Tinea capitis, a fungal infection of the scalp, commonly affects toddlers and is characterized by circular hair loss and flaky skin; it may present in various forms with differing symptoms. Diagnosis involves examining the scalp, often utilizing Wood's light and direct microscopy, while treatment typically includes antifungal shampoos. The prognosis is generally positive, with most patients experiencing complete recovery and hair regrowth, though severe cases may lead to scarring alopecia.

1. Tinea Capitis
Abdullatiff Sami Al-Rashed
Block 4.1 (Dermatology Week)
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

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.

4. 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.

5. Epidemiology
• Most common among toddlers and school age children.
• Much more common in blacks than in whites.

6. 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.

7. Etiology
• Organisms in the These genera causes Tinea Capitis:

8. Etiology
Etiology varies from country to country and from
region to region:

9. Transmission
 Person-to-person, animal-to-person, via fomites.
 Spores are present on asymptomatic carriers, animals,
or inanimate objects.

10. 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.

11. 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.

12. 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.

13. 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

14. History

15. History

16. Physical Exam and
Investigations

17. 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

18. 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

19. Differential Diagnoses

20. Treatment

21. Treatment
Adjunctive interventions:
• Antifungal shampoo : Selenium sulfide
5-10 ml on wet scalp, 2 applications each
week for 2 weeks will provide control.

22. 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.

23. Reference