Latest news with #CeliacDisease
Yahoo
14 hours ago
- Health
- Yahoo
Dementia Risk Declining With Each Generation, Says Promising New Study
Dementia cases are on the rise around the world. In 2021, 57 million people were living with one of the neurodegenerative diseases under the dementia umbrella, and by 2050, that number is expected to reach 153 million. But a new study suggests the tides may be turning, with younger generations facing lower risks for the disease as they age. The research team, led by economist Xiaoxue Dou from the University of Queensland in Australia, ran a cross-sectional observational study using health survey data from the US, Europe and England: one that's representative of cross-sections of the populations involved at a single point in time, and based on observational data. The researchers only used variables that were available across all the survey data to estimate participants' dementia status, to compensate for any missing observations. "Birth cohorts born more recently were less likely to develop dementia in all three regions, albeit at different rates," the authors state in a journal article. "This decreasing trend was more pronounced among women than men." They particularly focused on people aged 71 years or older, with the data sorted into age groups spanning four years. Compared with the older groups, younger cohorts had lower age-specific dementia prevalence rates: 21.2 percent for those in the US study; 38.9 percent in the European study; and 28.3 percent in England. "For example, in the US, among people aged 81 to 85, 25.1 percent of those born between 1890-1913 had dementia, compared to 15.5 percent of those born between 1939-1943," economist and co-author Sabrina Lenzen of the University of Queensland told Nicola Davis at The Guardian. The team cautions their data may not accurately reflect what is happening in minority groups. But the findings suggest that, while aging populations globally will probably mean greater numbers of people living with dementia, the percentage of people affected may actually be decreasing, at least among the groups studied. This generational decrease in dementia risk, the study's authors write, "has important implications for health care planning, long-term care policies, and workforce requirements in aging populations." This research was published in JAMA Network Open. Several Psychiatric Disorders Share The Same Root Cause, Study Finds New Smart Dental Floss Can Detect Your Stress From Saliva Gluten Intolerance vs Celiac Disease: Experts Reveal The Key Differences
Globe and Mail
18 hours ago
- Health
- Globe and Mail
Celiac Disease Market Analysis 2034: Clinical Trials, EMA, PDMA, FDA Approvals, Statistics, Revenue, Prevalence, Medication, Treatment Market and Companies by DelveInsight
"Celiac Disease Market" Celiac Disease Companies working in the treatment market are Sanofi (Provention Bio), Zedira, Dr. Falk Pharma, Takeda, ImmunoGenX, Provention Bio, Sanofi, Topas Therapeutics GmbH, Pfizer, 9 Meters Biopharma, Inc., ChemoCentryx, BioLineRx, Ltd., and others (Albany, USA) DelveInsight's 'Celiac Disease Market Insights, Epidemiology, and Market Forecast-2034″ report offers an in-depth understanding of the Celiac Disease, historical and forecasted epidemiology as well as the Celiac Disease market trends in the United States, EU4 (Germany, Spain, Italy, France) the United Kingdom and Japan. The Celiac Disease market report provides current treatment practices, emerging drugs, the market share of the individual therapies, and the current and forecasted Celiac Disease market size from 2020 to 2034, segmented by seven major markets. The Report also covers current Celiac Disease treatment practice/algorithm, market drivers, market barriers, and unmet medical needs to curate the best opportunities and assesses the underlying potential of the Celiac Disease market. To Know in detail about the Celiac Disease market outlook, drug uptake, treatment scenario and epidemiology trends, Click here; Some of the key facts of the Celiac Disease Market Report: The Celiac Disease market size is anticipated to grow with a significant CAGR during the study period (2020-2034) In May 2025, Teva Pharmaceutical Industries, Ltd. (NYSE and TASE: TEVA) today announced that the US Food and Drug Administration (FDA) granted Fast Track designation for investigational TEV-53408, an anti-IL-15 antibody, for the treatment of people with celiac disease on a gluten-free diet. TEV-53408 is currently being evaluated in a Phase 2a trial to assess the efficacy and safety in adults with celiac disease. In March 2025, Barinthus Biotherapeutics plc (NASDAQ: BRNS) has entered 2025 with a renewed strategic focus on immunological and inflammatory diseases. Following its restructuring, the company is well-positioned to advance its lead asset, VTP-1000, along with the SNAP-TI