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Updated: Dec 16 2021

Tinea Capitis

  • 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
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