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Tinea CapitisTinea Capitis

Mohammed Nabil J AlAliMohammed Nabil J AlAli5th Year Medical StudentAt King Faisal University

Group B (210006209)

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OUTLINES :

- OVERVIEW - ETIOLOGY- CLINICAL FEATURES- INVESTIGATIONS- DIAGNOSIS- COMPLICATIONS- TREATMENTS

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OVERVIEW• It is a disease caused by superficial fungal

infection of the skin (dermatophyte) of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles .

• Several synonyms are including ringworm of the scalp and tinea tonsurans.

• The term tinea meant parasitic infestation of the skin.

• Tinea capitis is caused by fungi of species of genera Trichophyton(T)  and  Microsporum(M) fungi.

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•  almost always occurs in small children and less frequently seen in adults

• The incidence of tinea capitis is increasing.

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ETIOLOGYTinea capitis is classified according to how the fungus invades the hair shaft.

1- Ectothrix infectiondue to infection with M. canis, M. audouinii, M. distortum, M. ferrugineum, M. gypseum, M. nanum, and T. verrucosum.

The fungal branches (hyphae) and spores (arthroconidia) cover the outside of the hair.

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2- Endothrix infectionresults from infection with              T. tonsurans, T. violaceum and T. soudanense.

The hair shaft is filled with fungal branches (hyphae) and spores (arthroconidia).

3- Favus ( tinea favosa )caused by T.schoenleinii  infection, which results in a honeycomb destruction of the hair shaft

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-Tinea capitis is most prevalent between 3 and 7 years of age.

- It is slightly more common in boys than girls. Infection by T. tonsurans may occur in adults.

CLINICAL FREATURES

Tinea capitis may present in several ways :- Dry scaling – like dandruff but usually with moth-eaten hair loss- Black dots – the hairs are broken off at the scalp surface, which is scaly- Smooth areas of hair loss- Kerion – very inflamed mass, like an abscess- Favus – yellow crusts and matted hair- Carrier state no symptoms and only mild scaling (T. tonsurans)

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Tinea capitis can occur in three distinctly different forms: gray patch ,black dot and favus .

Round grayish, scaly plaques with progressive expanding

Gray patch tinea capitis (GPTC)

It begins with an erythematous, scaling, well-demarcated patch on the scalp that spreads centrifugally for a few weeks or months, ceases to spread, and persists indefinitely, sometimes for years

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Black dot tinea capitis (BDTC)

Most often caused by Trichophyton tonsurans (endothrix)

usually begins as an asymptomatic, erythematous, scaling patch on the scalp, which slowly enlarges. Lesions may be single or multiple. Early lesions are easily overlooked and the disease is not usually noticed until areas of alopecia become evident.

A round patch of alopecia with overlying scale and "black dots" at the sites of follicular openings is present.

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Favus (tinea favosa )

most often due toTrichophyton schoenleinii (endothrix)

Perifollicular erythema on the scalp, which progresses to the characteristic finding of concave, cup-shaped yellow crusts called scutula.

Scutula are composed of fungi, neutrophils, dried serum, and epidermal cells.

It has unpleasant smell .

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INVESTIGATIONS

- Ectothrix infections can be identified by Woods light (long wave ultraviolet light)

- Endothrix infections do not fluoresce with Woods light.

- Spores are identifiable by KOH examination of the hair shaft, not by KOH scraping of the scale, though hyphae may be seen on occasion

- Culture on Sabouraud's medium

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DIAGNOSIS

- Tinea capitis is suspected if there is a combination of scale and bald patches.

- Wood's light fluorescence is helpful but not diagnostic

- The diagnosis of tinea capitis should be confirmed by microscopy and culture of skin scrapings and hair pulled out by the roots.

- Sometimes, diagnosis is made on skin biopsy showing characteristic histopathological features of tinea capitis.

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COMPLICATIONS

-Severe hair loss.

-Scarring alopecia “bald areas” ( Untreated kerion and favus).

- Psychological impact (ridicule, bullying, isolation, emotional disturbance, family disruption).

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TREATMENTS

- Treatment of carriers is necessary to prevent spread of infection. - Antifungal shampoo twice weekly for four weeks may be sufficient but if cultures remain positive, oral treatment is recommended.

Suitable shampoos include:- 2.5% selenium sulfide-1% to 2% zinc pyrithione- Povidone-iodine- 2% Ketoconazole

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 Griseofulvin (20 to 25 mg/kg/day for 6-12 weeks) has a long history of safety and efficacy in tinea capitis in children.

Terbinafine tablet treatment schedules are based on weight : 10 to 20 kg: 62.5 mg daily for two to four weeks20 to 40 kg: 125 mg daily for two to four weeksAbove 40 kg: 250 mg daily for two to four weeks

Oral itraconazole, and fluconazole are additional therapeutic options that allow shorter courses of treatment The duration is 4 to 6 weeks .

However, these medications are not always successful and it may be necessary to try another agent.

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Any Question ?Any Question ?

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REFERENCES

- http://www.uptodate.com

- http://dermnetnz.org/fungal/tinea-capitis.html

- http://emedicine.medscape.com/article/1091351-overview

- http://www.patient.co.uk/doctor/tinea-capitis

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Thank youThank you