Dermatology - Tinea Capitis

Dermatology - Tinea Capitis 
Tinea Capitis 
A particular class of fungus known as dermatiophytes is responsible for the infection of keratinized cutaneous tissues that causes tinea; arthrospores from these species can live for up to a year in skin scales.
The most prevalent ways for transmission are from person to person, from animals, and, less frequently, via soil. Children are the main victims of tinea capitis, a dermatophytic infection of the scalp and hair.

When tinea capitis is severe and unpleasant, it can cause painful nodules that drain pus (kerion) and cause scarring alopecia. It can also manifest as noninflammatory scaling patches, scaling and broken-off hairs. Usually, hair regrows after receiving antifungal therapy.

Widespread or localized alopecia is the appearance of noninflammatory scaling. The term "gray patch" refers to a partial alopecia that is typically round in shape, has fine scale and sharp borders, many broken-off hairs, and a dull gray color from an arthrospore coating. Larger patches are created when smaller ones combine. "Black dot" lesions are broken-off hairs close to the scalp that cause patients with black hair to seem to have enlarged hair shafts or "dots." The lesion is usually widespread, ill-defined, and may have low-grade folliculitis.
Kerion and favus are inflammatory masses that drain pus from numerous apertures, much like honeycomb, and are characterized by swampy, purulent, inflamed nodules and plaques that are typically unpleasant. Instead of breaking off, hairs come out and are painless to pluck. Pellicles may release pus, create sinuses, or have grains that resemble mycetomas. The surrounding hairs are matted together and have a thick crust. Although a single plaque is typical, the entire scalp may develop many lesions. Associated lymphadenopathy is often seen.

Fungal hyphae can be seen by direct microscopy of the hair shaft (collected by plucking) and scalp scales (collected with a brush covered in a drop of potassium hydroxide, or KOH). In addition to psoriasis, atopic dermatitis, lichen simplex chronicus, alopecia areata, and chronic cutaneous lupus erythematosus, the differential includes impetigo, ecthyma, crusted scabies, and kerion or favus.

Oral antidermophytes that work well are allylamines like Systemic Terbinafine 250 mg tablets.
Fluconazole 100-, 150-, or 200-mg pills, or oral suspension (10 or 40 mg/mL), are substitutes for itraconazole 100-mg capsules or oral solution (10 mg/mL).