//fpnotebook.com/
Tinea Capitis
Aka: Tinea Capitis
- See Also
- Scalp Dermatitis
- Epidemiology
- Children most often affected (esp. ages 4-14 years)
- Risk Factors
- Household exposure
- Low socioeconomic groups
- Causes
- Trichophyton tonsurans (90-95% of U.S. cases)
- Microsporum species from dogs and cats (fluoresce blue-green under wood's lamp)
- Microsporum canis
- Microsporum audouinii
- Pathophysiology: Contagious Spread
- Easily spread by fomites or hair
- Contaminated hats, brushes or barber instruments
- Infectious fungal particles are viable on fomites for months
- Person to Person Spread
- Non-Inflammatory Tinea Capitis
- Black dot Ringworm
- Spread from cats, dogs, and soil
- Inflammatory Tinea Capitis
- Differential Diagnosis
- Scaling and Inflammation predominant
- Seborrheic Dermatitis
- Atopic Dermatitis
- Psoriasis
- Impetigo
- Cellulitis
- Alopecia predominant
- Discoid Lupus
- Syphilis
- Alopecia Areata
- Trichotillomania
- Traction Alopecia
- Symptoms
- Pruritus (especially in Inflammatory Tinea Capitis)
- Signs
- General findings
- Circumscribed areas of Alopecia
- Boggy, raised lesion
- Rim of erythema (variable)
- Fine scale
- Microsporum lesions fluoresce under Wood's Lamp
- Trichophyton (92% of cases) does not fluoresce
- Hence most cases of Tinea Capitis do not fluoresce
- Classic presentation strongly suggests Tinea Capitis
- Pruritus
- Posterior Cervical Lymphadenopathy (absent in Alopecia)
- Alopecia
- Scaling
- Hubbard (1999) Arch Pediatr Adolesc Med 153(11): 1150-3 [PubMed]
- Non-inflammatory (epidemic) Tinea Capitis
- Hair gray or lusterless
- Hair breaks above scalp
- Wood's Lamp: Fluorescent (Microsporum species)
- Inflammatory Tinea Capitis
- Scalp red with Pustules or with painful, red, boggy Plaque (kerion)
- Psoriasis appearance, but hairs are broken off
- Purulent drainage
- Fever
- Posterior Cervical Lymphadenopathy
- Wood's Lamp: Fluorescent (Microsporum species)
- Black dot Ringworm
- Hair breaks off at skin level
- Scalp studded with tiny black dots
- Wood's Lamp: Not Fluorescent
- Diagnosis: Criteria for empiric treatment
- Criteria: Three or more of the following present
- Scalp Scaling
- Alopecia
- Occipital adenopathy
- Scalp Pruritus
- Interpretation
- Findings highly suggestive of Tinea Capitis in child
- Test Sensitivity: 92% (but small study)
- Justifies empiric Tinea Capitis therapy
- References
- Hubbard (1999) Arch Pediatr Adolesc Med 153:1150-3 [PubMed]
- Complications: Kerion
- Allergic sensitization to fungus
- Results in Alopecia if untreated
- Labs
- Potassium Hydroxide (KOH)
- Sample active border of inflamed patch
- Hair Fungal Culture
- Typically requires 6 weeks for results
- Management
- General
- Examine household contacts (and treat if Tinea Capitis present)
- Most Antifungal Medications require lab monitoring
- See specific agents for details
- Confirm the diagnosis first with Potassium Hydroxide (KOH) preparation and Fungal Culture
- Kerion treatment should be started immediately while awaiting culture results
- Children with classic findings (e.g. Pruritus, Scaling, Alopecia, adenopathy) may be treated empirically
- First Line: Terbinafine
- Adult (and child >40 kg): 250 mg orally daily for 2-4 weeks
- Child 20-40 kg: 125 mg (up to 187.5 mg) orally daily for 2 weeks
- Child <20 kg: 62.5 mg (up to 125 mg) orally daily for 2 weeks
- Trichophyton tonsurans may require 2-4 weeks of treatment
- Microsporum canis may require 4-8 weeks of treatment
- Alternative Agents
- Fluconazole
- Daily: 6 mg/kg (up to 150 mg) daily for 3-6 weeks
- Weekly: 6 mg/kg (up to 150 mg) each week for 8-12 weeks
- Itraconazole
- Daily
- Solution 3 mg/kg/day up to 500 mg/day for 4-6 weeks
- Capsules 5 mg/kg/day up to 500 mg/day for 4-6 weeks
- Monthly
- Solution 3 mg/kg/day up to 500 mg/day, daily for one week per month for 2-3 months
- Capsules 5 mg/kg/day up to 500 mg/day, daily for one week per month for 2-3 months
- Griseofulvin microsize (Griseofulvin V)
- Ultrasize preparations are also available but are significantly more expensive
- Adults: 500 mg (up to 1 g) orally daily for 6-8 weeks
- Child: 10-20 mg/kg/day (up to 20-25 mg/kg/day, maximum 1 g/day) until Hair Growth (typically 8 weeks)
- Less effective for Trichophyton tonsurans (accounts for most cases of U.S. Tinea Capitis)
- May be more effective for microsporum species
- Concurrent Topical Antifungal reduces transmission
- May also be used in asymptomatic household contacts
- Apply for 5 minutes 2-3 times each week
- Agents
- Selenium Sulfate (2.5%) or
- Topical Ketoconazole or
- Povidone Iodine lotion or Shampoo
- Kerion
- Antifungal agent AND
- Corticosteroid
- Prednisone 1 mg/kg/day or
- Topical triamcinolone 0.1% Cream
- References
- Gilbert (2013) Sanford Guide to Antimicrobials
- Andrews (2008) Am Fam Physician 77(10): 1415-20 [PubMed]
- Ely (2014) Am Fam Physician 90(10): 702-10 [PubMed]
- Schwartz (2004) Lancet 364(9440):1173-82 [PubMed]
- Nesbitt (2000) Int J Dermatol 39(4):261-2 [PubMed]