platform, for the treatment of celiac disease. With innovative design features that enhance antigen targeting, allow intramuscular administration, and potentially improve tolerability, VTP-1000 has the potential to become a leading therapy for the approximately 80 million people worldwide affected by celiac disease. In February 2025, PhaseV, a leader in software and machine learning (ML) for clinical trial optimization, announced a strategic partnership with Alimentiv Inc., a global gastrointestinal (GI) contract research organization (CRO). This collaboration aims to enhance the design and execution of advanced adaptive clinical trials for various GI conditions, including inflammatory bowel disease (IBD), celiac disease, eosinophilic gastrointestinal disease (EGID), and other related disorders. In October 2024, Topas Therapeutics reported positive topline results from its Phase IIa trial of TPM502 in celiac disease patients. The findings provide the first clinical proof of concept for the company's proprietary nanoparticle platform, highlighting its potential to induce targeted, antigen-specific tolerogenic effects. In September 2024, Barinthus Biotherapeutics plc (NASDAQ: BRNS), a clinical-stage biopharmaceutical company focused on developing innovative immunotherapies that direct T cells to manage diseases, has commenced its first-in-human Phase 1 trial of VTP-1000 in adults with celiac disease. This randomized, placebo-controlled study, incorporating a controlled gluten challenge, aims to assess the safety, tolerability, pharmacokinetics, and pharmacodynamics of VTP-1000. In May 2024, Entero Therapeutics, Inc. (previously known as First Wave BioPharma, Inc.) has introduced its new corporate identity and website. This rebranding comes after its recent merger with ImmunogenX and underscores the company's commitment to tackling unmet needs in gastrointestinal health, including celiac disease, a condition that currently lacks approved treatments. In 2023, the United States represented the largest portion of the celiac disease market among the 7MM, contributing roughly 70% to the overall market. Among the EU4 and the UK, Italy had the highest market valuation for celiac disease, estimated at around USD 200 million. At present, a gluten-free diet is the sole effective treatment for celiac disease, with the market in Japan valued at around USD 1,500 million in 2023. Celiac disease exhibits a significant gender imbalance, primarily affecting females. In Germany, for example, around 60% of diagnosed cases are female. In 2023, classical celiac disease accounted for approximately 30% of all celiac disease cases in Japan. According to the Beyond Celiac foundation (2024), approximately 1 in 133 Americans, or around 1% of the population, has celiac disease. It is also estimated that up to 83% of Americans with celiac disease remain undiagnosed or are incorrectly diagnosed with other medical conditions. According to Stahl et al. (2023), Celiac disease is a prevalent chronic condition globally, with an aggregated prevalence of 1.4%, though it can be significantly higher in specific regions. In a prospective birth cohort study involving infants at risk for celiac disease in Europe and the United States, the incidence was estimated to be 3% in Sweden and 2.4% in Colorado. According to the Celiac Disease Foundation, celiac disease is a significant autoimmune disorder estimated to impact 1 in 100 people globally. Additionally, 2.5 million Americans remain undiagnosed and are susceptible to potential long-term health issues. Key Celiac Disease Companies: Sanofi (Provention Bio), Zedira, Dr. Falk Pharma, Takeda, ImmunoGenX, Provention Bio, Sanofi, Topas Therapeutics GmbH, Pfizer, 9 Meters Biopharma, Inc., ChemoCentryx, BioLineRx, Ltd., and others Key Celiac Disease Therapies: PRV-015, TAK-227/ZED1227, Latiglutenase(IMGX003), Ordesekimab, TAK-101 and Zamaglutenase, TPM502, Ritlecitinib, TAK-062, larazotide acetate, CCX282-B, BL-7010, and others The Celiac Disease epidemiology based on gender analyzed that, females are affected more than males The Celiac Disease market is expected to surge due to the disease's increasing prevalence and awareness during the forecast period. Furthermore, launching various multiple-stage Celiac Disease pipeline products will significantly revolutionize the Celiac Disease market dynamics. Celiac Disease Overview Celiac Disease is a chronic autoimmune disorder triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. Celiac Disease causes an immune response that damages the lining of the small intestine, leading to malabsorption of essential nutrients. Celiac Disease affects both children and adults and can present with a wide range of gastrointestinal and non-gastrointestinal symptoms. Celiac Disease symptoms commonly include abdominal pain, bloating, diarrhea, constipation, fatigue, weight loss, and