Tinea capitis - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
Initially appear as erythematous scaly ring like papule on scalp Tinea capitis is a superficial dermatophyte fungal infection involving the skin of scalp, eyebrows and eye lashes. It is caused by organisms of genera Trichophyton and Microsporum. Fungi of human sources (anthrophilic organisms) cause balding and scaly areas with minimal inflammation. ,,, Initially appear as erythematous scaly ring like papule on scalp
Tinea capitis is a superficial dermatophyte fungal infection involving the skin of scalp, eyebrows and eye lashes. It is caused by organisms of genera Trichophyton and Microsporum. Fungi of human sources (anthrophilic organisms) cause balding and scaly areas with minimal inflammation. ,,,
Boggy swelling Due to acute severe inflammation, with pus infiltration and crust formation results in a boggy swelling. This is known as a 'kerion'. Fungi coming from animal sources (zoophilic fungi) induce a more intense inflammation than those from person to person. , Boggy swelling
Due to acute severe inflammation, with pus infiltration and crust formation results in a boggy swelling. This is known as a 'kerion'. Fungi coming from animal sources (zoophilic fungi) induce a more intense inflammation than those from person to person. ,
Alopecia Areas of hair loss occur due to breakage of infected hair shafts. Dermatophyte infection can be divided into endothrix, which refers to spread within the hair shaft and ectothrix, which refers to spread outside the hair shaft. In endothrix infected hairs break off sharply at the follicular orifice.This is associated with 'kerion' formation. In an ectothrix infection destruction of cuticle occurs. ,,, Alopecia
Areas of hair loss occur due to breakage of infected hair shafts. Dermatophyte infection can be divided into endothrix, which refers to spread within the hair shaft and ectothrix, which refers to spread outside the hair shaft. In endothrix infected hairs break off sharply at the follicular orifice.This is associated with 'kerion' formation. In an ectothrix infection destruction of cuticle occurs. ,,,
Pruritis Most of the patients complain of pruritus and this ranges from mild to intense itching. , Pruritis
Most of the patients complain of pruritus and this ranges from mild to intense itching. ,
Contact history Tinea capitis is a contagious and communicable fungal infection. Therefore contact history with infected family member or regular sharing of hats, combs,hair brushes, towels and pillows or animal contact may be positive in the history. Overcrowding and poor social conditions are also risk factors. , Contact history
Tinea capitis is a contagious and communicable fungal infection. Therefore contact history with infected family member or regular sharing of hats, combs,hair brushes, towels and pillows or animal contact may be positive in the history. Overcrowding and poor social conditions are also risk factors. ,
Common among pre adolescents In puberty the sebum content of skin surface increases. Sebum which is rich in lipids provide a suitable media for growth of causative organisms. Common among pre adolescents
In puberty the sebum content of skin surface increases. Sebum which is rich in lipids provide a suitable media for growth of causative organisms.

Clinicals - Examination

Fact Explanation
Single or numerous erythematous scaly circular ring like papule on scalp. Tinea capitis is a superficial dermatophyte fungal infection involving the skin of scalp, eyebrows and eye lashes. ,, Single or numerous erythematous scaly circular ring like papule on scalp.
Tinea capitis is a superficial dermatophyte fungal infection involving the skin of scalp, eyebrows and eye lashes. ,,
Inflammed crusts and exudate. As the immune response increases a few pustules appear and an exudate may be present. At worst, a 'kerion' develops resulting in a boggy mass. ,, Inflammed crusts and exudate.
As the immune response increases a few pustules appear and an exudate may be present. At worst, a 'kerion' develops resulting in a boggy mass. ,,
Patchy alopecia. Areas of hairloss occur due to breakage of infected hair shafts a few millimeters above the skin of the scalp. There may be black dots that indicate intrafollicular hair shafts that have broken off as the shaft protrudes above the scalp surface. ,, , Patchy alopecia.
Areas of hairloss occur due to breakage of infected hair shafts a few millimeters above the skin of the scalp. There may be black dots that indicate intrafollicular hair shafts that have broken off as the shaft protrudes above the scalp surface. ,, ,
Cervical lympadenopathy May be positive in patients with a severe acute inflammation associated with 'kerion' formation . Cervical lympadenopathy
May be positive in patients with a severe acute inflammation associated with 'kerion' formation .
Widespread papulo pustular rash on the trunk. Extensive infection is occasionally accompanied by a widespread papulo pustular rash on the trunk. This is known as an 'id reaction'. This is probably due to the host immune response to fungus. It resolves when fungal infection is treated. Widespread papulo pustular rash on the trunk.
Extensive infection is occasionally accompanied by a widespread papulo pustular rash on the trunk. This is known as an 'id reaction'. This is probably due to the host immune response to fungus. It resolves when fungal infection is treated.

