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Tinea Capitis

Scalp Ringworm

Tinea capitis is a condition characterized by a fungal infection that affects the scalp, eyebrows, and eyelashes. It is also known as ringworm of the scalp.


Presentation

Tinea capitis presents with the following signs and symptoms [6]:

  • Development of round patches on the scalp along with presence of black spots that occur because hair has broken from that particular part
  • Patches expand gradually and eventually enlarge
  • The affected areas turn scaly with redness
  • Hair becomes brittle and breaks off easily
  • Affected area is tender and painful to touch
  • Pruritus

In many instances, there is permanent hair loss and scars. Affected individuals can also suffer from low grade fever. Swollen lymph node is yet another important marker in individuals with tinea capitis.

Increased Susceptibility to Infections
  • Despite the neonate's increased susceptibility to infections, tinea capitis is rare in this population. We present the case of a 16-day-old infant with tinea capitis caused by Microsporum canis and effectively treated with topical bifonazole 1%.[ncbi.nlm.nih.gov]
Thyroid Nodule
  • Fine needle aspiration cytology was suggested whenever ultrasound thyroid nodules presented suspicious features. We observed a 54 % frequency of thyroid nodules and a 2.8 % frequency of thyroid carcinoma (38/1,375).[ncbi.nlm.nih.gov]
Periodontitis
  • Report of clinical and microbiological periodontal findings before and 6 months after treatment of two siblings with Papillon-Lefèvre syndrome (PLS) and tinea capitis.[ncbi.nlm.nih.gov]
Blepharitis
  • Two cases of tinea ciliaris with blepharitis due to Microsporum audouinii and Trichophyton verrucosum and review of the literature. Mycoses. 2014 Apr 13. [Medline]. Akbaba M, Ilkit M, Sutoluk Z, Ates A, Zorba H.[emedicine.com]
Alopecia
  • Both chronic and acute inflammatory infections may damage the hair follicle leading to secondary cicatricial alopecia. In rare instances, the initial presentation can mimic a primary cicatricial alopecia.[ncbi.nlm.nih.gov]
  • We discuss a patient with central centrifugal cicatricial alopecia (CCCA) who developed severe scalp pruritus that was initially attributed to the cicatricial alopecia and ultimately diagnosed as tinea capitis.[ncbi.nlm.nih.gov]
  • In adults, alopecic patches have to be distinguished from those due to other dermatoses inducing alopecia.[ncbi.nlm.nih.gov]
  • We report on an adult patient with tinea capitis caused by Microsporum canis, who presented with diffuse alopecia and follicular pustules, mimicking folliculitis decalvans.[ncbi.nlm.nih.gov]
  • We conclude that tinea capitis should remain in the differential diagnosis of adults with alopecia and pyoderma-like presentations.[ncbi.nlm.nih.gov]
Eruptions
  • In each child, the eruption resolved despite continuation of oral antifungal therapy. Our experience suggests that dermatophytid secondary to tinea capitis is much more common than reported.[ncbi.nlm.nih.gov]
  • A little boy from a Nigerian family who lives in a little industrialized village in the suburbs of Bergamo, (Northern Italy), has never been to his country but presented with tinea capitis and with a secondary papular pruritic eruption of the trunk.[ncbi.nlm.nih.gov]
  • […] information 1 Department of Dermatology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan. kyasuhir@md.tsukuba.ac.jp Abstract We report clinical findings in a 12-year-old girl with long-term recurrent and disseminated multiple eruptions[ncbi.nlm.nih.gov]
  • One month later, however, the patient relapsed with several skin eruptions that first occurred in the temporal region as well as on the forearms, and then spread to the trunk and extremities.[medicaljournals.se]
  • Case reports Case 1 A 45 year old Afro-Caribbean woman had had an itchy pustular eruption of the scalp with associated hair loss for several months.[bmj.com]
Dry Skin
  • For example, very dry skin or breaks in the skin compromises its barrier function.[healthitalk.com]
Annular Skin Lesion
  • The differential diagnosis includes other annular skin lesions. Most patients with tinea corporis are diagnosed clinically. KOH microscopy of a skin scraping can determine if hyphae are present. Culture confirmation is usually not required.[aafp.org]
Plantar Hyperkeratosis
  • Both patients exhibited palmar and plantar hyperkeratosis. Seven teeth were extracted from RG, and nine from NG. Six months after treatment, PPD had been reduced to[ncbi.nlm.nih.gov]

Workup

A preliminary careful visual examination of the scalp and a history of symptoms experienced, often provide a useful insight in the diagnosis of tinea capitis. Sometimes this is enough for diagnosing the condition. However, when appropriate diagnosis cannot be made clinically, then certain additional swab tests may also be required. These would include swab samples of the scalp, hair and scrapings from the scaly skin. These samples would be sent for culture which may take 3 weeks for the results to arrive [7]. In rare cases, skin biopsy would be necessary.

