​Dermatology - Tinea Capitis

​Dermatology - Tinea Capitis
Tinea is a fungal infection that affects the outer layers of the skin, nails, and hair. It is caused by a specific type of fungus called dermatophytes. The spores of these fungi, known as arthrospores, can remain viable in skin flakes for a period of up to 12 months.
Transmission primarily occurs through interpersonal contact, followed by transmission from animals, and least frequently, from soil. Tinea capitis is a fungal infection of the scalp and hair that mainly affects youngsters.

Tinea capitis can manifest as noninflammatory patches of scaling, broken-off hairs, or as acute and painful inflammation accompanied by painful, swollen nodules that release pus (known as kerion) and can lead to permanent hair loss due to scarring, particularly if there is a subsequent infection. Typically, hair regrowth ensues following the administration of antifungal treatments.
Abnormalities
Alopecia can manifest as either broad or restricted hair loss without any signs of inflammation, and is accompanied with scaling. The "gray patch" is a form of partial hair loss that typically takes on a circular shape with well-defined edges and a fine layer of scales. It is characterized by the presence of many damaged hairs and appears dull gray due to the accumulation of arthrospores. Small patches merge together, creating larger patches. "Black dot" lesions refer to damaged hairs located near the scalp that provide the appearance of "dots" or enlarged hair shafts in individuals with dark hair. The lesion typically has a widespread and indistinct appearance, and there may be a presence of mild inflammation of the hair follicles.
Kerion and favus are inflammatory masses distinguished by swollen, pus-filled, inflamed nodules and patches that typically cause discomfort and discharge pus from many apertures, resembling a honeycomb. Hair strands do not fracture but rather shed naturally and can be extracted without causing discomfort. Follicles can release pus, leading to the formation of sinuses and the presence of mycetoma-like grains. There is a dense formation of crusts with tangled nearby hairs. Typically, there is only one plaque, although it is possible to have several lesions that affect the entire scalp. Often, there is concurrent lymphadenopathy.

Utilize direct microscopy of the hair shaft (obtained by plucking) and scalp scales collected using a brush coated with a small amount of potassium hydroxide (KOH) to demonstrate the existence of fungal hyphae. The differential diagnosis comprises seborrheic dermatitis, psoriasis, atopic dermatitis, lichen simplex chronicus, alopecia areata, and chronic cutaneous lupus erythematosus. In cases of kerion or favus, impetigo, ecthyma, and crusted scabies should also be considered.


The 250-mg tablet of Terbinafine is a systemic allylamine that serves as the most potent oral antidermophytic medication. Other options consist of itraconazole capsules with a strength of 100 mg or an oral solution with a concentration of 10 mg/mL. Additionally, fluconazole tablets are available in strengths of 100 mg, 150 mg, and 200 mg, as well as an oral suspension with concentrations of 10 mg/mL or 40 mg/mL.