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Tinea Capitis

Interactive Seminar, Dermatology Week

Block 4.1 , College of Medicine, King Faisal University

Al-Ahsa, Saudi Arabia

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Tinea Capitis

  1. 1. Tinea Capitis Abdullatiff Sami Al-Rashed Block 4.1 (Dermatology Week) College of Medicine, King Faisal University Al-Ahsa, Saudi Arabia
  2. 2. Case A 3-year-old boy presents with a 3-week history of a circular scalp area of hair loss and flaky skin. He attends daycare and is provided with a sleep mat for an afternoon nap, which is not exclusively for his use. The scalp lesion is not itchy, but has not gone away with an anti-dandruff shampoo. There are no other skin lesions present.
  3. 3. Definition • Tinea capitis is a fungal infection of the scalp that most often presents with pruritic, scaling areas of hair loss. • Several synonyms are used, including ringworm of the scalp and tinea tonsurans.
  4. 4. Epidemiology • Most common among toddlers and school age children. • Much more common in blacks than in whites.
  5. 5. Etiology • Tinea capitis is a dermatophyte infection. • Dermatophytes are filamentous fungi in the genera Trichophyton, Microsporum, and Epidermophyton that infect keratinized tissue of skin, hair, or nails.
  6. 6. Etiology • Organisms in the These genera causes Tinea Capitis:
  7. 7. Etiology Etiology varies from country to country and from region to region:
  8. 8. Transmission  Person-to-person, animal-to-person, via fomites.  Spores are present on asymptomatic carriers, animals, or inanimate objects.
  9. 9. Clinical presentation Non- inflammatory infection  Partial alopecia, often circular in shape, showing numerous broken-off hairs, dull gray from their coating of arthrospores.  Fine scaling with fairly sharp margin.  Infammatory response minimal, but massive scaling.
  10. 10. Clinical presentation Black dot  Broken off hairs near the scalp give appearance of “dots”.  Tends to be diffuse and poorly circumscribed.  Low-grade folliculitis may be present.
  11. 11. Clinical presentation kerion  Inflammatory mass in which remaining hairs are loose.  Characterized by boggy, purulent, inflamed nodules, and plaques  Usually painful; drains pus from multiple openings, like honeycomb.  thick crusting with matting of adjacent hairs.  Frequently, associated with lymphadenopathy.
  12. 12. Clinical presentation Favus  Early cases show perifollicular erythema and matting of hair.  Later, thick yellow adherent crusts (scutula)composed of skin debris and hyphae that are pierced by remaining hair shafts.  Fetid odor.  Shows little tendency to clear spontaneously. Often results in scarring alopecia
  13. 13. History
  14. 14. History
  15. 15. Physical Exam and Investigations
  16. 16. Physical Exam and Investigations  Examination of the affected area with a Wood's light can help identify tinea capitis in patients with some ectothrix infections and favus.  Ectothrix infections secondary to M. canis often exhibit green- yellow fluorescence.  T. tonsurans does not fluoresce. Wood’s light
  17. 17. Diagnosis  skin scales contain hyphae and arthrospores.  Ectothrix: arthrospores can be seen surrounding the hair shaft.  Endothrix: spores within hair shaft.  Favus: loose chains of arthrospores and airspaces in hair shaft Direct Microscopy ”potassium hydroxide” Growth of dermatophytes usually seen in 10-14 days. Rule out bacterial infection, usually S. aureus or GAS. Fungal Culture Bacterial Culture
  18. 18. Differential Diagnoses
  19. 19. Treatment
  20. 20. Treatment Adjunctive interventions: • Antifungal shampoo : Selenium sulfide 5-10 ml on wet scalp, 2 applications each week for 2 weeks will provide control.
  21. 21. Prognosis • The prognosis of tinea capitis is excellent, with complete clearance occurring in most patients after a course of treatment. • Complete hair regrowth occurs in most children with hair loss. • Patients with chronic or severe infections (eg, kerion, favus) have the greatest risk for permanent scarring alopecia.
  22. 22. Reference

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Interactive Seminar, Dermatology Week Block 4.1 , College of Medicine, King Faisal University Al-Ahsa, Saudi Arabia

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