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.

• Fever

  Redness, swelling, pain, fever and pustules may develop. The lymph nodes in the back of the neck may increase in size. Your provider may take a swab culture from your child's scalp to confirm the diagnosis. [kenwooddermatology.com]

  The patient experiences pain, swelling, and, sometimes, fever. Without treatment, a kerion can leave permanent scarring and hair loss. [healthcommunities.com]

  Other symptoms associated with severe tinea capitis are fever and large, tender lymph nodes in the neck. How is Tinea Capitis diagnosed? Sometimes, the scalp is scraped superficially to look under the microscope for fungus. [dermindy.com]

  The child will have swelling, pain and pus in the scalp; fever may also develop. If your child develops these symptoms, he or she should be seen by a primary care provider right away. [cincinnatichildrens.org]

  Treatment of tonsillitis See your doctor if your child has a sore throat and a fever. [healthdirect.gov.au]

• Constitutional Symptom

  She had no constitutional symptoms and no family member affected. However there was a history of contact with healthy cats at home. There was no significant drug history. [austinpublishinggroup.com]

• Infertility

  […] careful attention to detail, SIS offers a powerful new gynaecological investigative tool in the investigation of bleeding disorders (including menorrhagia, intermenstrual and postmenopausal bleeding), uncertain endometrial Findings on vaginal ultrasound, infertility [obgyn.onlinelibrary.wiley.com]

• Nausea

  Grifulvin V syrup can most commonly cause nausea and vomiting (usually improved by lowering the dose and taking on a full stomach). It can also cause headaches and increased sun sensitivity. [childrens.com]

  If the child experiences side effects from the medication such as headache or nausea, the dose can be split and given twice a day. [drhull.com]

  One child stopped taking itraconazole after 28 days, before it was clinically cured, because of nausea. Nevertheless, this child also achieved clinical and mycological cure. No other side-effects were reported. [ncbi.nlm.nih.gov]

  If patients are started on antifungal, they may experience side effects like headache, nausea, and diarrhea and raised liver enzymes. Liver function test should be monitored. [medthical.com]

• Vomiting

  Grifulvin V syrup can most commonly cause nausea and vomiting (usually improved by lowering the dose and taking on a full stomach). It can also cause headaches and increased sun sensitivity. [childrens.com]

  Younger children may have nausea, vomiting or stomach pain. They may be unusually fussy and drool a lot because they can’t swallow. Not every sore throat is due to tonsillitis. [healthdirect.gov.au]

  In a third double-blind study of 35 patients taking griseofulvin or itraconazole, 12 percent of the patients taking griseofulvin stopped therapy because of nausea, vomiting and abdominal pain. [aafp.org]

  See your family GP or go to the emergency department if you develop any of the following have a severe headache or stiff neck have a fever that lasts longer than two to three days and is unrelieved by painkillers inability to swallow fluids or are vomiting [healthywa.wa.gov.au]

• Alopecia

  Prompt, appropriate diagnosis and treatment is necessary to prevent the long-term complications of scarring alopecia. [ncbi.nlm.nih.gov]

  Secondary cicatricial alopecia may occur in tinea capitis as a result of chronic persistent infection. Rarely, initial presentation can mimic primary cicatricial alopecia. [austinpublishinggroup.com]

• Dermatitis

  Clinical forms were distributed in following way: kerion 73 (41,5%), grey patch with single lesions 71 (40,3%), seborrheic dermatitis-like form 14 (8%), agminate folliculites 12 (6,8%) and black-dot dermatophytosis 6 (3,4%). [ncbi.nlm.nih.gov]

  Babies can develop seborrheic dermatitis on their scalps, which is also known as cradle cap. According to the National Eczema Association, seborrheic dermatitis is slightly more common in males than in females. [medicalnewstoday.com]

• 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]

  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]

• Blister

  Some ringworm infections develop vesicles (fluid-filled blisters) caused by the immune system's exaggerated response to the infection. Ringworm can look different on certain parts of the body. [dermatology.about.com]

  […] and special shampoo It can take a long time to get rid of scalp ringworm Symptoms include: A dry, scaly rash on your head that may itch Sometimes, flaking of your scalp that looks like dandruff Sometimes, a painful swollen patch on the scalp that may blister [msdmanuals.com]

  Kerions are very swollen patches with tiny blisters (pustules) oozing fluid from the site. It is seen in very severe scalp ringworm infections. [healthitalk.com]

  This may lead to intensely painful inflammations on the scalp, blisters oozing pus (kerions), followed by crusty formations Recurrence of the infection Children with Ringworm Infection of the Scalp may suffer mental and emotional agony - they may face [dovemed.com]

• Dry Skin

  For example, very dry skin or breaks in the skin compromises its barrier function. [healthitalk.com]

• Suggestibility

  Etiological diagnosis is based on suggestive clinical findings and confirmation depends on the fungus growth in culture. However, it is not always possible to perform this test due to lack of availability. [ncbi.nlm.nih.gov]

  Although in vitro susceptibility data suggest that terbinafine is active against Microsporum spp, in vivo data suggest that a 6-week course of oral terbinafine may be inadequate in treating tinea capitis caused by Microsporum canis (Table 9-1). [healio.com]

• Negativism

  After this period of treatment, the first negativization of the culture for M. canis was observed. [bmcpediatr.biomedcentral.com]

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

  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]

• Trichophyton Tonsurans

  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]

  Keywords: Trichophyton violaceum, Trichophyton violaceum white variant, Trichophyton tonsurans, dermatophyte This work is published and licensed by Dove Medical Press Limited. [dovepress.com]

• Trichophyton Rubrum

  Dermatophytosis of scalp or beard NOS (disorder) Scalp ringworm Tinea capitis (disorder) Trichophyton rubrum tinea capitis dermatophytosis of scalp or beard tinea capitis due to Trichophyton rubrum Dermatophytosis of scalp scalp dermatophytosis Statements [wikidata.org]

  Other species were occasionally isolated, including Trichophyton violaceum (1.4%) and Trichophyton rubrum (0.8%). [ncbi.nlm.nih.gov]

• Trichophyton Mentagrophytes

  In case of inflammatory forms (predominantly kerion) caused by Trichophyton verrucosum and Trichophyton mentagrophytes ID reaction was manifested by disseminated follicular papules. [ncbi.nlm.nih.gov]

• KOH Preparation showing Fungal Hyphae

  Physical exam shows scaly patches with alopecia and black dots. Potassium hydroxide (KOH) preparation shows fungal hyphae around hair follicles. [step1.medbullets.com]

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.

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].

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].

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].

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].

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.

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].

• 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.

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.