available on the British Association of Dermatologists' (BAD) website, http://www.bad.org.uk]. The guideline development group consisted of consultant, specialist registrar and associate specialist dermatologists, and a mycologist. The draft document was circulated to the BAD membership, British Dermatological Nursing Group (BDNG) and Primary Care Dermatological Society (PCDS) for comments, and was peer reviewed by the Clinical Standards Unit of the BAD (made up of the Therapy & Guidelines Subcommittee) prior to publication. This set of guidelines has been developed using the BAD's recommended methodology1 and with reference to the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument (www.agreetrust.org).2 Recommendations were developed for implementation in the National Health Service (NHS) using a process of considered judgement based on the evidence. The PubMed, Medline and Embase databases were searched for meta-analyses, randomized and nonrandomized controlled clinical trials, case series, case reports and open studies involving tinea capitis published in the English language from January 1999 to March 2014; search terms and strategies are detailed in the Supporting Information (see Table S1). Working in pairs, the authors screened the identified titles, and those relevant for first-round inclusion were selected for further scrutiny. The abstracts for the shortlisted references were then reviewed and the full papers of relevant material were obtained; disagreements in the final selections were resolved by discussion among the entire development group. Additional relevant references were also isolated from citations in shortlisted and reviewed literature, as well as (independent) targeted searches carried out by the coauthors. The structure of the 2000 guidelines was then discussed and re-evaluated, and different coauthors were allocated separate subsections. Each coauthor then performed a detailed appraisal of the selected literature with discussions with the entire development group to resolve any issues, for example with the quality of evidence and making the appropriate recommendations. All subsections were subsequently collated and edited to produce the final guideline. This document has been prepared on behalf of the BAD and is based on the best data available when the document was prepared. It is recognized that under certain conditions it may be necessary to deviate from the guidelines and that the results of future studies may require some of the recommendations herein to be changed. Failure to adhere to these guidelines should not necessarily be considered negligent, nor should adherence to these recommendations constitute a defence against a claim of negligence. Limiting the review to English language references was a pragmatic decision, but the authors recognize this may exclude some important information published in other languages. The proposed revision for this set of recommendations is scheduled for 2019; where necessary, important interim changes will be updated on the BAD website. Tinea capitis is an infection of scalp hair follicles and the surrounding skin, caused by dermatophyte fungi, usually species in the genera Microsporum and Trichophyton. Tinea capitis continues to be predominantly a disorder of prepubertal children, common in inner-city cosmopolitan communities, with no sign of a reduction in incidence. Although across Europe Microsporum canis remains the most commonly involved organism, in the U.K., a shift towards anthropophilic species continues to be observed.3 Trichophyton tonsurans is reported to account for 50–90% of dermatophyte scalp isolates in the U.K.3 This rise in anthropophilic dermatophyte infections is attributed to immigration and travel patterns. An accurate diagnosis remains a vital component of management. Clini