Tinea capitis

Tinea capitis

Description, Causes and Risk Factors:

ICD-10: B35.0

Tinea capitis is an infection caused by dermatophyte fungi (usually species in the genera Microsporum and Trichophyton) of scalp hair follicles and the surrounding skin.

There are three recognized patterns: endothrix, ectothrix and favus. The latter, a pattern of hair loss caused by T. schoenleinii, is rarely seen in the U.K. being largely confined to eastern Europe and Asia and is not considered further here. Endothrix infections are characterized by arthroconidia (spores) within the hair shaft. The cuticle is not destroyed. Ectothrix infections are characterized by hyphal fragments and arthroconidia outside the hair shaft, which leads eventually to cuticle destruction.

Children are the usual suspects of this disease. The condition normally affects young children and vanishes as they grow up and head towards puberty. However, the disease can occur in patients of any age.

Certain people are at more risk from this condition than others. If you have had minor skin injuries or have suffered from scalp injuries recently, you may get this disease. The condition also affects people who sweat a lot or have poor hygiene. Dermatophytes thrive in warm, moist areas.

Tinea capitis can be transmitted from infected human beings, animals vectors, from soil and fomites. People who come in contact with infected persons or articles used by them such as combs or clothes can also contract the disease. You can also contract the infection from pets like cats.

The disease may occur in people of all ages, of all races, and of both sexes.


The signs and symptoms may include:

    Round patches of hair loss that slowly increase in size.

  • Scaling (flaking) of the scalp.

  • Yellow crusts on scalp.

  • Hairs broken close to scalp surface creating dark or blond “dots.”

  • Mild itching of the scalp.


Laboratory diagnosis of tinea capitis depends on examination and culture of rubbings, scrapings, pluckings, or clippings from lesions. Infected hairs appearing as broken stubs are best for examination. They can be removed with forceps without undue trauma or collected by gentle rubbing with a moist gauze pad or toothbrush. Selected hair samples are cultured or allowed to soften in 10-20% potassium hydroxide (KOH) before examination under the microscope. Examination of KOH preparations (KOH mount) usually determines the proper diagnosis if a tinea infection exists.

Microscopic examination of the infected hairs may provide immediate confirmation of the diagnosis of tinea capitis and establishes whether the fungus is small-spore or large-spore ectothrix or endothrix. Culture provides precise identification of the species for epidemiological purposes. Primary isolation is carried out at room temperature, usually on Sabouraud agar containing antibiotics (penicillin/streptomycin or chloramphenicol) and cycloheximide (Actidione), which is an antifungal agent that suppresses the growth of environmental contaminant fungi. In cases of tender kerion, the agar plate can be inoculated directly by pressing it gently against the lesion.

Diagnosis takes about 2 weeks to be performed, in some cases, other tests involving nutritional requirements and hair penetration in are necessary to confirm the identification.


The aim of treatment is to achieve a clinical and mycological cure as quickly as possible. Oral antifungal therapy is generally needed.

Topical treatment alone is not recommended for the management of tinea capitis. It may however, reduce the risk of transmission to others in the early stages of systemic treatment. Selenium sulphide and Povidone-iodine shampoos, used twice weekly, reduce the carriage of viable spores and are assumed to reduce infectivity.

The use of corticosteroids (both oral and topical) for inflammatory varieties, e.g. kerions and severe id reactions is controversial, but may help to reduce itching and general discomfort.

Medications May Include:

Griseofulvin, terbinafine, itraconazole fluconazole, and ketoconazole. Side effects positive. Risks and benefits of the medications should be discussed with your dermatologist.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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