nutrient deficiencies. Celiac Disease may also manifest through skin rashes, neurological issues, anemia, osteoporosis, and infertility in some individuals. Celiac Disease is strongly associated with genetic factors, particularly the HLA-DQ2 and HLA-DQ8 genes. Celiac Disease diagnosis involves a combination of serologic testing for specific antibodies and confirmation through a small intestinal biopsy. Celiac Disease management requires a strict lifelong gluten-free diet, which helps in healing the intestinal lining and preventing further complications. Celiac Disease patients must avoid even trace amounts of gluten to maintain health and prevent flare-ups. Celiac Disease awareness and early detection are crucial to preventing long-term health consequences. Celiac Disease research continues to explore potential therapies beyond dietary management, including enzyme treatments and immune-modulating agents to improve patient outcomes. Celiac Disease Epidemiology The epidemiology section provides insights into the historical, current, and forecasted epidemiology trends in the seven major countries (7MM) from 2020 to 2034. It helps to recognize the causes of current and forecasted trends by exploring numerous studies and views of key opinion leaders. The epidemiology section also provides a detailed analysis of the diagnosed patient pool and future trends. Celiac Disease Epidemiology Segmentation: The Celiac Disease market report proffers epidemiological analysis for the study period 2020–2034 in the 7MM segmented into: Total Prevalent Population of Celiac Disease in the 7MM Total Diagnosed Prevalent Population of Celiac Disease in the 7MM Type-specific Prevalent Population of Celiac Disease in the 7MM Gender-specific Prevalent Population of Celiac Disease in the 7MM Age-specific Distribution of Celiac Disease in the 7MM Download the report to understand which factors are driving Celiac Disease epidemiology trends @ Celiac Disease Prevalence Celiac Disease Drugs Uptake and Pipeline Development Activities The drugs uptake section focuses on the rate of uptake of the potential drugs recently launched in the Celiac Disease market or expected to get launched during the study period. The analysis covers Celiac Disease market uptake by drugs, patient uptake by therapies, and sales of each drug. Moreover, the therapeutics assessment section helps understand the drugs with the most rapid uptake and the reasons behind the maximal use of the drugs. Additionally, it compares the drugs based on market share. The report also covers the Celiac Disease Pipeline Development Activities. It provides valuable insights about different therapeutic candidates in various stages and the key companies involved in developing targeted therapeutics. It also analyzes recent developments such as collaborations, acquisitions, mergers, licensing patent details, and other information for emerging therapies. Celiac Disease Therapies and Key Companies PRV-015 : Sanofi (Provention Bio) TAK-227/ZED1227: Zedira, Dr. Falk Pharma, and Takeda Latiglutenase(IMGX003): ImmunoGenX Ordesekimab: Provention Bio/Sanofi TAK-101 and Zamaglutenase: Takeda TPM502: Topas Therapeutics GmbH Ritlecitinib: Pfizer TAK-062: Takeda larazotide acetate: 9 Meters Biopharma, Inc. CCX282- B: ChemoCentryx BL-7010: BioLineRx, Ltd. Discover more about therapies set to grab major Celiac Disease market share @ Celiac Disease Treatment Market Celiac Disease Market Strengths The pipeline activity of Celiac Disease is quite efficient with the presence of variable key players such as First Wave BioPharma, Sanofi, Takeda, etc., which are efficiently involved in developing milestone treatment options. Latiglutenase has the potential to be a first to-market treatment for celiac disease, a GIdisorder that impacts approximately three million people in the US and for which no approved pharmacologic treatment currently exists. Celiac Disease Market Opportunities Several organizations such as Celiac Disease Foundation, National Celiac Association (NCA), American Celiac Disease Alliance (Celiac Disease A), Coelic UK etc. are actively working to provide information and awareness of the disorder. There is ongoing research into celiac disease, including potential treatments and therapies. Individuals with celiac disease can contribute to this research by participating in clinical trials or fundraising for research organizations. Scope of the Celiac Disease Market Report Study Period: 2020–2034 Coverage: 7MM [The United States, EU5 (Germany, France, Italy, Spain, and the United Kingdom), and Japan] Key Celiac Disease Companies: Sanofi (Provention Bio), Zedira, Dr. Falk Pharma, Takeda, ImmunoGenX, Provention Bio, Sanofi, Topas Therapeutics GmbH, Pfizer, 9 Meters Biopharma, Inc., ChemoCentryx, BioLineRx, Ltd., and others Key Celiac Disease Therapies: PRV-015, TAK-227/ZED1227, Latiglutenase(IMGX003), Ordesekimab, TAK-101 