Title:Tinea Capitis: An Updated Review
Volume: 14
Issue: 1
Author(s): Alexander K.C. Leung*, Kam L. Hon, Kin F. Leong, Benjamin Barankin and Joseph M. Lam
Affiliation:
- Department of Pediatrics, The University of Calgary, Alberta Children’s Hospital, Calgary, Alberta,Canada
Keywords:
Alopecia, black dots, favus, dermatophytes, fluconazole, griseofulvin, itraconazole, kerion, terbinafine.
Abstract:
Background: Tinea capitis is a common and, at times, difficult to treat, fungal infection of
the scalp.
Objective: This article aimed to provide an update on the evaluation, diagnosis, and treatment of tinea
capitis.
Methods: A PubMed search was performed in Clinical Queries using the key term “tinea capitis”. The
search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies,
and reviews. The search was restricted to English literature. The information retrieved from the
above search was used in the compilation of the present article.
Patents were searched using the key term “tinea capitis” at www.freepatentsonline.com.
Results: Tinea capitis is most often caused by Trichophyton tonsurans and Microsporum canis. The
peak incidence is between 3 and 7 years of age. Non-inflammatory tinea capitis typically presents as
fine scaling with single or multiple scaly patches of circular alopecia (grey patches); diffuse or patchy,
fine, white, adherent scaling of the scalp resembling generalized dandruff with subtle hair loss; or single
or multiple patches of well-demarcated area (s) of alopecia with fine-scale, studded with broken-off
hairs at the scalp surface, resulting in the appearance of “black dots”. Inflammatory variants of tinea
capitis include kerion and favus. Dermoscopy is a highly sensitive tool for the diagnosis of tinea capitis.
The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wetmount
preparation and fungal culture. It is desirable to have mycologic confirmation of tinea capitis
before beginning a treatment regimen. Oral antifungal therapy (terbinafine, griseofulvin, itraconazole,
and fluconazole) is considered the gold standard for tinea capitis. Recent patents related to the management
of tinea capitis are also discussed.
Conclusion: Tinea capitis requires systemic antifungal treatment. Although topical antifungal therapies
have minimal adverse events, topical antifungal agents alone are not recommended for the treatment of
tinea capitis because these agents do not penetrate the root of the hair follicles deep within the dermis.
Topical antifungal therapy, however, can be used to reduce transmission of spores and can be used as
adjuvant therapy to systemic antifungals. Combined therapy with topical and oral antifungals may increase
the cure rate.
