Rapid Onset of Tinea Capitis in Pediatric Patient Using Baricitinib.

Rapid Onset Tinea Infections within days of Starting Baricitinib

A variety of infections are slightly more likely in those who use JAK inhibitors. This includes bacterial, viral, fungal and opportunistic infections. There is an increased risk of tuberculosis, herpes zoster reactivation, pneumonia, urinary tract infections, cellulitis, gastritis, hepatitis, meningitis, aspergillosis, or candidiasis.

 

Rotaru  S et al.  2023

Authors of a new report describe an 8-year-old girl who developed inflammatory tinea capitis within just 10 days of starting oral baricitinib 2 mg for alopecia areata.

The patient had multiple painful erythematous alopecic nodules and follicular pustules on the scalp and neck as well as painful cervical adenopathy. Microsporum canis was detected in fungal cultures. Treatment with baricitinib was stopped and the patient was started on a 4-week course of oral terbinafine (125 mg/day) in combination with topical therapy comprising ciclopirox cream. After 4 weeks of treatment the tinea capitis was completely cured.

Fiocco et al. 2022

Fiocco et al reported a 36 year old man with atopic dermatitis who developed disseminated tinea corporis starting within days of starting baricitinib. The patient had a lymphopenia, slight reduced monocytes and reduced eosinophils which may be facilitated infection. He grew T rubrum. The systemic therapy with baricitinib was stopped. An oral therapy with terbinafine was initiated alongside topical treatment with ciclopirox cream and ciclopirox shampoo.

Tinea corporis in 36 year old male patient using the JAK inhibitor baricitinib for atopic dermatitis. SOURCE: Fiocco Z et al. Disseminated tinea corporis under baricitinib therapy for atopic dermatitis. Dermatol Ther. 2022 Apr;35(4):e15351. Used with creative common license.

Conclusion

This study by Rotaru et al and the study of Fiocco et al are nice reminders of how fast tinea infections can occur in immunosuppressed patients using JAK inhibitors. Cultures are important to guide therapy and to ensure that there are no mimickers of infections. Rarely, disseminated tinea infections can mimic a variety of diseases including SCLE

REFERENCE

Rotaru  S et al. Severe inflammatory tinea capitis in a child receiving baricitinib therapy for alopecia areata. Ann Dermatol Venereol. 2023 Mar 22;S0151-9638(23)00012-1.

Fiocco Z et al. Disseminated tinea corporis under baricitinib therapy for atopic dermatitis. Dermatol Ther. 2022 Apr;35(4):e15351.