Snapshot A 10-year-old previously healthy African-American boy presents to the office with 2 weeks of a pruritic scalp. His mother reports that he has had patchy hair loss, and his two younger brothers have had mild scalp itchiness. She cuts all of their hair with the same hair trimmer. On exam, he has three scaly and circular patches about 3 cm in diameter, as well as alopecia and black dots in the areas of hair loss. He also has diffuse and shotty cervical lymphadenopathy. Introduction Clinical definition superficial fungal skin infection of the scalp Epidemiology Incidence common Demographics most common in pre-pubertal boys more common in African-Americans Location on the scalp ("capitis" = "head") Etiology Infectious agents are fungi called dermatophytes, including Trichophyton Microsporum Acquired through direct contact with the fungus e.g., shared combs and hats athletes with head-to-head contact (wrestling) Presentation Symptoms pruritic scalp with patchy hair loss Physical exam single or multiple scaly patches on the scalp alopecia with small black dots from broken-off hairs cervical lymphadenopathy less common kerion inflammatory plaque with drainage and crusting favus perifollicular erythema progresses to yellow cupping Studies Labs potassium hydroxide (KOH) prep will show fungal elemants inside or surrounding hair Wood lamp with ultraviolet light if hair fluoresces Microsporum spp. is the cause if hair does not fluoresce probable cause is Trichophyton spp. Culture can be done for definitive diagnosis Diagnostic criteria most commonly diagnosed based on physical findings Differential Alopecia areata autoimmune form of hair loss presents with patchy alopecia with black dots without scaling Seborrheic dermatitis presents with diffuse scaling on the scalp with erythema and pruritis Psoriasis presents with scaly, erythematous plaques that are well-demarcated Treatment Conservative management of close contacts indication when multiple children are in the home treatments use of antifungal shampoo by all house members avoid sharing and clean hair clippers, combs, and hats Medical oral antifungals indication when diagnosis is made by physical exam before culture results are available must be given for tinea capitis or kerions as topical therapy alone is insufficient medications griseofulvin terbinafine less common azoles (fluconazole and itraconazole) Complications May progress to kerion or favus Prognosis Excellent since most cases resolve with treatment