Microsporum
  • Tinea capitis caused by Microsporum audouinii is reported herein from two Brazilian schoolchildren, which are brothers.[ncbi.nlm.nih.gov]
  • The zoophilic dermatophyte Microsporum canis was most frequently identified as the causative agent of tinea capitis.[ncbi.nlm.nih.gov]
  • Further, the effectiveness of griseofulvin in Microsporum tinea capitis has been corroborated, while newer antimycotic drugs like fluconazole or terbinafine failed.[ncbi.nlm.nih.gov]
  • Microsporum audouinii is highly transmissible and often resistant to oral terbinafine. Recognizing tinea capitis trends in a given environment will improve patient care. 2018 Wiley Periodicals, Inc.[ncbi.nlm.nih.gov]
  • Important clinical and etiological relationship was revealed between kerion and Trichophyton mentagrophytes, as well as between grey patch with single lesions and Microsporum canis.[ncbi.nlm.nih.gov]
Trichophyton Tonsurans
  • Trichophyton tonsurans continued to be the predominant organism. These trends may be a result of improved education, recognition, diagnosis, and treatment of TC and increased use of new oral antifungals.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Tinea capitis is still the most common cause of Trichophyton tonsurans in New York City.[ncbi.nlm.nih.gov]
  • KEYWORDS: Microsporum audouinii var. langeronii; Tinea capitis; Trichophyton soudanense; Trichophyton tonsurans[ncbi.nlm.nih.gov]
  • Abstract Trichophyton tonsurans is an anthropophilic dermatophyte, with a worldwide distribution, although its prevalence varies considerably between different geographical regions.[ncbi.nlm.nih.gov]
  • In Brazil, the main causative agents are Microsporum canis and the Trichophyton tonsurans. Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture.[ncbi.nlm.nih.gov]
Alternaria
  • Trichophyton tonsurans (n 40) was the most prevalent causative species identified on culture, followed by Alternaria species (n 10) and Microsporum canis (n 1).[ncbi.nlm.nih.gov]

Treatment

Antifungal medications are primarily the most effective regime for treating tinea capitis. These medications include lamisil and griseofulvin. The duration of the medications would depend on the severity of the condition [8].

In addition to administration of oral medications, a medicated shampoo may also be given to wash the scalp. This would help prevent spread of the infection to other parts of the body as well as to other individuals. The prescription-strength medicated shampoo also helps in destroying the fungal spores on the scalp [9].

Individuals who use the medicated shampoo for washing their hair should ensure that their towels be washed in warm and soapy water. It is also necessary that the combs and brushes be soaked in a mixture of bleach and water for 1 hour at least for 3 days. These steps would prevent the infection from spreading.

Prognosis

In many cases, tinea capitis gets corrected on its own when the child reaches puberty. However, in some cases, the condition can come back even after it has been promptly treated. Certain percentages of affected individuals also suffer from permanent hair loss accompanied by development of scars [5].

Etiology

Fungal infection is the major and the only cause of tinea capitis. The variety of fungi that can cause tinea capitis are known as dermatophytes. They are a type of mold like fungi which significantly affects the outer layer of the scalp. Warm and moist areas are favorable areas for the growth of fungi.

Tinea capitis can spread from human to human contact and through pets such as cats and dogs. Sharing objects like combs, towels, brushes and bed linens of the infected persons can also spread the infection [2].

Epidemiology

The incidence of tinea capitis is not correctly known. This is so because such a type of contagious disease is no longer registered by public health agencies. The condition is prevalent in areas such as Central, North and South America and Afro-Carribbean extraction. Tinea capitis is also common in India and Africa. Both boys and girls are equally affected by the condition. However, when tinea capitis affects the adult population, women are more prone to develop it [3].