Investigations - Diagnosis

Fact Explanation
Wood's light examination Utilizes a ultra violet light to observe the scalp skin closely. Usually gives a green fluorescence glow in Microsporum audouini and M.canis infections.This method is useful for screening children in institutions where outbreaks of tinia capitis can occur, however the most common fungus causing tinea capitis - Trychophyton tonsurans does not fluorescence. , Wood's light examination
Utilizes a ultra violet light to observe the scalp skin closely. Usually gives a green fluorescence glow in Microsporum audouini and M.canis infections.This method is useful for screening children in institutions where outbreaks of tinia capitis can occur, however the most common fungus causing tinea capitis - Trychophyton tonsurans does not fluorescence. ,
Light microscopic examination of skin scrapings. The scrapings should be taken from the scaly margin of the lesion, with small curette or a scalpel blade. Specimens are prepared with Potassium hydroxide. Branching hyphae can be seen on light microscopic examination. Hyphae may also be seen within the cleared hair shaft and spores may be seen around it. , Light microscopic examination of skin scrapings.
The scrapings should be taken from the scaly margin of the lesion, with small curette or a scalpel blade. Specimens are prepared with Potassium hydroxide. Branching hyphae can be seen on light microscopic examination. Hyphae may also be seen within the cleared hair shaft and spores may be seen around it. ,
Culture Culture should be carried out in a mycology or bacteriology laboratory. A transport medium is not necessary. Specimens can be sent in folded black paper or in a dry petri dish. Culture results may take up to 1 month. , Culture
Culture should be carried out in a mycology or bacteriology laboratory. A transport medium is not necessary. Specimens can be sent in folded black paper or in a dry petri dish. Culture results may take up to 1 month. ,

Management - Supportive

Fact Explanation
Patient education and counselling Inform the patient that this is a common superficial fungal infection which can be treated successfully with local application of anti fungals. ,, Patient education and counselling
Inform the patient that this is a common superficial fungal infection which can be treated successfully with local application of anti fungals. ,,
Education on hygiene This is a contagious condition. Patients should be advised not to share their personal combs, hair brushes, hats, towels and pillows to prevent recurrences. Regular bathing and wearing of clean dry clothes can prevent many superficial fungal infections. , Education on hygiene
This is a contagious condition. Patients should be advised not to share their personal combs, hair brushes, hats, towels and pillows to prevent recurrences. Regular bathing and wearing of clean dry clothes can prevent many superficial fungal infections. ,

Management - Specific

Fact Explanation
Topical Imidazole preparations This is for minor lesions and is considered ineffective in tinea capitis. Topical Imidazole preparations
This is for minor lesions and is considered ineffective in tinea capitis.
Griseofulvin Was the drug of choice for many years for tinea capitis. It has proven to be safe drug. (500mg b.d for 2-6 weeks) But treatment may have to be stopped if there are persistent headaches, nausea, vomiting or skin eruptions. It prevents fungal growth by inhibiting mitosis. The drug should not be given in pregnancy or in patients with liver failure or porphyria. It interacts with coumarin anticoagulants, therefore the dosage of may have to be increased. ,,, Griseofulvin
Was the drug of choice for many years for tinea capitis. It has proven to be safe drug. (500mg b.d for 2-6 weeks) But treatment may have to be stopped if there are persistent headaches, nausea, vomiting or skin eruptions. It prevents fungal growth by inhibiting mitosis. The drug should not be given in pregnancy or in patients with liver failure or porphyria. It interacts with coumarin anticoagulants, therefore the dosage of may have to be increased. ,,,
Terbinafine Acts by inhibiting ergosterol synthesis in fungi by inhibition of squalene epoxidase which is a part of the fungal cell membrane synthesis pathway. It is fungicidal. It cures dermatophyte infections more quickly and more reliably than griseofulvin. For tinea capitis administration of 250mg daily for 4 week is effective. ,, Terbinafine
Acts by inhibiting ergosterol synthesis in fungi by inhibition of squalene epoxidase which is a part of the fungal cell membrane synthesis pathway. It is fungicidal. It cures dermatophyte infections more quickly and more reliably than griseofulvin. For tinea capitis administration of 250mg daily for 4 week is effective. ,,
Itraconazole This is now preferred over Ketoconazole, which may cause liver damage. Fungistatic rather than fungicidal. It interferes with cytochrome P-450 enzyme system of the liver. Given as 100mg daily for 2-6 weeks. Serious side effects are uncommon but interactions with other drugs must be avoided. ,,, Itraconazole
This is now preferred over Ketoconazole, which may cause liver damage. Fungistatic rather than fungicidal. It interferes with cytochrome P-450 enzyme system of the liver. Given as 100mg daily for 2-6 weeks. Serious side effects are uncommon but interactions with other drugs must be avoided. ,,,
Ketoconazole The drug should be reserved for patients with severe and resistant disease because of the possibility of serious hepatotoxicity and occurrence of other side effects such as rashes, thrombocytopenia and gastrointestinal disturbances. ,,, Ketoconazole
The drug should be reserved for patients with severe and resistant disease because of the possibility of serious hepatotoxicity and occurrence of other side effects such as rashes, thrombocytopenia and gastrointestinal disturbances. ,,,

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