Diagnosis and Treatment of

Tinea Capitis

By:
Aimie Farhanah Binti Zakaria C111 11 834
Siti Fatimah Binti Othman C111 11 881
Ahmad Yani Sukarso C111 11 152
Advisor:
dr. Rani
Supervisor:
dr. Asnawi Madjid, Sp.KK

Definition
It is a disease caused by superficial fungal
infection of the skin (dermatophyte) of the
scalp, eyebrows, and eyelashes, with a
propensity for attacking hair shafts and
follicles.
Several synonyms are including ringworm of
the scalp.
The term tinea meant parasitic infestation of
the skin.
Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,2Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Epidemiology
Tinea capitis occurs primarily in children
and occasionally in other age groups.
It is seen most commonly in children
between 3 and 14 years of age.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,3Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Etiology
Tinea capitis describes
dermatophyte infection of
hair and scalp
Typically caused by
Trichophyton and
Microsporum species, with
exception of Trichophyton
concentricum.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Pathogenesis

The incubation period of tinea

capitis lasts 24 days, although
the period is highly variable and
asymptomatic
carriers
are
common.
The hyphae grow downward into
the follicle, on the hairs surface,
and the intrafollicular hyphae
break up into chains of spores.
There is a period of spread (4
days to 4 months) during which
the lesions enlarge and new
lesions appear.

Reference: William D. James, T.G.B., Dirk M. Elston, Andrews' Diseases of the Skin Clinical Dermatology, W. Daniel, Editor 2010,
Saunders Elsevier: United Kingdom. p. 287-290

Pathogenesis
At about 3 weeks hairs
break off a few millimeters
above the skin surface.
Within the hair, hyphae
descend to the upper limit
of the keratogenous zone
and here form Adamson
fringe on about the 12th
day.

Reference: William D. James, T.G.B., Dirk M. Elston, Andrews' Diseases of the Skin Clinical Dermatology, W. Daniel, Editor 2010,
Saunders Elsevier: United Kingdom. p. 287-290

Pathogenesis
No new lesions develop during the refractory period (4
months to several years).
The clinical appearance is constant, with the host and
parasite at equilibrium.
This is followed by a period of involution in which the
formation of spores gradually diminishes.

Reference: William D. James, T.G.B., Dirk M. Elston, Andrews' Diseases of the Skin Clinical Dermatology, W. Daniel, Editor 2010,
Saunders Elsevier: United Kingdom. p. 287-290

Pathogenesis
In ectothrix infections only
the arthroconidia on the
surface of the hair shaft
may
be
visualized,
although hyphae are also
present within the hair
shaft.
The cuticle can be
destroyed.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Pathogenesis
In endothrix infections,
arthroconidia and hyphae
remain within the hair
shaft and leave the cortex
and cuticle intact.
Appearance of black
dots which represent
broken hairs at the
surface of the scalp.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Pathogenesis
Favus is characterized by longitudinally arranged
hyphae and air spaces within the hair shaft.
Arthroconidia are not usually noted in infected hairs.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Clinical Features
Tinea capitis can occur in three
distinctly different forms: gray patch,
black dot and kerion.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,11
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

1. Gray Patch Tinea Capitis

It begins with an erythematous, scaling,
well-demarcated patch on the scalp that
spreads centrifugally for a few weeks or
months, ceases to spread, and persists
indefinitely, sometimes for years
Figure 1. Round grayish, scaly
plaques with progressive
expanding.
Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,12
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

2. Black dot Tinea Capitis

Usually begins as an asymptomatic,
erythematous, scaling patch on the
scalp, which slowly enlarges. Lesions
may be single or multiple. Early lesions
are easily overlooked and the disease
is not usually noticed until areas of
alopecia become evident.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,13
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

2. Black dot Tinea Capitis

Figure 2. A round patch of alopecia with overlying scale and "black

dots" at the sites of follicular openings is present

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,14
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

3. Kerion
This is the inflammatory type of tinea
capitis.
The disease presence with painful,
boggy mass in which hair is lose and
broken off.
Kerion may be followed by scarring and
permanent alopecia in the areas of
inflammation and suppuration.
Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,15
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

3. Kerion

Figure 3. Kerion of the scalp

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,16
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Diagnosis
The diagnosis of dermatophyte infection can be
determined by looking at the clinical features.
Confirmed by microscopic detection of fungal
elements, by identification of the species through
culture, or by histologic evidence of the presence of
hyphae in the stratum corneum.
In addition, fluorescence patterns under Woods light
examination may support a clinical suspicion.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

1. Woods light
Examination involved hair
bearing areas, such as the
scalp or beard, with a
Woods lamp (365 nm) may
reveal pteridine fluorescence
of hair infected with
particular fungal pathogens.
Hairs that fluoresce should
be selected for further
examination, including
culture.

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

2. Laboratory Test

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

2. Laboratory Test (cont.)

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Other Diagnostic Tools

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

DIFFERENTIAL DIAGNOSIS
1. SEBORRHOIC DERMATITIS

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

DIFFERENTIAL DIAGNOSIS
2. PSORIASIS

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

DIFFERENTIAL DIAGNOSIS
3. ALOPECIA AREATA

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

TREATMENT
MEDICAMENTOUS
TOPICAL
SYSTEMIC

NON-MEDICAMENTOUS

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

MEDICAMENTOUS
TOPICAL TREATMENT
Povidone-iodine shampoo
Ketoconazole 2% shampoo
Selenium-sulphide 1%

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

 Systemic treatment
Anti mitotic :
Griseofulvin (1st line therapy)
Terbinafine
Azole drugs: ketoconazole, itraconazole,
fluconazole

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

NON-MEDICAMENTOUS
EDUCATIONAL
SCREENING
ERADICATION OF POTENTIAL
SOURCE

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

COMPLICATION
Severe hair loss.
Scarring alopecia bald areas
(Untreated kerion).
Psychological impact (ridicule, bullying,
isolation, emotional disturbance, family
disruption).

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA,33
Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

PROGNOSIS
Bonam: under proper treatment

Reference: Schieke SM, Garg A. Superficial Fungal Infection. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K,
editors. Fitzpatricks Dermatology in General Medicine. 8 ed. New York: Mc Graw Hill; 2012. p. 2277-2286, 2293-2295.

Wassalamualaikum wr. wb.

and
Thank You