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Tinea capitis

Etiology: - Trichophyton tonsurans (most common) Epidemiology: - predominantly affects black children - less commonly occurs in adults Pathology: - fungal forms within the hair shaft - hair fiber breakage * histopathology images [5,8] Clinical manifestations: 1) non-inflammatory a) one or multiply scaly plaques or patches b) broken hair &/or stubs (black dots) c) alopecia with minimal inflammation 2) inflammatory a) papular or nodular erythematous plaque b) alopecia c) may develop into boggy purulent nodule often with a surface yellow crust 3) pruritic 4) lymphadenopathy common * images [5,7,8,9] Laboratory: (see Tinea) Differential diagnosis: 1) psoriasis 2) seborrheic dermatitis 3) alopecia areata 4) trichotillomania Management: 1) oral terbinafine, fluoconazole or itraconazole for ~6 weeks [4] 2) oral griseofulvin for ~12 weeks (older treatment) [4] 3) ketoconazole is less effective 4) topical antifungal agents are generally ineffective 5) clean contaminated combs 6) evaluate family members, close contacts

General

Tinea

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 918, 997-1000
  2. Journal Watch 22(9):72, 2002 Friedlander SF, Aly R, Krafchik B, Blumer J, Honig P, Stewart D, Lucky AW, Gupta AK, Babel DE, Abrams B, Gourmala N, Wraith L, Paul C; Tinea Capitis Study Group. Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study. Pediatrics. 2002 Apr;109(4):602-7. PMID: 11927703
  3. Journal Watch 24(24):186, 2004 Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004 Nov;114(5):1312-5. PMID: 15520113
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  5. Kao GF, Elston DM (images) Medscape: Tinea Capitis http://emedicine.medscape.com/article/1091351-overview
  6. Gonzalez U, Seaton T, Bergus G et al Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD004685. PMID: 17943825
  7. DermNet NZ. Tinea capitis (images) http://www.dermnetnz.org/fungal/tinea-capitis.html
  8. Fremerey C, Nenoff P. Tinea Capitis in a Newborn. N Engl J Med 2018; 378:2022. May 24, 2018 PMID: 29791821 Free full text https://www.nejm.org/doi/full/10.1056/NEJMicm1711862
  9. Elston CA, Elston MD Identifying Lesions on Skin of Color. Medscape. 2021. May 10 https://reference.medscape.com/slideshow/identifying-lesions-6007985 - Elston CA, Elston DM Identifying Lesions on Skin of Color. Medscape. October 25, 2022 https://reference.medscape.com/slideshow/identifying-lesions-6007985