Tinea Capitis

Tinea capitis is a dermatophyte infection of the scalp. It is most commonly seen in children, particularly African-American children.

CLINICAL FEATURES Clinically one sees areas of alopecia with broken-off hairs and scale at the periphery. The alopecia is patchy and usually nonscarring ( Fig. 238-4). Occasionally, tinea capitis is associated with an intense inflammatory response. This is manifested as a boggy, tender, indurated plaque with superficial pustules and overlying alopecia. This is referred to as a kerion, and it may result in permanent scarring and alopecia.

DIAGNOSIS Diagnosis is based on a positive potassium hydroxide preparation or positive fungal culture. A potassium hydroxide preparation of the hair is necessary; scraping only the scalp rarely gives a positive KOH exam. Culture is often necessary to establish or confirm the diagnosis. Wood's light examination may be helpful as certain types of dermatophytes fluoresce under Wood's light examination.

TREATMENT After a diagnosis is established, the current first-line therapy is griseofulvin. Topical treatment alone is not affective. Ultramicrosized griseofulvin at doses of 15 mg/kg/day given bid with meals is recommended. Individuals should be treated for six weeks, at which time the patient should be reevaluated to determine whether therapy should be continued longer. Nizoral shampoo at least three times per week is recommended in addition to griseofulvin.

DISPOSITION Other family members, especially children, and other close contacts, such as classmates at school or day care, should be evaluated as well. Other affected members should be treated simultaneously to prevent reinfection. Follow-up is crucial and should be stressed as persistent infection may only manifest as scale and go unrecognized by caregivers. Follow-up should be with a primary care provider or a dermatologist.

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