12.46).įungal infection of the scalp can be confirmed by a KOH examination of infected hairs ( Fig. Patients with tinea capitis often have associated occipital, postauricular, and posterior cervical adenopathy (see Fig. Importantly, when pustules or weeping and crusting lesions involve the scalp or hair line, the infection is far more likely to be of fungal than bacterial origin. Incision and drainage of kerion is not indicated, because loculations are small and septae thick. Unless treated promptly and aggressively with oral antifungal agents and, in cases characterized by severe inflammation, systemic steroids, the latter may produce scarring and permanent hair loss. Less commonly, intense inflammation causes formation of raised, tender, boggy plaques or masses studded with pustules that simulate abscesses, termed kerions (see Fig. Some cases are characterized by patches of heaped-up scale in association with small pustules (see Fig. As the latter rupture, the area weeps and golden crusts form, simulating impetigo (see Fig. In yet other children, sensitization to the infecting organism results in more erythema, edema, and pustule formation. On occasion, scalp lesions are annular, simulating tinea corporis.
In other cases, there is widespread breakage at the scalp, creating a “salt-and-pepper” appearance, with the short residual hairs appearing as black dots on the surface of the scalp (see Fig. In some patients mild erythema and scaling of the scalp occur in association with partial alopecia ( Fig. Microsporum canis (the dog and cat ringworm) accounts for a smaller percentage of cases.Ĭlinical presentations of tinea capitis vary. tonsurans is the organism responsible for more than 95% of cases in the United States, and for unknown reasons, infection with this strain is endemic among African-American school children, although there is some evidence of spread by inadequately disinfected barber tools. This typically results in the development of multiple patches of partial alopecia, commonly referred to as ringworm. Zitelli MD, in Zitelli and Davis' Atlas of Pediatric Physical Diagnosis, 2018 Tinea Capitis (Fungal Infections of the Hair and Scalp)įungal infection of the hair weakens the shaft, causing breakage. The 1% solution is less expensive.īasil J. When using selenium sulfide shampoo as adjunctive treatment of tinea capitis, there is no difference between the 2.5% and 1% preparations in time required to produce a negative surface culture. Because of the risk of hepatotoxicity, the expense of the drug, the lack of superiority to griseofulvin in controlled studies, and the emergence of other more promising antifungal agents, oral ketoconazole is not the preferred treatment choice.
TINEA CAPITIS SCALP ADULT PATCH
2.īlack dot: Early lesions with erythema and scaling patch are easily overlooked until areas of alopecia develop. One or several lesions may be present sometimes the lesions join to form larger ones. The hairs within the patch break off a few millimeters above the scalp. Gray patch: Lesions are scaly and well demarcated.
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