The Assessment and Management of Tinea Capitis in Children

Abstract

Tinea capitis is an infection of the scalp and hair shaft caused by dermatophyte fungi. It is seen in all age groups, and the incidence seems to be on the rise in North America. Clinical diagnosis of tinea capitis can be challenging, as symptoms can vary from minimal pruritus with no hair loss, to severe tenderness, purulence, and permanent scarring in inflammatory kerion lesions. The diagnosis of tinea capitis must be confirmed in the laboratory by using fungal stains or obtaining cultures, since treatment may be prolonged with potential side effects. Systemic therapy is needed because topical antifungals cannot effectively penetrate the hair shaft to eradicate the infection. Oral griseofulvin remains the standard treatment agent, but terbinafine and itraconazole are also effective alternatives (although currently without Food and Drug Administration approval).

Tinea Capitis: An Adult Invasion of a Childhood Scourge

“…A study by Honig et al showed that although antibiotic and steroid therapy in addition to antifungals, help to reduce pruritus and scaling in patients with kerions, they did not reduce the time taken for kerions to flatten [13]. However, other reports that show that prednisolone used at 1 mg/kg/day for 7 days provides success [14,15]. Most dermatologists concur that steroids are useful in preventing the dreaded complication of scarring alopecia in inflammatory tinea capitis.…”

Childhood Fungal Infections

“…Etkilenen çocuklarda özgüven kaybı, değersizlik hissi gelişebilir 8 . Nadiren skar bırakan alopesi ve kerion olgularının beraberinde eritema nodosum görülebilir 15 .…”

“…Kültürde (%50) yalancı negatiflik görüldüğü hatırlanmalıdır 8 . Kültür için örnek nemlendirilmiş steril pamuk çubuk veya diş fırçasıyla alınabilir 6,15 .…”

“…İngiltere ve ABD de %90'dan fazla olguda etken T.tonsurans'tır. Batı Avrupa'da, Akdeniz ülkeleri ve komşularında, Güney Amerika ve Orta Doğu ülkelerinde en sık rastlanan etken M. canis olarak bildirilmektedir [12][13][14][15] . Ülkemizde tinea kapitis sıklığı ilköğrenim çağında Erzurum'da %0,08, İstanbul'da %0,08, İzmir'de %0,1, Diyarbakır'da %0,1, Batman'da %0,2, ve Afyon'da %0,4, Adana'da %0,05 olarak bildirilmiştir.…”

Answer to April 2014 Photo Quiz

“…Upon presentation, the patient was diagnosed with kerion, the most exaggerated cellular response to tinea capitis, a fungal infection of the scalp and hair shaft (1,2). A patient's history and physical examination results are often used to make a clinical diagnosis; however, clinical diagnosis is often unreliable, making laboratory confirmation necessary (3,4).…”