Tinea Capitis

Tinea capitis is a superficial fungal infection of the scalp and hair shafts caused by dermatophyte fungi.It primarily affects children, especially those aged 3–12 years, and is uncommon after puberty because protective fatty acids develop in sebum.

The infection spreads easily in communities, schools, and households and is one of the most contagious fungal skin diseases.

Causative Organisms

Common Dermatophytes

Epidemiology & Transmission

Spread occurs via:

• Direct head-to-head contact

• Sharing combs, caps, pillows, towels

• Barbershop equipment

• Infected animals (kittens/puppies)

• Contaminated school environments

Risk Factors

• Crowded living conditions

• Poor hygiene

• Malnutrition

• Contact sports (wrestling)

• Immunosuppression

Pathophysiology

Dermatophytes invade keratinized tissue only:

1. Fungal spores attach to stratum corneum

2. Penetrate hair follicle

3. Invade hair shaft keratin

4. Hair becomes brittle → breaks → alopecia

Hair invasion types

Clinical Presentation

A. Non-Inflammatory (Most Common)

• Enlarging annular scaly patches

• Fine scaling (“dandruff-like”)

• Patchy hair loss

• Broken hairs (“black dots”)

• Mild itching

B. Inflammatory Tinea Capitis (Kerion)

Severe immune reaction:

• Painful boggy swelling

• Pus discharge

• Crusting

• Fever ± lymphadenopathy

• Risk of permanent scarring alopecia

Often mistaken for bacterial abscess

C. Favus (Severe Chronic Form)

• Yellow cup-shaped crusts (scutula)

• Mousy odor

• Permanent hair loss

• Scarring

Diagnostic Criteria

Diagnosis is clinical when:

• Scaly alopecic patches

• Broken hairs

• Annular lesions

• Cervical lymphadenopathy

• Occurs in children

Investigations

Differential Diagnosis

• Alopecia areata

• Seborrheic dermatitis

• Psoriasis

• Trichotillomania

• Bacterial folliculitis

• Lichen planopilaris

Treatment

Topical therapy alone is NOT curativeThe fungus is inside hair shafts → requires systemic therapy

A. Non-Pharmacological Treatment

• Do not share combs/hats

• Wash bedding frequently

• Treat infected pets

• School screening of contacts

• Hair clipping (not shaving)

• Clean barber equipment

• Family screening

B. Pharmacological Treatment

1. First-Line Systemic Therapy

Griseofulvin (Drug of choice)

Adults: 500 mg every 12 hours for 4–8 weeks

Children: 10–20 mg/kg/day for 6–8 weeks

Take with fatty meal to improve absorption

2. Alternative Systemic Therapy

3. Adjunct Topical Therapy (Reduces transmission only)

Whitfield ointment — 12 hourlyORMiconazole 2% — 12 hourlyORKetoconazole shampoo — twice weekly

Continue 5–7 days after clearance

Kerion Management

• Oral antifungal mandatory

• Short course oral steroids (prevent scarring)

• Antibiotics only if secondary infection

Complications

• Permanent scarring alopecia

• Secondary bacterial infection

• School outbreaks

• Psychological distress in children

Prevention

• Avoid sharing hair equipment

• Treat infected family members

• Regular scalp hygiene

• Veterinary care for pets

• School health education

• Barber sterilization

• Early treatment of dandruff-like lesions

Prognosis

• Excellent with early therapy

• Hair regrows after treatment

• Kerion may cause permanent baldness if untreated