Tinea capitis

Background

• Infection caused by dermatophytes that feed on keratin

Tinea Types

• Tinea capitis (head)
• Tinea corporis (body)
• Tinea pedis (foot)
• Tinea cruris (groin)

Clinical Features

Tinea capitis

Tinea Capitis

• Scaly, variable pruritus
• Patchy alopecia

Differential Diagnosis

Neonatal Rashes

• Atopic dermatitis
• Candidiasis
• Diaper dermatitis
• Erythema toxicum neonatorum
• Neonatal acne
• Psoriasis
• Seborrheic dermatitis
• Tinea capitis
• Impetigo
• Contact dermatitis
• Perianal streptococcal dermatitis
• Milia
• Miliaria
• Mongolian spots
• Omphalitis
• Pustular melanosis
• Sucking blisters

Evaluation

• Clinical diagnosis
• Can be complicated by development of kerion

Management

• Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetrating of hair follicles and may miss sites of subclinical infection
• Griseofulvin (first line)
  • No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
  • Microsize formulation: 20-25 mg/kg per day (max daily dose 1000mg per day) for 6-12 weeks
    • Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 weeks
  • Ultramicrosize formulation: 10-15 mg/kg (max daily dose 750mg per day) per day for 6-12 weeks
    • Typical initial dose 10mg/kg per day for 6-8 weeks, if partial response increase to 15mg.kg per day for 12 weeks
  • Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
• Terbinafine is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
  • 10 to 20 kg: 62.5 mg daily for four to six weeks
  • 20 to 40 kg: 125 mg daily for four to six weeks
  • Above 40 kg: 250 mg daily for four to six weeks
• Second line (both below with limited efficacy data):
  • Fluconazole 6mg/kg PO (max daily dose 400mg)per day x 3-6 weeks
  • Itraconazole 3-5mg/kg PO (max daily dose 400mg) per day x 4-6 weeks
• Adjunctive interventions
  • Selenium sulfide 1 or 2.5%, ciclopirox 1%, or ketoconazole 2% shampoo at least twice weekly to decrease shedding of fungal spores
  • Use of antifungal shampoo by other household members may also decrease the risk for reinfection
  • Combs and hair trimming equipment be cleaned mechanically and disinfected (eg, with household bleach)

Disposition

• Discharge

See Also

• Tinea