Similar to tinea coporis, tinea capitis is due to fungal infection of the skin, but it is only common in children before puberty. It is usually transferred from one child to another at school, except in the cases where the source is from animals, for example adult can contract tinea capitis from cows through contact.

Signs

One or more areas have some scattered hair loss and skin peeling off. There is usually inflammation with redness, of varying degree, but some may have none at all. Although it may occasionally cause itchiness, most people do not have any feeling, and it is usually discovered by the parents.

Generally speaking, fungus of animal origin causes more inflammation in tinea capitis. Sometimes it may be severe with large area of inflammation, folliculitis, boils, and pus formation.

Clinical Diagnosis

It is usually unnecessary to do any test for the diagnosis, but if the diagnosis is uncertain, a sample of skin scrapping or hair cut from the area can be sent for laboratory testing.

An ultra violet light (Wood’s light) can help in the diagnosis, where some (not all) fungal infections of the scalp will turn a fluorescent green or yellow under this light.

If it is a case of animal fungus type infection, then it may be necessary to examine those animals that have been in contact, such as the pets at home.

Treatments

School children suffering from tinea capitis have to stay away from attending school, usually after having used the medicated shampoo and oral treatment for 5 days. Fellow schoolmates need to be examined for the signs of tinea capitis, while close contact such as family members need to use medicated shampoo to reduce the chance of carriage.

The fungal spores can exist in the inside or outside of the hair shaft. Usually it is the external one that is more difficult to treat and will require a longer course of treatment.

Medicated Shampoo

It usually contains ketaconazole. However this external treatment is not totally effective when used on its own, because it cannot penetrate deep enough into the centre of hair follicles and the hair root. It should be regarded only as a supplementary treatment, to reduce the number of fungal spores on the outside of hair shaft and therefore the spread, as well as to speed up the recovery.

Oral Treatments

In the past, the traditional treatment has been Griseofulvin, which has a very good safety profile in children. The usual course is 4 to 6 weeks of treatment, with some types of fungi needing a longer course. The incidence of fungi becoming resistant to griseofulvin has increased a lot recently.

Terbinafine and Itraconazole have been shown more recently to be safe too in children, and because of their much better efficacy, more and more doctors have turned to prescribe them instead.

The course of Terbinafine is 2 to 4 weeks. The cure rate can be as high as 80 to 100%. Some types of fungi may require a longer course. For those cases of external spores, the cure rate is not too satisfactory, even when the course is increased to 8 to 12 weeks.

Itraconazole has the same course period of 2 to 4 weeks, and again may require a longer period for some types of fungi. The cure rate is similar to Terbinafine. It has a suspension preparation, which is more convenient for small children. It can also be taken in a cyclical regime, where only 1 week’s treatment is taken in a given month. The cure rate can be as high as 90% after 2 to 3 cycles.