Tinea Capitis

Start oral antifungal therapy when the clinical pattern is compatible with tinea capitis, particularly in a prepubertal child with scalp scale, broken hairs, patchy alopecia, pustules, or inflammatory swelling. Tinea capitis occurs primarily in prepubertal children but can occur at any age, including adulthood. publications aap+1publications aapTinea Capitis (Ringworm of the Scalp) - AAP Publicationspublications aapTinea Capitis (Ringworm of the Scalp) | Red Book - AAP Publications The dermatophyte penetrates the follicular outer root sheath and may invade the hair shaft; therefore, topical antifungal monotherapy is ineffective. publications aap+2publications aapSuperficial Fungal Infections | Pediatrics In Review - AAP PublicationsPubMedTinea Capitis - StatPearls - NCBI Bookshelfcomposer publications aapRed Book - AAP

Escalate urgency for a painful, boggy, pustular scalp plaque or nodule consistent with kerion. This inflammatory form can result in permanent alopecia, unlike typical noninflammatory tinea capitis. PubMedPubMedTinea Capitis - StatPearls - NCBI Bookshelf Obtain mycologic specimens before or at treatment initiation when possible, but do not defer systemic therapy for culture results in a clinically convincing kerion. Oral griseofulvin, terbinafine, itraconazole, or fluconazole may be required for kerion, with anti-inflammatory treatment considered as an adjunct rather than a replacement for antifungal therapy. Wiley+2WileyThe kerion: an angry tinea capitis - John - 2018 - Wiley Online LibraryWileyBritish Association of Dermatologists' guidelines for the ...PubMedTinea Capitis - StatPearls - NCBI Bookshelf

Sample active scalp scale and plucked affected hairs for direct microscopy and fungal culture. KOH examination can provide immediate confirmation, whereas culture is required for definite identification in selected infections and permits species-level assessment. ScienceDirect+2ScienceDirectTrichophytosis - an overview | ScienceDirect TopicsOxford Academicsingle-centre, retrospective cohort study of paediatric tinea capitis in ...ScienceDirectCurrent concepts in systemic and topical therapy for superficial mycoses - ScienceDirect KOH dissolves keratin and permits visualization of fungal septate hyphae; reported KOH sensitivity and specificity are 61% and 95%, respectively, with performance dependent on specimen quality and examiner technique. ScienceDirectScienceDirectPotassium Hydroxide - an overview

Use Wood lamp examination as a supplemental, not exclusionary, test. Some ectothrix Microsporum infections fluoresce blue-green, but T tonsurans—the leading U.S. cause—does not fluoresce. ScienceDirect+3ScienceDirectPotassium Hydroxide - an overviewpublications aapTinea Capitis (Ringworm of the Scalp) - AAP Publicationspublications aapTinea Capitis (Ringworm of the Scalp) | Red Book - AAP PublicationsPubMedIn vitro pharmacodynamic characteristics of griseofulvin against dermatophyte isolates of Trichophyton tonsurans from tinea capitis patients - PubMed A negative Wood lamp examination therefore does not rule out tinea capitis in U.S. practice.

Griseofulvin remains a core first-line systemic option. Use microsize griseofulvin 15-20 mg/kg orally once daily, maximum 1 g/day, or ultramicrosize griseofulvin 5-10 mg/kg orally once daily, maximum 750 mg/day. Give griseofulvin after a meal containing fat to optimize administration. composer publications aapcomposer publications aapRed Book - AAP A typical course is 4-6 weeks and should continue for 2 weeks beyond clinical resolution. composer publications aapcomposer publications aapRed Book - AAP Another clinical reference describes systemic therapy courses of 4-8 weeks, supporting reassessment based on clinical and mycologic response rather than a fixed calendar endpoint alone. PubMedPubMedTinea Capitis - StatPearls - NCBI Bookshelf

