Journal of Drug Delivery Science and Technology 74 (2022) 103496 Available online 9 June 2022 1773-2247/© 2022 Elsevier B.V. All rights reserved. Photodynamic therapy of tinea capitis in children using curcumin loaded in nanospanlastics: A randomized controlled comparative clinical study Eman M. Abdullah a , Abeer Tawfk a , Maha Fadel b , Jehan Alsharnoubi c , Doaa A. Abdel Fadeel b, * , Noha Abdallah a a Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt b A Pharmaceutical Technology Unit, Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Egypt c Pediatrics Unit, Department of Medical Applications of Lasers, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt A R T I C L E INFO Keywords: Curcumin Tinea capitis Griseofulvin Nano-spanlastics Photodynamic therapy ABSTRACT Tinea capitis is a common scalp dermatophyte infection in children. Treatment necessitates oral antifungal therapy which represents a therapeutic challenge. Photodynamic therapy (PDT) has emerged as a new antifungal therapeutic approach. The effcacy of PDT depends on the proper choice of the photosensitizer and its delivery system. Curcumin, a natural polyphenol, is well studied as a photosensitizer, however, its hydrophobicity hinders its clinical use. This study aims to improve the use of curcumin in PDT by loading it to a novel vesicular nano spanlastics (NVS) and examine their effcacy in PDT of tinea capitis. A prospective, randomized, controlled comparative study was conducted. Fifty-two children with Tinea Capitis were randomly divided into four groups; Cur-PDT group, oral griseofulvin group, topical curcumin group, and blue light group. Clinical and dermoscopic assessments were done, at baseline, every two weeks and after 6 months for follow-up. The results were confrmed by potassium hydroxide (KOH) 10% and fungal culture before and after the treatment. Complete cure was based on clinical, dermoscopic, and mycological cures. Cur-PDT group showed complete clearance in 46% of children with variable response among fungal species, compared to 100% in the griseofulvin group. No effects were observed in curcumin or light groups. Cur-PDT group showed very mild tolerable burning pain. Griseofulvin group experienced systemic side effects in some cases. Cur-PDT can be a promising well-tolerated alternative treatment of tinea capitis, but with variable re- sponses among fungal species. 1. Introduction Tinea capitis is one of the commonest dermatophyte infections, mainly of the Microsporum and Trichophyton species, affecting the scalp and hair [1]. It occurs mostly in children and rarely in adults. However, recent studies show a higher incidence of adult infection than previously reported [2–4]. Tinea capitis prevalence differs according to the geographical distribution [4,5]. The patient can present a localized area of hair loss, scaling, grey patch, black dots, kerion, favus, agminate folliculitis, erythema, or impetigo-like lesions [6]. This variability is related to the causative organism, the immune response, or the type of hair infection [7]. Topical antifungals have a limited role in the treatment of tinea capitis except as an adjunctive to oral therapy [1]. Oral antifungals such as griseofulvin, terbinafne, itraconazole, and fuconazole are the mainstay treatment [8]. They are facing many therapeutic problems such as long duration of treatment, multiple drug interactions, many adverse effects, lack of a syrup form in some countries, the need for higher doses for certain species, resistance, chronicity, and recurrence of infection. Photodynamic therapy (PDT) has been recently introduced as an alternative therapeutic modality for many microbial diseases. It depends on a group of light-sensitive compounds, called photosensitizers (PS). Upon irradiation by light of an appropriate wavelength in the presence of tissue oxygen, PS can be excited from their ground state to higher energy levels. When they relaxed to their ground state again, they un- dergo two types of photochemical reactions producing free radicals, reactive oxygen species (ROS), and singlet oxygen which have a * Corresponding author. Pharmaceutical Technology Unit, Medical Laser Applications, National Institute of Laser Enhanced Sciences (NILES) Cairo University, Egypt. E-mail addresses: d_fadeel@cu.edu.eg, doaa.fadeel@niles.edu.eg (D.A. Abdel Fadeel). Contents lists available at ScienceDirect Journal of Drug Delivery Science and Technology journal homepage: www.elsevier.com/locate/jddst https://doi.org/10.1016/j.jddst.2022.103496 Received 31 March 2022; Received in revised form 31 May 2022; Accepted 7 June 2022