and Zamaglutenase, TPM502, Ritlecitinib, TAK-062, larazotide acetate, CCX282-B, BL-7010, and others Celiac Disease Therapeutic Assessment: Celiac Disease current marketed and Celiac Disease emerging therapies Celiac Disease Market Dynamics: Celiac Disease market drivers and Celiac Disease market barriers Competitive Intelligence Analysis: SWOT analysis, PESTLE analysis, Porter's five forces, BCG Matrix, Market entry strategies Celiac Disease Unmet Needs, KOL's views, Analyst's views, Celiac Disease Market Access and Reimbursement To know more about Celiac Disease companies working in the treatment market, visit @ Celiac Disease Clinical Trials and Therapeutic Assessment Table of Contents 1. Celiac Disease Market Report Introduction 2. Executive Summary for Celiac Disease 3. SWOT analysis of Celiac Disease 4. Celiac Disease Patient Share (%) Overview at a Glance 5. Celiac Disease Market Overview at a Glance 6. Celiac Disease Disease Background and Overview 7. Celiac Disease Epidemiology and Patient Population 8. Country-Specific Patient Population of Celiac Disease 9. Celiac Disease Current Treatment and Medical Practices 10. Celiac Disease Unmet Needs 11. Celiac Disease Emerging Therapies 12. Celiac Disease Market Outlook 13. Country-Wise Celiac Disease Market Analysis (2020–2034) 14. Celiac Disease Market Access and Reimbursement of Therapies 15. Celiac Disease Market Drivers 16. Celiac Disease Market Barriers 17. Celiac Disease Appendix 18. Celiac Disease Report Methodology 19. DelveInsight Capabilities 20. Disclaimer 21. About DelveInsight About DelveInsight DelveInsight is a leading Business Consultant and Market Research firm focused exclusively on life sciences. It supports pharma companies by providing comprehensive end-to-end solutions to improve their performance. Get hassle-free access to all the healthcare and pharma market research reports through our subscription-based platform PharmDelve. Media Contact Company Name: DelveInsight Business Research LLP Contact Person: Ankit Nigam Email: Send Email Phone: +14699457679 Address: 304 S. Jones Blvd #2432 City: Albany State: New York Country: United States Website:
Yahoo
3 days ago
- Health
- Yahoo
New study reveals the cellular network behind food tolerance and allergies
Weizmann scientists uncover why our immune system lets us eat without harm, how it tolerates food—and why it sometimes fails. If you are allergic to peanuts, milk products, or strawberries, you usually blame your immune system for this unfortunate reaction. But when people enjoy a varied diet without any troublesome reaction, they generally don't realize that this is thanks to their immune system. Our ability to ingest chicken, meat, or tomatoes, for example – which constitute material foreign to the body and could have been a hostile invader – is due to the immune mechanism known as oral tolerance. Though this tolerance is vital for our survival, how it works had remained puzzling despite years of research. Now, a new study entitled 'A coordinated cellular network regulates tolerance to food,' published in the prestigious journal Nature by Dr. Ranit Kedmi and her team at the Department of Systems Immunology at the Weizmann Institute of Science in Rehovot, has resolved a long-standing paradox surrounding oral tolerance and revealed the cellular network that is responsible. Their findings could help researchers understand this network's malfunctions that underlie food allergies, sensitivities, and disorders such as celiac disease (a bad reaction to gluten in foods containing wheat, spelt, barley, and rye). Tolerance to food begins to develop in the womb as the fetus's immune system is exposed to substances derived from food consumed by the mother. It continues to mature while she nurses the baby and as the child begins to eat solid food, as well as through interactions with beneficial gut bacteria that produce their own potential allergens that the immune system must learn to ignore. For years, tolerance to food was thought to be orchestrated by immune cells called dendritic cells (DC). They were discovered by Prof. Ralph Steinman, a Canadian-born Jewish physician and medical researcher at Rockefeller University in New York City. For his research on the leading causes of the immune system's attacks, he was posthumously awarded the 2011 Nobel Prize in Physiology or Medicine. When announcing the prize, the Nobel committee was unaware that Steinman had died from pancreatic cancer three days earlier. In infection, DCs chop up microbes and present their bits and pieces to other cells, triggering an assault by the immune system. The prevailing view of oral tolerance was that, after checking out digested food, DCs could instead decide to keep that attack at bay, instructing the immune cells to stand down and suppress any action. Yet, strangely, when researchers eliminated the suspected subset of DCs in animal models, oral tolerance still developed. Kedmi thought that the answer must be sought in a type of cell she had discovered during her postdoctoral studies: ROR-gamma-t cells, whose exact lineage is still unknown. This hunch proved true. In their new study, Kedmi's team, led by doctoral student Anna Rudnitsky, showed that ROR-gamma-t, rather than conventional dendritic cells, set off the tolerance mechanism. When Rudnitsky eliminated the ability of these particular cells to introduce food particles to the immune system in mice, the animals rapidly developed food allergies. 