Interactive Seminar, Dermatology Week Block 4.1 , College of Medicine, King Faisal University Al-Ahsa, Saudi Arabia

1. Tinea Capitis
Abdullatiff Sami Al-Rashed
Block 4.1 (Dermatology Week)
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

2. Case
A 3-year-old boy presents with a 3-week history of a
circular scalp area of hair loss and flaky skin.
He attends daycare and is provided with a sleep mat
for an afternoon nap, which is not exclusively for his
use.
The scalp lesion is not itchy, but has not gone away
with an anti-dandruff shampoo. There are no other skin
lesions present.

4. Definition
• Tinea capitis is a fungal infection of the scalp that most
often presents with pruritic, scaling areas of hair loss.
• Several synonyms are used, including ringworm of the
scalp and tinea tonsurans.

5. Epidemiology
• Most common among toddlers and school age children.
• Much more common in blacks than in whites.

6. Etiology
• Tinea capitis is a dermatophyte infection.
• Dermatophytes are filamentous fungi in the
genera Trichophyton, Microsporum, and
Epidermophyton that infect keratinized tissue of skin,
hair, or nails.

7. Etiology
• Organisms in the These genera causes Tinea Capitis:

8. Etiology
Etiology varies from country to country and from
region to region:

9. Transmission
 Person-to-person, animal-to-person, via fomites.
 Spores are present on asymptomatic carriers, animals,
or inanimate objects.

10. Clinical presentation
Non- inflammatory infection
 Partial alopecia, often circular in
shape, showing numerous
broken-off hairs, dull gray from
their coating of arthrospores.
 Fine scaling with fairly sharp
margin.
 Infammatory response minimal,
but massive scaling.

11. Clinical presentation
Black dot
 Broken off hairs near the
scalp give appearance of
“dots”.
 Tends to be diffuse and
poorly circumscribed.
 Low-grade folliculitis may
be present.

12. Clinical presentation
kerion
 Inflammatory mass in which
remaining hairs are loose.
 Characterized by boggy, purulent,
inflamed nodules, and plaques
 Usually painful; drains pus from
multiple openings, like
honeycomb.
 thick crusting with matting of
adjacent hairs.
 Frequently, associated with
lymphadenopathy.

13. Clinical presentation
Favus
 Early cases show perifollicular
erythema and matting of hair.
 Later, thick yellow adherent
crusts (scutula)composed of
skin debris and hyphae that are
pierced by remaining hair
shafts.
 Fetid odor.
 Shows little tendency to clear
spontaneously. Often results in
scarring alopecia

14. History

15. History

16. Physical Exam and
Investigations

17. Physical Exam and
Investigations
 Examination of the affected
area with a Wood's light can
help identify tinea capitis in
patients with some ectothrix
infections and favus.
 Ectothrix infections secondary
to M. canis often exhibit green-
yellow fluorescence.
 T. tonsurans does not
fluoresce.
Wood’s light

18. Diagnosis
 skin scales contain hyphae and arthrospores.
 Ectothrix: arthrospores can be seen surrounding the hair shaft.
 Endothrix: spores within hair shaft.
 Favus: loose chains of arthrospores and airspaces in hair shaft
Direct Microscopy ”potassium
hydroxide”
Growth of dermatophytes
usually seen in 10-14 days.
Rule out bacterial infection,
usually S. aureus or GAS.
Fungal Culture Bacterial Culture

19. Differential Diagnoses

20. Treatment

21. Treatment
Adjunctive interventions:
• Antifungal shampoo : Selenium sulfide
5-10 ml on wet scalp, 2 applications each
week for 2 weeks will provide control.

22. Prognosis
• The prognosis of tinea capitis is excellent, with complete
clearance occurring in most patients after a course of
treatment.
• Complete hair regrowth occurs in most children with hair
loss.
• Patients with chronic or severe infections (eg, kerion,
favus) have the greatest risk for permanent scarring
alopecia.

23. Reference