Head and neck lesions in a cohort irradiated in childhood for tinea capitis treatment
2011; Elsevier BV; Volume: 11; Issue: 3 Linguagem: Inglês
10.1016/s1473-3099(11)70047-0
ISSN1474-4457
AutoresPaula Boaventura, Paula Soares, Dina Pereira, José Teixeira-Gomes, Manuel Sobrinho‐Simões,
Tópico(s)Nonmelanoma Skin Cancer Studies
ResumoWe read with interest Shifra Shvarts and colleagues' Historical Review on the tinea capitis treatment campaign in 1950s Serbia.1Shvarts S Sevo G Tasic M et al.The tinea capitis campaign in Serbia in the 1950s.Lancet Infect Dis. 2010; 10: 571-576Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar Treatment of tinea capitis infection that included radiation was also used in Portugal in the same period, in accordance with the same Kienbock-Adamson technique.2Brandão N The roentgentherapy of ringworm of the scalp: technical aspects and problems.O Médico. 1953; (in Portuguese).: 857-864Google Scholar We had access to the registries of a cohort treated in the north of Portugal, which included patients' details, treatment dates, tinea diagnoses (type of infection), and doses received (table).TableRegistry variables of the tinea capitis irradiated cohort in the 1950–63 study, from the Dispensário de Higiene Social do Porto, and participants of the present studyCohort member (n=5358)Participants (n=1287)SexFemale2804 (52%)767 (60%)Male2554 (48%)520 (40%)Type of infectionFavus tinea1164 (22%)215 (17%)Microsporic or trycophitic tinea4191 (78%)1072 (83%)Not known3 ( 5 and ≤153765 (70%)850 (66%)>15185 (4%)18 (1%)Not known56 (1%)0Irradiation dose325–475 roentgens5024 (94%)1206 (94%)≥630 roentgens318 (6%)74 (6%)Not known16 (<1%)7 (<1%)Thyroid pathologyThyroid carcinoma..33 (3%)Follicular adenoma..18 (1%)Thyroid nodules..462 (36%)Data are number (%). Open table in a new tab Data are number (%). In March, 2006, we started to locate and contact the cohort members; this was a difficult task because 40–50 years have passed since their tinea capitis treatment. Nevertheless we have traced 3548 individuals, to whom we sent information letters with a free-phone contact number. This method allowed us to clinically examine 1287 individuals, all by the same clinician (TG), and report that 292 are dead and 85 are living abroad. We recommended neck ultrasounds, and 886 (70%) of the participants had the examination. A fine-needle aspiration biopsy was advised in 221 patients who had nodules with suspicious features. Surgery was proposed for 45 people whose biopsy samples showed malignant or follicular lesions. At clinical examination, 18 individuals had been previously diagnosed with thyroid carcinoma, and we diagnosed 15 more. In total, we recorded a 2·6% prevalence of thyroid carcinoma; similar to the 2·1% reported for survivors of the Hiroshima and Nagasaki atomic bombs in a survey study by Misa Imaizumi and colleagues3Imaizumi M Usa T Tominaga T et al.Radiation dose-response relationships for thyroid nodules and autoimmune thyroid diseases in Hiroshima and Nagasaki atomic bomb survivors 55–58 years after radiation exposure.JAMA. 2006; 295: 1011-1022Crossref PubMed Scopus (166) Google Scholar that used a similar protocol (thyroid ultrasonography). If we exclude from our study the previous diagnoses, the prevalence decreases to 1·4%, which is similar to the 0·95% reported by Siegal Sadetzki and co-workers.4Sadetzki S Chetrit A Lubina A et al.Risk of thyroid cancer after childhood exposure to ionizing radiation for tinea capitis.J Clin Endocrinol Metab. 2006; 91: 4798-4804Crossref PubMed Scopus (85) Google Scholar Our data seem to agree with the high risk of thyroid tumours reported in Shvarts and colleagues' study.1Shvarts S Sevo G Tasic M et al.The tinea capitis campaign in Serbia in the 1950s.Lancet Infect Dis. 2010; 10: 571-576Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar We have observed in our cohort a high prevalence of meningiomas and basal-cell carcinoma (data not shown), not mentioned by Shvarts and colleagues. We have also shown in this cohort that the favus tinea infection gives an eight-times increase in risk of alopecia when compared with trichophytic tinea, even after adjustment for age and irradiation dose.5Boaventura P Bastos J Pereira D et al.Alopecia in women submitted to childhood x-ray epilation for tinea capitis treatment.Br J Dermatol. 2010; 163: 643-644Crossref PubMed Scopus (7) Google Scholar Our data support and emphasise the arguments presented by Shvarts and colleagues, that physicians should be aware of particular subsets of population that might be at risk of late radiation-associated health effects. These data justify a close follow-up of the irradiated tinea capitis cohorts to identify those head and neck lesions that are undiagnosed. This work was supported by a grant from Fundação Calouste Gulbenkian (ref 76636) and Portuguese Foundation for Science and Technology (FCT) (project: PIC/IC/83154/2007), and further funding from the FCT by a grant to PB (SFRH/BPD/34276/2007). IPATIMUP is an Associate Laboratory of the Portuguese Ministry of Science, Technology and Higher Education, and is partly supported by the FCT. We thank all the individuals that agreed to participate in this study as well as all the physicians who provided us the clinical material and information. ErrataBoaventura P, Soares P, Pereira D, Teixeira-Gomes J, Sobrinho-Simões M. Head and neck lesions in a cohort irradiated in childhood for tinea capitis treatment. Lancet Infect Dis 2011; 11: 163–64. In this Correspondence, the labels for the table rows under the heading Sex were the wrong way round—the data on the first row are for female patients and the data on the second row are for male patients. The online version has been corrected as of April 27, 2011. Full-Text PDF
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