'Apparently, there is much more division of labor in the immune system than previously appreciated,' Kedmi told The Jerusalem Post in an interview. 'We want to understand food sensitivities in general. The reason why babies are exposed to peanut products like Bamba as a positive experience early in their lives is that it causes oral tolerance. If they are exposed to infection, which is a negative experience, it could be harmful.' She added, 'It's not that dendritic cells always decide whether or not to attack foreign substances. Instead, completely different players – specific, rare cells – are dedicated to launching a mechanism that makes sure we can consume food safely.' They next aimed to fully decipher the oral tolerance mechanism. By selectively manipulating genes and eliminating different cell types in mice and then using advanced genetic tools and microscopy to monitor cellular responses to food, the researchers identified a coordinated network of four cell types crucial for preventing immune reactions to food. This network is initiated by ROR-gamma-t cells, and their signals are relayed through two other cell types to ultimately suppress the fourth, the immune system's militant CD8 cells, which normally have the job of killing infected cells or triggering inflammation against perceived threats. These discoveries, particularly of the last link in the network, raised further intriguing questions for Kedmi. What would happen if the immune system encountered microbial proteins that are similar to food ingredients? How could it effectively fight microbial infection after suppressing the CD8 response to these ingredients? And, if oral tolerance suppresses this immune response, why haven't microbes evolved to disguise themselves as food to evade CD8's killing power? To address these questions, the researchers tested whether mice could develop immunity to a microbe that expresses a protein already identified by the mouse immune system as food. They revealed a remarkable reaction: Faced with a threat, the mice's immune systems temporarily suspended the tolerance program, deploying CD8 cells to combat the infection. Only after the infection cleared did the cellular network enable the tolerance program to resume. Using the analogy of two peaceful neighboring countries, Kedmi said that 'if an aggressor suddenly fires across the border, that person will be swiftly neutralized by the other side's forces, peace accords notwithstanding. The immune system operates on a similar principle. In the face of infection, it prioritizes fighting the disease-causing microbe, temporarily setting aside tolerance mechanisms.' Thus, the team has discovered a sophisticated, dynamic cellular network that allows the immune system to prevent inflammatory responses to food while simultaneously staying on guard against infection. This discovery opens promising new avenues for research into malfunctions in the oral tolerance mechanism that lead to allergies and diseases. It may explain how the final stage of the tolerance mechanism, the suppression of the CD8 cells, fails in celiac disease, causing the CD8s to mistakenly attack the intestinal lining in response to gluten. A detailed understanding of the specific points of failure within the oral tolerance network in all types of food allergies and sensitivities could pave the way for improved treatments, the study stated. Sign up for the Health & Wellness newsletter >>
Washington Post
22-05-2025
- Health
- Washington Post
Mothers and their babies face starvation in Gaza, where hospitals are overwhelmed
KHAN YOUNIS, Gaza Strip — Grabbing her daughter's feeble arm, Asmaa al-Arja pulls a shirt over the 2-year-old's protruding ribs and swollen belly. The child lies on a hospital bed, heaving, then wails uncontrollably, throwing her arms around her own shoulders as if to console herself. This isn't the first time Mayar has been in a Gaza hospital battling malnutrition, yet this 17-day stint is the longest. She has celiac disease, an autoimmune disorder that means she can't eat gluten and requires special food. But there's little left for her to eat in the embattled enclave after 19 months of war and Israel's punishing blockade , and she can't digest what's available.
