Tinea capitis
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Syndrome: Scalp
ringworm
Major points
• Most common in preschool or school-age
children (ages 3–9 years)
• Clinical presentation is an incomplete
alopecia especially prominent on the crown and occipital regions, with scaling
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• Other clinical presentations:
1.
Asymptomatic scaling
2.
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Widespread scaling with minimal hair loss (seborrheic dermatitis-like pattern)
3.
Black-dot tinea –
discrete areas of hair loss with stubs of broken hairs resembling dots
4.
Kerion – painful,
inflamed, crusted mass with purulent discharge; often with associated fever and
regional lymphadenopathy
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• Transmission is person-to-person or
fomites such as combs, clothing, bedding, toys and furniture
•Asymptomatic
individuals, especially family members, act as reservoirs for infection (~25%
of family members affected)
Diagnosis
• Clinical examination
• KOH preparation: observe spores within
broken-off hairs, rarely hyphae
• Culture – collect specimen by rubbing a
sterile cotton swab over the scalp and inoculating in fungal media
• Skin biopsy may be necessary to confirm diagnosis
Treatment
• Topical antifungals not fully effective
• Oral griseofulvin:
1. Microsize griseofulvin 20mg/kg per day (maximum 1 g/24 hours)
2.
Ultramicrosize
griseofulvin 10mg/kg per day (maximum 750 mg/24 hours)
Take BID with fatty
foods to increase absorption
Minimal duration of
treatment is 4–6weeks; continue for 2 weeks past clinical resolution
• Adjuvant treatment to decrease fungal
shedding and spread of infection
1. Selenium sulfide 2.5% shampoo 2–3 times a
week
- Ketoconazole
1–2%shampoo2–3 times a week
• Newer oral antifungal therapies shown to
be safe and effective
terbinafine, itraconazole, fluconazole
• Obtain follow-up cultures until negative
result is obtained
• Evaluate household contacts and treat if
necessary
• For severe inflammatory kerion:
prednisone 1 mg/kg per day in addition to antifungal therapy, can hasten
reduction of scaling and pruritus
• Secondary bacterial infection in a
kerion should be treated with appropriate antibiotic therapy for Staphylococcus
coverage
Prognosis
• Usually resolves without permanent
alopecia
• With severe inflammatory disease,
scarring and permanent hair loss may occur, but tends to be rare and spotty
