Remember that common skin lesions may be passed from family member to family member

Author: Johann Peterson, MD

What to Do - Gather Appropriate Data

Tinea capitis is a fungal infection of the hair follicles of the scalp and is more common in prepubertal children than in adolescents or adults. It is typically caused by fungal species of the genera Trichophyton and Microsporum. Infection can be passed between members of a family, especially on fomites such ashairbrushesandpillows,andsomespeciescanbeacquiredfromhousehold pets. Clinically, tinea capitis takes both inflammatory and noninflammatory forms. The noninflammatory form consists of patches of localized scaly alopecia, which are often itchy, with an annular appearance. Ringworm may also be present on the body. The inflammatory form manifests as scattered pustules, abscesses, or a kerion (a boggy, inflamed swelling of the scalp, often painful or pruritic). Lymphadenopathy, especially occipital, is common. Tinea capitis is sometimes accompanied by an id (dermatophytid) reaction, especially after trauma to the affected skin or after the initiation of treatment. An id reaction is a systemic immune-mediated response to a localized dermatitis, and presents as a symmetric, pruritic, fine papulovesicular rash, although it can sometimes mimic a drug eruption. Fungal studies of the id lesions will be negative, and the rash resolves with effective treatment of the primary infection.

Diagnosisof tineacapitis canbe made clinicallyin obvious cases,by fungalcultureofhairorscrapings,orbyidentificationoffungalelementsonlight microscopy of a potassium hydroxide preparation. Some dermatophytes fluoresce under Wood's light, but this depends on the species and is unreliable. Treatment consists of systemic antifungals for an extended period, until signs of infection have resolved or culture is negative. Griseofulvin is the agent of choice and is typically prescribed for a minimum of 8 weeks. Other choices include fluconazole or terbinafine. Other family members should be examined and treated if necessary. Some recommend that infected patients use a topical treatment (e.g., selenium sulfide shampoo every other day for 1 to 2 weeks) initially to reduce the risk of spreading the infection.

Some patients with inflamed tinea can appear to have cellulitis. Their lesions are sometimes treated as such, with incision and drainage plus intravenous antibiotics. A fluctuant, inflamed lesion on the scalp without fever should make you doubt the diagnosis of cellulitis. Also look for tinea elsewhere on the patient and his or her family. If your patient is not ill– appearing, consider diagnostic studies before you treat.

Suggested Readings

Elewski BE. Clinical diagnosis of common scalp disorders. J Investig Dermatol Symp Proc. 2005;10(3):190–193.
Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol. 2000;42(1 Pt 1):1–20.
Martin ES, Elewski BE. Tinea capitis in adult women masquerading as bacterial pyoderma. J Am Acad Dermatol. 2003;49(2 Suppl):S177–S179.

Book Source Details

• Book Title: Avoiding Common Pediatric Errors
• Author(s): Anthony D Slonim MD, DrPH; Lisa Marcucci MD
• Year of Publication: 2008
• Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Lippincott Williams & Wilkins.

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Copyright Details: Avoiding Common Pediatric Errors, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Avoiding Common Pediatric Errors Authors: Anthony D Slonim MD, DrPH; Lisa Marcucci MD Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7489-6

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