Medscape
15-05-2025
- Health
- Medscape
Young Wrestler With Scaly Purulent Scalp Plaque
Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians, but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please email us at ccsuggestions@ with the subject line "Case Challenge Suggestion." We look forward to hearing from you. Background and Presentation A previously healthy 11-year-old boy presented with a 1-month history of multiple scaly plaques over the scalp. He is an avid wrestler and recalls that these symptoms appeared shortly after he wrestled with one of his friends. He stopped wrestling as soon as the symptoms appeared. He was prescribed topical corticosteroids (betamethasone valerate 0.1% cream) and topical antifungals (1% clotrimazole and 1% terbinafine) by his primary care physician, with no improvement of his symptoms. One day prior to presentation, the plaque over his left occiput became more raised and painful, with purulent discharge, prompting a visit to the emergency department. His medical history is significant only for celiac disease. He has no food or drug allergies and avoids gluten. He is healthy, and his immunizations are up to date. He does not take any other medications, and his family history is unremarkable. On presentation, the patient had a scaly plaque over his occipital scalp with purulent discharge (Figure 1). Figure 1. Well-demarcated scaly plaque over the patient's left occiput with purulent discharge. Physical Examination and Workup On general inspection, the patient was well-appearing and in no apparent distress. His vital signs were normal, with a blood pressure of 118/79 mm Hg, heart rate of 86 beats/min, respiratory rate of 24 breaths/min, oxygen saturation of 99% without respiratory support, temperature of 97.8 °F (36.6 °C), and weight of 79 lb (36 kg). On cutaneous examination, the patient had several scaly plaques over his scalp with a raised, boggy exophytic nodule with purulent drainage to his posterior scalp. Wood lamp examination revealed blue and green fluorescence (Figure 2). There was no sign of lymphadenopathy around the occipital region. Figure 2. Wood lamp examination revealing blue and green fluorescence within a well-demarcated plaque over the left occiput. Discussion Tinea capitis is a fungal infection affecting the scalp and hair follicles.[1-4] It typically presents as an itchy, scaly scalp with inflammation, which is the primary clinical presentation observed in this patient.[1,2] However, noninflammatory variants can manifest as gray patches, black dots, or diffuse scaling. In contrast, inflammatory forms, often resulting from untreated infections, can present as diffuse pustules, kerions, favus, and dermatophytid reactions.[2] This patient exhibited a kerion (ie, boggy exophytic nodule with purulent drainage) upon physical examination. The clinical findings are most consistent with tinea capitis with a kerion. Although irritant or allergic contact dermatitis can present with localized dermatitis and occasionally vesicles and bullae localized to areas of allergen exposure,[5] in this case the patient's symptoms have progressively worsened over the past month even after stopping wrestling, making contact dermatitis less likely. A drug-induced allergic reaction is unlikely because symptoms of immunoglobulin (Ig)E-mediated drug-induced allergic reactions, such as urticaria, generally present with erythematous wheals featuring pale centers.[6] The absence of these hallmark dermatologic findings reduces the likelihood of an IgE-mediated drug-induced allergic reaction in this patient. Macular and papular drug eruptions are not solitary, but are disseminated and usually involve the trunk rather than the scalp. Pityriasis rosea is a noncontagious dermatologic condition that presents with a distinctive scaly oval herald patch on the trunk, followed by multiple smaller lesions arranged in a "Christmas tree" distribution.[7] The lack of these distinctive clinical features makes pityriasis rosea an unlikely diagnosis. Although a bacterial abscess can present with purulence, the patient's history of wrestling and positive Wood lamp examination suggest something more than a bacterial abscess.[8] Condition Overview Tinea capitis is a contagious dermatophyte infection primarily affecting preadolescent boys aged 6-10 years, similar to the patient in this case.[1,2] Although the predominant causative species vary by geographic region, the most common dermatophyte species responsible for tinea capitis belong to the Microsporum and Trichophyton genera. The prevalence of specific species typically is influenced by socioeconomic and environmental factors.