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| |  Back-To-School Season Ushers In Heightened Threat of Ringworm RARITAN, N.J., Sept. 16, 1996 -- As teachers prepare for another year of getting the three "R's" -- reading, (w)riting and (a)rithmetic -- into their student's heads, health care professionals are concerned about keeping a fourth 'R' out of them. "Ringworm of the scalp, more commonly known as tinea capitis, is a contagious infectious disease," says Mary Gail Mercurio, M.D., assistant professor of dermatology, Columbia-Presbyterian Medical Center, New York. "While it is not tracked by U.S. health authorities, there is general agreement among health care professionals that its prevalence has been increasing steadily over the past few years, and that it now constitutes a significant public health problem in this country. Screening by school nurses is crucial because of the contagious nature of tinea capitis, and because early recognition and treatment are essential both to slowing the spread of infection and to preventing reinfection." Dr. Mercurio, along with several other health care professionals, recently participated in a roundtable discussion on what school nurses need to know about identifying and managing fungal infections of the scalp. The discussion will be published as a special educational supplement to the October issue of "Journal of School Nursing." Tinea capitis is the most common pediatric fungal scalp infection worldwide, accounting for over 90 percent of fungus infections of the skin in children under the age of 10. It is more common in African-American children, especially those in urban areas, than in white children. While the reason for the greater prevalence in this segment of the population is not fully understood, it has been postulated that extensive use of hair dressings, such as pomades, and tight hair braiding practices may play a role. Dr. Mercurio stresses, however, that the infection is known to defy demographics. "Failure to consider ringworm as a possibility in every child carries the risk of missed diagnoses, with resulting absence of treatment, persistent infection and unwanted transmission to others." Recognition of ringworm of the scalp is difficult because the symptoms often mimic other scalp conditions. Typical early signs include redness, itching, and flaking. The average ringworm patient is between four-and six-years-old. In addition to schools, outbreaks have been noted in day-care centers, as well as in nurseries among infants as young as nine-days old, and frequently among high-school age athletes, particularly wrestlers. Tinea capitis is also becoming increasingly common in adults. The infection spreads through close human contact, as well as from contact with inanimate objects such as combs and brushes, barrettes, bed linens, stuffed animals, telephones, wrestling mats, and theater seat-backs. Topical therapy is not effective in eradicating tinea capitis. The only medication currently indicated for the treatment of tinea capitis is griseofulvin, which has been the standard of treatment for the condition for nearly 40 years. One form of griseofulvin, available in a liquid suspension formulation for children, is GRIFULVIN V(R) (griseofulvin oral suspension). Parents may find that the liquid suspension form is easier and more pleasant for children to take, which may increase the likelihood of compliance with the full regimen. When side effects occur, they are most commonly of the hypersensitivity type, such as skin rashes and hives. "Compliance is crucial to treatment," emphasizes Dr. Mercurio. "The full course of treatment must be completed without regard to whether symptoms have improved." For a free flyer, "What Can I do to Reduce The Spread of Ringworm of the Scalp?," consumers can send a self-addressed-stamped-envelope to: What Can I Do?
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