Sex distribution
Age distribution

Pathophysiology

The condition of tinea capitis is caused by the fungi species belonging to the genus Tricophyton and Microsporum. These mold like fungi are present in the noncornified layer, which are even capable of invading the internal layers. Children are the most affected group; the reason being the normal microflora of the scalp of which Pityrosporum ovale forms an essential part.

Tinea capitis is classified into 3 groups based on the manner in which the fungi invade the hair shaft. These include ectothrix, endothrix infection and favus. In the first 2 types, the arthroconidia develops on the exterior and interior of the hair shaft respectively. In the third type, there is development of crusts along with hair loss [4].

Prevention

Preventing tinea capitis is not easy as the causative organism is widespread in nature and is highly contagious. However, the following can be done to prevent its spread [10]:

  • It is necessary to avoid sharing of personal belongings.
  • Maintaining good personal hygiene is very important. 
  • Shampooing hair regularly is advised.

Summary

Tinea capitis is a highly infectious disease which spreads by contact and is common amongst toddlers and school going children. The disorder is a type of dermatophytosis and infections of this kind are common across the globe. The follicles and hair shafts of the individuals are severely affected by the fungal infection. Inflammation accompanied by scarring and permanent hair loss are some of the common symptoms [1].

Patient Information

  • Definition: Tine capitis is a type of fungal infection, that essentially affects the scalp causing hair loss and itching. The condition is also referred to as ringworm of the scalp.
  • Cause: Dermatophytes cause tinea capitis. These are mold like fungi that grow in warm moist areas. It is a highly contagious disease, which is spreads by human to human contact, animal to human contact and by sharing personal belongings of infected individuals.
  • Symptoms: In affected individuals, some areas of the scalp turn red or become swollen. These regions are tender to touch and even painful. The areas turn bald and have black spots due to breakage of hair from that part. Affected individuals also can also develop low grade fever and have swollen lymph nodes.
  • Diagnosis: A visual examination of the scalp is enough for diagnosing tinea capitis. A history of symptoms is also taken for appropriate diagnosis. In addition, swabs tests from the scalp and hair, can also be required. In many cases, a wood’s lamp test can also aid in diagnosis of tinea capitis. In rare instances, skin biopsy is required.
  • Treatment: Antifungal medications form the basis of the treatment regime. Oral administration of medications is the preferred method. Individuals are also given medicated shampoo to wash their scalp to get rid of the fungal spores. This is also necessary to prevent spread of infection to other body areas and also to other individuals.

References

Article

  1. Thakur R. Tineacapitis in Botswana. Clin Cosmet Investig Dermatol. 2013;6:37-41.
  2. Elewski BE. Tineacapitis: a current perspective. J Am Acad Dermatol 2000; 42:1.
  3. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections. Mycopathologia. Nov-Dec 2008;166(5-6):335-52.
  4. Miteva M, Tosti A. Hair and scalp dermatoscopy. J Am Acad Dermatol 2012; 67:1040.
  5. Trovato MJ, Schwartz RA, Janniger CK. Tineacapitis: current concepts in clinical practice. Cutis. Feb 2006;77(2):93-9
  6. Elewski BE, Hughey LC, Sobera JO. Fungal diseases. In: Dermatology, 3rd ed, Bolognia JL, Jorizzo JL, Schaffer JV. (Eds), Elsevier Limited, 2012. Vol 2, p.1251.
  7. Friedlander SF, Pickering B, Cunningham BB, Gibbs NF, Eichenfield LF.Use of the cotton swab method in diagnosing Tineacapitis. Pediatrics. Aug 1999;104(2 Pt 1):276-9.
  8. Shemer A, Plotnik IB, Davidovici B, Grunwald MH, Magun R, Amichai B. Treatment of tineacapitis - griseofulvin versus fluconazole - a comparative study. J Dtsch Dermatol Ges. Apr 10 2013;
  9. Trovato MJ, Schwartz RA, Janniger CK. Tineacapitis: current concepts in clinical practice. Cutis. Feb 2006;77(2):93-9
  10. Iglesias ME, España A, Idoate MA, Quintanilla E. Generalized skin reaction following tineapedis (dermatophytids). J Dermatol 1994; 21:31.

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Last updated: 2019-07-11 22:14