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Chapter 143: Tinea Capitis

Richard P. Usatine

PATIENT STORY

An 11-year-old boy has a history of 2 months of progressive patchy hair loss (Figure 143-1). He has some itching of the scalp, but his mother is worried about his hair loss. Physical examination reveals alopecia with scaling of the scalp and broken hairs looking like black dots in the areas of hair loss. A KOH preparation is created by using a #15 scalpel to scrape some scale and small broken hairs onto a slide. With the help of a fungal stain and KOH, branching septate hyphae are seen under the microscope. The most likely cause of this tinea capitis is Trichophyton tonsurans; therefore 4 weeks of oral terbinafine is prescribed. The tinea capitis fully resolves and the hair does grow back over time.

FIGURE 143-1

Tinea capitis in a young black boy. The most likely organism is Trichophyton tonsurans. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows several small baldy patches in the scalp of a boy.
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INTRODUCTION

Tinea capitis is a fungal infection involving the scalp and hair. Common signs include hair loss, scaling, black dots, erythema, and impetigo-like plaques.

SYNONYMS

Ringworm of the scalp.

EPIDEMIOLOGY

  • Tinea capitis is the most common type of dermatophytoses in children younger than 10 years (Figures 143-1, 143-2, 143-3, 143-4, 143-5). It is much less common after puberty or in adults. The infection has a worldwide distribution.

  • Tinea capitis is more common in young African-American children.1 Boys are infected more often than girls.1

  • Combs, brushes, couches, and sheets may harbor the live dermatophyte for a long period of time.

  • Spread from person to person with direct contact or through fomites (especially Trichophyton tonsurans).

  • Occasionally spread from cats and dogs to humans (especially Microsporum species).

FIGURE 143-2

Tinea capitis with patchy hair loss and scaling of the scalp in a young boy. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows baldy patches in the scalp of a boy. The patches appear dry, pale white, and are devoid of hair.
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FIGURE 143-3

A kerion resulting from inflammation of the tinea capitis on this young boy. The kerion looks superinfected, but it is nothing more than an exuberant inflammatory response to the dermatophyte. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows an inflamed bald patch in the scalp on top of head, appearing pinkish with bright red spots.
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FIGURE 143-4

Close-up of black dot alopecia in a 7-year-old girl showing the black dots where infected hairs have broken off. (Reproduced with permission from Richard P. Usatine, MD.)

A photo shows patch of scalp with black dots and sparse hair.
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ETIOLOGY AND PATHOPHYSIOLOGY

  • Tinea capitis is a superficial fungal infection affecting hair shafts and follicles on the scalp.

  • Caused ...

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