[1] Rapid diagnostic modalities include Wood lamp examination, trichoscopy, reflectance confocal microscopy, and direct microscopy with potassium hydroxide staining.[1-3] However, these tests are not definitive and do not provide species differentiation.[1] Histopathologic analysis is another diagnostic tool, although it requires a biopsy and may take up to 5 days to yield results; it also lacks the ability to differentiate fungal species. Alternatively, fungal culture and polymerase chain reaction (PCR) testing provide definitive species identification, but fungal cultures require several weeks and PCR analysis can be costly.[1] In this case, Wood lamp examination was used for rapid screening and helped support the diagnosis of tinea capitis. Of note, a negative Wood lamp result does not rule out a dermatophyte infection, because fungi that invade the hair shaft (an endothrix infection) may not fluoresce on Wood lamp examination. Preventive measures primarily focus on personal hygiene. Regular scalp washing and hair cleansing can reduce the risk of contracting tinea capitis. Routine scalp inspection is also recommended. Avoiding the sharing of personal items is critical because fungal spores can be transmitted via fomites. Infected individuals should ideally refrain from attending populated environments, such as schools, to reduce the rate of transmission.[1,2] The treatment of tinea capitis typically involves antifungal therapy. Topical antifungal monotherapy is not recommended because it does not adequately penetrate the hair shaft where the infection resides; however, it may help reduce fungal spore load and transmission. Oral antifungal agents are considered the first-line treatment, and combination therapy with both oral and topical antifungals is generally advised.[1-3] Further treatment options are discussed later in the case. First-line oral antifungal therapies that have been approved by the US Food and Drug Administration (FDA) for tinea capitis include terbinafine and griseofulvin.[1] Treatment Terbinafine has been demonstrated to be particularly effective against Trichophyton species.[2,3] A 2024 network meta-analysis by Gupta and colleagues indicated that terbinafine is generally more effective than griseofulvin in treating tinea capitis.[1] The FDA-approved formulation of terbinafine for tinea capitis treatment consists of granules for individuals aged 4 years and older.[1] The recommended dosage is 125 mg/d in persons weighing < 25 kg, 187.5 mg/d in those weighing 25-35 kg, and 250 mg/d in those weighing > 35 kg, administered over 6 weeks.[1,9,10] It is critical to note that terbinafine is also available in tablet form, which follows a different dosing regimen: 62.5 mg/d in persons weighing 10-20 kg, 125 mg/d in those weighing 20-40 kg, and 250 mg/d in those weighing > 40 kg.[1-3,11,12] Failure to consider formulation differences may result in underdosing. A randomized controlled trial by Koumantaki and colleagues demonstrated that doubling the standard dosage (125 mg/d in persons weighing 10-25 kg and 250 mg/d in those weighing > 25 kg) led to improved clinical outcomes in children without increasing adverse effects.[13] This study underscores the necessity of appropriate dosing. In this case, given the patient's weight of 36 kg, the recommended medication with the correct dose is terbinafine granules, 250 mg/d. Griseofulvin is particularly effective against Microsporum species.[2,3] The recommended dosage is 10-20 mg/kg/d for microsize griseofulvin tablets and 20-25 mg/kg/d for microsize griseofulvin oral suspension, administered for at least 6 weeks. Both formulations are FDA-approved for individuals aged 2 years or older.[1] Second-line treatment options include itraconazole tablets, administered at 50 mg for individuals weighing < 20 kg or 100 mg for those weighing > 20 kg for 4-6 weeks, depending on the dermatophyte species.[2,3] An oral solution formulation with lower dosing requirements is also available.[1] Fluconazole may be considered in exceptional cases; however, it has demonstrated the lowest efficacy among the four discussed antifungal agents.[1,2] Monitoring Management Many antifungal medications have the potential to be hepatotoxic, and liver function tests are warranted in patients with a history of liver impairment. While specific recommendations vary by medication, liver function testing is generally advised after 4-6 weeks of antifungal therapy. For terbinafine, absolute lymphocyte counts can be assessed alongside a liver panel in immunocompromised patients.[1] Routine liver function tests may not be necessary in healthy patients without a personal or family history of hepatic impairment. A retrospective review of approximately 5000 adult and pediatric patients by Stolmeier and colleagues suggested that abnormal laboratory findings were rarely seen.