Original article
Epidemiologic trends in pediatric tinea capitis: A population-based study from Kaiser Permanente Northern California

https://doi.org/10.1016/j.jaad.2013.08.031Get rights and content

Background

Epidemic levels of tinea capitis (TC) have previously been reported in children.

Objective

We sought to determine new epidemiologic trends for TC among northern California children from 1998 through 2007.

Methods

Annual incidence of TC was based on diagnosis code or first-time antifungal prescriptions in all children up to age 15 years at Kaiser Permanente Northern California.

Results

An average of 672,373 children/y met the inclusion criteria. Trend analyses showed decreases in TC by diagnosis code and by prescriptions (73.7% and 23.7%, respectively). Girls had lower incidence rates than boys by diagnosis (111.9 vs 146.4, P < .001 for 1998, and 27.9 vs 39.9, P < .001 for 2007). African Americans had the highest incidence rates by diagnosis (447.3 in 1998 and 184.1 in 2007) compared with other ethnic groups. Trichophyton tonsurans was the predominant organism (89.4% of all positive fungal cultures in 1998 and 91.8% in 2007). Prescriptions for griseofulvin declined, whereas the prescriptions for other antifungals increased.

Limitations

This was a retrospective study.

Conclusions

In this cohort, there was a significant decrease in incidence of TC over the study period. Trichophyton tonsurans continued to be the predominant organism. These trends may be a result of improved education, recognition, diagnosis, and treatment of TC and increased use of new oral antifungals.

Section snippets

Methods

This was a retrospective database analysis of 2 separate cohorts. The first cohort, hereafter termed “diagnosis cohort,” was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for TC (110.0, dermatophytosis scalp and beard). To obtain an alternative estimate of TC, a second cohort, hereafter termed “first-time prescription cohort,” was ascertained based on first-time prescriptions for oral antifungal medications

Demographics

An average of 672,373 children per year met the inclusion criteria, of which 49% were girls in both 1998 and 2007. Reported ethnicity in 1998 was 9.3% African American, 17.6% Hispanic, 11.8% Asian, 42.2% white, 3.2% others, and 15.9% unknown. In 2007 these proportions were 7.6% African American, 21.7% Hispanic, 14.2% Asian, 32.7% white, 4.3% others, and 19.5% unknown. Mean ages ranged from 6.9 to 8.1 years (diagnosis cohort) and 7.1 to 8 years (first-time prescription cohort) over the study

Incidence

In this population-based study, there was a significant downward trend in the incidence of TC over the study period. Historical comparison shows a rate per 10,000 of 19.3 in 1984 and 80 in 1993 based on KPNC griseofulvin prescriptions,8 compared with KPNC oral antifungal prescriptions of 51 in 1998 and 38.9 in 2007 in our prescription cohort. Although the identification of TC cases in these 2 studies was slightly different, it suggests a peak incidence of TC in the mid to late 1990s. Using

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  • Cited by (0)

    Supported by Kaiser Permanente Northern California Community Benefits Grant.

    Conflicts of interest: None declared.

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