Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


Therapeutic Approach

Tinea capitis is a dermatophyte fungal infection that targets the hair follicle and shaft. It is commonly found in children but may also occur in adults. Tinea capitis presents with alopecia, scaly patches, pruritus, and lymphadenopathy. Severe cases may present with a kerion, a painful and inflamed abscess that can lead to scarring and permanent alopecia.a1

Zoophilic organism infections present with more inflammation than anthropophilic organisms.2 In ectothrix infections, fungi surround the outside of the hair shaft; in endothrix infections, species invade the hair follicle. This may cause hair breakage at the opening of the follicle, causing a “black-dot” appearance. Favus infections have a yellow appearance that may be nodular, crusted, or scutular.1-4

Clinical presentation and geographic location may guide empiric treatment, though ultimately cultures are needed to ascertain the exact species. Immigrant populations may carry species uncommon to the United States; for example, T. violaceum and T. soudanense have recently been identified among African patients.5 Recent literature suggests that terbinafine may be considered first-line treatment in the United States given the predominance of T. tonsurans, for which terbinafine may be most effective.4-11 In contrast, griseofulvin is more efficacious for zoophilic species. Fluconazole can be used for children under 2 years of age, griseofulvin for children age 2 years and older, and terbinafine for children ≥4 years of age or ≥20 kg.8-10 See Table 86-1.

Table 86-1Tinea Capitis Treatment Table

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.