Tinea capitis

Background

• Infection caused by dermatophytes that feed on keratin

Tinea Capitis

Clinical Features

• Scaly, variable pruritus
• Patchy alopecia

Differential Diagnosis

Tinea Types

• Tinea capitis (head)
• Tinea corporis (body)
• Tinea pedis (foot)
• Tinea cruris (groin)

Neonatal Rashes

• Acne
• Atopic dermatitis
• Candidiasis
• Contact dermatitis
• Diaper dermatitis
• Erythema toxicum neonatorum
• Impetigo
• Mastitis
• Milia
• Miliaria
• Mongolian spots
• Omphalitis
• Perianal streptococcal dermatitis
• Psoriasis
• Pustular melanosis
• Seborrheic dermatitis
• Sucking blisters
• Tinea capitis

Diagnosis

• Clinical diagnosis

Treatment

• Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetration of hair follicles and may miss sites of subclinical infection
• Griseofulvin Microsize: 20-25 mg/kg/day (max 1000mg) x 6-12 weeks; Ultramicrosize: 10-15 mg/kg/day (max 750mg) x 6-12 weeks (first line)
  • No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
  • Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
• Terbinafine 10-20kg: 62.5mg daily; 20-40kg: 125mg daily; >40kg: 250mg daily x 4-6 weeks is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
• Second line (both below with limited efficacy data):
  • Fluconazole 6mg/kg PO daily (max 400mg) x 3-6 weeks
  • Itraconazole 3-5mg/kg PO daily (max 400mg) x 4-6 weeks
• Adjunctive interventions
  • Selenium sulfide 1 or 2.5%, ciclopirox 1%, or ketoconazole 2% shampoo at least twice weekly to decrease shedding of fungal spores
  • Use of antifungal shampoo by other household members may also decrease the risk for reinfection
  • Combs and hair trimming equipment be cleaned mechanically and disinfected (eg, with household bleach)

Disposition

• Discharge

See Also

• Tinea