Treatment Guideline Chart
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.

Tinea%20capitis%20(pediatric) Diagnosis


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 and/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 and debris left at the opening appears as a black dot
  • Color of “dot” will depend on hair color
  • Caused by T tonsurans, T soudanense, T violaceum, M audouinii
Grey Patch Pattern
  •  Patient has circular patches with hair loss and fine scaling which 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 with pustules on and/or in surrounding skin
  • Hypersensitivity to fungus may form a boggy, indurated, tumor-like mass that exudes pus and referred to as kerion
Diffuse Pustular Type
  • Discrete pustules or scabbed areas without scaling or significant hair loss
  • Pustules result from superimposed bacterial infection
  • An inflammatory variant characterized by yellow cup-shaped crusted lesions called scutula
  • Commonly seen in the Middle East and North Africa, caused by T schoenleinii

Laboratory Tests

  • Provides the most rapid means of diagnosis but may not always show positive in affected patients
  • Scalp scales and/or hair are mounted in 10-30% potassium hydroxide (KOH) solution, gently heated and viewed under light or fluorescence microscope
  • Positive results reveal hairs and scales invaded by spores and/or hyphae
Causative Agents
  • Large-spored endothrix pattern chains of large spores within hair (T tonsurans, T violaceum)
  • Large-spored ectothrix (T verrucosum, T mentagrophytes)
  • Small-spored ectothrix randomly arranged in masses inside and on the surface of the hair shaft (M canis, M audouinii)
  • Allows accurate identification of organism but results may take up to 4 weeks (6 weeks for T verrucosum, T violaceum and T soudanense)
  • Use of Sabouraud agar with 1 or more plates with cycloheximide is recommended
    • Options for growth media that can be used include Kimmig fungal agar and other agars that contain antibiotics and cycloheximide (eg Mycosel® agar)
  • Results may be positive even when microscopy is negative
  • Necessary in hair fungal infections to identify the source of infection and verify the infecting species
  • A noninvasive in vivo imaging technique that may aid in the diagnosis of tinea capitis, especially in patients with black dot pattern
  • Used for rapid initial assessment and when mycological tests are unavailable
  • May also be used when choosing a suitable sampling site and for treatment monitoring, in combination with ultraviolet light
Wood’s Light Exam
  • Useful for certain ectothrix infections (eg M canis, M audouinii, M rivalieri)
  • If present, will cause hair to fluoresce bright green
  • T tonsurans, T rubrum and T mentagrophytes, which cause tinea capitis (depending on the region), does not fluoresce
Molecular Methods
  • Eg conventional polymerase chain reaction (PCR) with subsequent species identification by sequencing, enzyme-linked immunosorbent assay (ELISA), microarray, blot, real-time PCR, matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry
  • Highly sensitive and specific, and significantly faster compared to KOH preparation and culture
  • Currently the only methods capable of species identification from clinical material
Histologic Exam
  • Histologic examination of biopsies with staining may be considered in post-treatment patients with a negative mycological test result especially those with deep dermatophytosis
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