[11] The few detected abnormalities were primarily low-grade and did not necessitate further investigation. Similar findings have been reported in another retrospective analysis.[12] Thus, current evidence supports a shared decision-making approach regarding bloodwork for patients on oral terbinafine, allowing them to make informed choices on the basis of risk likelihood. Systemic antifungal medications have been associated with renal, cardiovascular, and thyroid-related adverse effects. A systematic review and meta-analysis conducted by the Cochrane Library on various systemic antifungal therapies for tinea capitis identified nausea, abdominal discomfort, and headache as among the most frequently reported adverse effects.[14] Beyond hepatotoxicity and potential drug interactions, no other rare but serious adverse effects were documented. After 3 days of taking the systemic antifungal medication, the patient developed disseminated monomorphic erythematous papules on his torso, arms, and legs (Figures 3 and 4). There were also pustules on his forehead and ears bilaterally (Figure 5). Otherwise, the patient is stable with normal vital signs. Figure 3. Monomorphic erythematous papules on the torso. Figure 4. Monomorphic erythematous papules on the left anterior thigh. Figure 5. Multiple monomorphic pustules on the left external auditory canal and inner aspect of the pinna, extending to the posterior left cheek. Potential Treatment Reactions A dermatophytid (or "id") reaction is a secondary immune response mediated by activated T lymphocytes or antibodies that typically targets antigens derived from nonliving organisms. Id reactions can arise from various infectious or inflammatory dermatologic conditions, including fungal, bacterial, viral, or parasitic infections. However, fungal infections — particularly tinea capitis — are the most common causative agents. When an id reaction originates from a dermatophyte infection, it is specifically termed a dermatophytid reaction.[15] Dermatophytid reactions secondary to tinea capitis commonly present as generalized papular or vesicular lesions affecting the scalp, neck, ears, and extremities distant from the original site of infection.[2,16] In some cases, they manifest as small, pale-red follicular papules, which may appear either scattered or clustered. These papules can occasionally develop fine, spiny projections or pustules. In other instances, dermatophytid reactions present as plaquelike lesions resembling seborrheic dermatitis. In rare cases, the rash may exhibit a morbilliform or scarlatinoid pattern.[15] Studies suggest that dermatophytid reactions may be more prevalent than currently reported.[17,18] They may develop at the peak of fungal infection or at any time before or during systemic antifungal treatment. This temporal association frequently results in misdiagnosis as an allergic reaction. Unlike an id reaction, an allergic reaction typically involves urticaria (itchy wheals or hives); angioedema; swelling of the lips, throat, and tongue; and, in severe cases, anaphylaxis.[6,19,20] Accurate diagnosis is essential because dermatophytid reactions do not warrant discontinuation of antifungal therapy; rather, adherence to the prescribed regimen is safe and necessary to treat the dermatophyte infection.[1,15,17,18] Although a dermatophytid reaction typically is not life-threatening and does not usually require hospital admission, patient follow-up is essential to prevent long-term complications. If left untreated or unrecognized, tinea capitis may result in scarring, alopecia, chronic infection, and alterations in skin texture. Particularly in pediatric patients, the condition may have substantial psychosocial consequences, affecting self-esteem, peer interactions, and academic performance.[1] Beyond terbinafine allergy and urticaria, the differential diagnosis includes drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome, a severe drug-induced reaction. DRESS syndrome typically presents with erythroderma, a morbilliform rash, facial edema, and diffuse lymphadenopathy. Systemic manifestations, including fever, pruritus, malaise, and organ involvement, are also common.[21] However, in this case, the patient's stable vital signs, absence of systemic symptoms, and presence of a papular eruption (as opposed to a morbilliform eruption) decrease the likelihood of DRESS syndrome. Acute generalized exanthematous pustulosis is also unlikely. It is frequently associated with fever and edematous erythema, neither of which are present in this patient.[22]
