3. OVERVIEW
• It is a disease caused by superficial fungal
infection of the skin (dermatophyte) of the
scalp, eyebrows, and eyelashes, with a
propensity for attacking hair shafts and
follicles .
• Several synonyms are including ringworm of
the scalp and tinea tonsurans.
• The term tinea meant parasitic infestation of
the skin.
• Tinea capitis is caused by fungi of species of
genera Trichophyton(T) and Microsporum(M)
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4. • almost always occurs in small children
and less frequently seen in adults
• The incidence of tinea capitis is increasing.
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5. ETIOLOGY
Tinea capitis is classified according to how the
fungus invades the hair shaft.
1- Ectothrix infection
due to infection with
M. canis, M. audouinii, M. distortum, M. ferrugineum,
M. gypseum, M. nanum, and T. verrucosum.
The fungal branches (hyphae) and spores
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(arthroconidia) cover the outside of the hair.
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6. 2- Endothrix infection
results from infection with
T. tonsurans, T. violaceum
and T. soudanense.
The hair shaft is filled with
fungal branches (hyphae) and
spores (arthroconidia).
3- Favus
( tinea favosa )
caused by T.schoenleinii infection,
which results in a honeycomb
destruction of the hair shaft
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7. CLINICAL FREATURES
-Tinea capitis is most prevalent between 3 and 7
years of age.
- It is slightly more common in boys than girls.
Infection by T. tonsurans may occur in adults.
Tinea capitis may present in several ways :
- Dry scaling – like dandruff but usually with moth-eaten hair loss
- Black dots – the hairs are broken off at the scalp surface,
which is scaly
- Smooth areas of hair loss
- Kerion – very inflamed mass, like an abscess
- Favus – yellow crusts and matted hair
- Carrier state no symptoms and only mild scaling (T. tonsurans)
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8. Tinea capitis can occur in three distinctly
different forms:
gray patch ,black dot and favus .
Gray patch tinea capitis (GPTC)
It begins with an erythematous, scaling,
well-demarcated patch on the scalp that
spreads centrifugally for a few weeks or
months, ceases to spread, and persists
indefinitely, sometimes for years
Round grayish, scaly plaques with
progressive expanding
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9. Black dot tinea capitis (BDTC)
usually begins as an asymptomatic,
erythematous, scaling patch on the
scalp, which slowly enlarges.
Lesions may be single or multiple.
Early lesions are easily overlooked
and the disease is not usually
noticed until areas of alopecia
become evident.
A round patch of alopecia with
overlying scale and "black dots" at the
sites of follicular openings is present.
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Most often caused by Trichophyton tonsurans (endothrix) Page 9
10. Favus (tinea favosa )
Perifollicular erythema on the
scalp, which progresses to the
characteristic finding
of concave, cup-shaped
yellow crusts called scutula.
Scutula are composed of fungi,
neutrophils, dried serum, and
epidermal cells.
It has unpleasant smell .
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most often due toTrichophyton schoenleinii (endothrix)
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11. INVESTIGATIONS
- Ectothrix infections can be
identified by Woods light
(long wave ultraviolet light)
- Endothrix infections do not
fluoresce with Woods light.
- Spores are identifiable by KOH
examination of the hair shaft, not by
KOH scraping of the scale, though
hyphae may be seen on occasion
- Culture on Sabouraud's medium
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12. DIAGNOSIS
- Tinea capitis is suspected if there is a combination
of scale and bald patches.
- Wood's light fluorescence is helpful but not
diagnostic
- The diagnosis of tinea capitis should be
confirmed by microscopy and culture of skin
scrapings and hair pulled out by the roots.
- Sometimes, diagnosis is made on skin biopsy
showing characteristic
histopathological features of tinea capitis.
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14. TREATMENTS
- Treatment of carriers is necessary to prevent
spread of infection.
- Antifungal shampoo twice weekly for four
weeks may be sufficient but if cultures remain
positive, oral treatment is recommended.
Suitable shampoos include:
- 2.5% selenium sulfide
-1% to 2% zinc pyrithione
- Povidone-iodine
- 2% Ketoconazole
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15. Griseofulvin (20 to 25 mg/kg/day for 6-12 weeks) has a
long history of safety and efficacy in tinea capitis in
children.
Terbinafine tablet treatment schedules are based on
weight :
10 to 20 kg: 62.5 mg daily for two to four weeks
20 to 40 kg: 125 mg daily for two to four weeks
Above 40 kg: 250 mg daily for two to four weeks
Oral itraconazole, and fluconazole are additional therapeutic
options that allow shorter courses of treatment
The duration is 4 to 6 weeks .
However, these medications are not always successful
and it may be necessary to try another agent.
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