tinea%20capitis%20(pediatric)
TINEA CAPITIS (PEDIATRIC)
Tinea capitis lesions are a type of contagious dermatophytosis that are found on the scalp, hair follicles and/or surrounding skin.
It is most common in the crowded areas as infection originates from contact with a pet or an infected person and asymptomatic carriage persists indefinitely.
It primarily affects children 3-7 year of age.
The causative agents are the genus Trichophyton and Microsporum.
Cardinal clinical feature is the combination of inflammation with hair breakage and loss.

Assessment

Patterns of Clinical Infection:
  • Host T-lymphocyte response determines clinical infection patterns
Seborrheic Dermatitis Type
  • Diffuse or patchy, fine, white, adherent scales on the scalp resembling dandruff
  • There are tiny, perifollicular pustules &/or hair stubs from the scalp
Black Dot Pattern
  • Patient has areas of noninflammatory hair loss that are well demarcated; hairs are broken off at the follicular orifice & debris left at the opening appears as a black dot
  • Color of “dot” will depend on hair color
Grey Patch Pattern
  •  Patient has circular patches w/ hair loss & fine scaling w/c is dull grey in color
  • Greying is caused by the spores covering the affected hair
Inflammatory Forms
  • Intense inflammation manifests as single or multiple boggy, tender areas of alopecia w/ pustules on &/or in surrounding skin
  • Hypersensitivity to fungus may form a boggy, indurated, tumor-like mass that exudes pus & referred to as kerion
Diffuse Pustular Type
  • Discrete pustules or scabbed areas w/o scaling or significant hair loss
  • Pustules result from superimposed bacterial infection
Favus
  • An inflammatory variant characterized by yellow cup-shaped crusted lesions called scutula
  • Commonly seen in the Middle East & North Africa, caused by T. schoenleinii

Laboratory Tests

Microscopy
  • Provides the most rapid means of diagnosis but may not always show positive in affected patients
  • Scalp scales &/or hair are mounted in 10-30% Potassium hydroxide (KOH) solutionn, gently heated & viewed under light or flourescence microscope
  • Positive results reveal hairs &scales invaded by spores &/or hyphae
Culture
  • Allows accurate identification of organism but results may take up to 4 week
  • Use of Sabouraud agar w/ 1 or more plates w/ cycloheximide is recommended
  • Results may be positive even when microscopy is negative
  • Necessary in hair fungal infections to identify the source of infection & verify the infecting species
Dermoscopy
  • A noninvasive in vivo imaging technique that may aid in the diagnosis of tinea capitis, especially in patients w/ black dot pattern
Wood’s Light Exam
  • Useful for certain ectothrix infections (eg M canis, M audouinii, M rifalieri)
  • If present, will cause hair to fluoresce bright green
  • T tonsurans, T rubrum & T mentagrophytes, which cause tinea capitis (depending on the region), does not fluoresce
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