Terbinafine is an oral alternative, and continuous dosing has demonstrated high mycologic cure rates; griseofulvin and terbinafine are both supported therapies for tinea capitis. Wiley+1WileyAn update on tinea capitis in children - Gupta - Wiley Online LibraryPubMedTinea Capitis - StatPearls - NCBI Bookshelf Organism identification is clinically useful because treatment duration may vary by dermatophyte: one review describes 2-4 weeks for Trichophyton infections and 8-12 weeks for Microsporum infections. ScienceDirectScienceDirectTinea Capitis: Trends in Spain - ScienceDirect.com Do not infer species from a negative Wood lamp examination, because the common U.S. organism T tonsurans does not fluoresce. ScienceDirect+1ScienceDirectPotassium Hydroxide - an overviewPubMedIn vitro pharmacodynamic characteristics of griseofulvin against dermatophyte isolates of Trichophyton tonsurans from tinea capitis patients - PubMed

Reserve itraconazole or fluconazole as oral alternatives when a standard agent is unsuitable or response is inadequate, with species confirmation and reassessment of the diagnosis. Wiley+1WileyThe kerion: an angry tinea capitis - John - 2018 - Wiley Online LibraryPubMedTinea Capitis - StatPearls - NCBI Bookshelf Available excerpts do not provide regimen-specific doses, renal adjustments, hepatic monitoring schedules, or contraindication algorithms for terbinafine, fluconazole, or itraconazole; use current product labeling and local prescribing guidance before selecting these agents.

A kerion is the inflammatory presentation of tinea capitis and may present as a painful nodular or boggy scalp lesion with pustules. PubMed+1PubMedTinea Capitis - StatPearls - NCBI BookshelfScienceDirectFirst report of kerion (tinea capitis) caused by combined Trichophyton mentagrophytes and Microsporum canis Because inflammatory tinea capitis may result in scarring alopecia, begin systemic antifungal therapy promptly and document baseline alopecia and the distribution of inflammatory disease for response assessment. PubMedPubMedTinea Capitis - StatPearls - NCBI Bookshelf

Consider short-course systemic corticosteroids as adjunctive anti-inflammatory therapy for kerion or severe id reactions; corticosteroids do not replace oral antifungal treatment. Wiley+1WileyBritish Association of Dermatologists' guidelines for the ...PubMedTinea Capitis - StatPearls - NCBI Bookshelf Reassess after treatment initiation for reduced pain, swelling, pustulation, and progression of alopecia. Persistent or progressive disease should trigger repeat fungal sampling and verification of the causative organism. Oxford Academic+1Oxford Academicsingle-centre, retrospective cohort study of paediatric tinea capitis in ...cks nice org ukScenario: Management of fungal skin infection - scalp - CKS - NICE

Examine siblings and other household contacts for evidence of tinea capitis. composer publications aapcomposer publications aapRed Book - AAP One clinical reference recommends treating asymptomatic individuals and using antifungal or selenium shampoo for 2-4 weeks to interrupt ongoing transmission. PubMedPubMedTinea Capitis - StatPearls - NCBI Bookshelf Recommend that household members avoid sharing combs, brushes, ribbons, hats, and other hair-care items. composer publications aapcomposer publications aapRed Book - AAP

Use selenium sulfide shampoo or an antifungal shampoo as adjunctive shedding reduction, not as curative monotherapy. PubMed+1PubMedTinea Capitis - StatPearls - NCBI Bookshelfcomposer publications aapRed Book - AAP Children receiving treatment can attend school and usual activities; school exclusion is not required simply because tinea capitis is diagnosed. composer publications aapcomposer publications aapRed Book - AAP Instruct affected children not to share combs, hair brushes, hats, or hair ornaments with classmates until treatment has begun. composer publications aapcomposer publications aapRed Book - AAP

At follow-up, assess clinical resolution and adherence to the full systemic course. For griseofulvin, treatment is usually continued for 2 weeks beyond clinical resolution. composer publications aapcomposer publications aapRed Book - AAP If disease remains active, repeat scalp and hair sampling and reassess the organism, treatment duration, and competing diagnosis rather than extending treatment without reevaluation. Oxford Academic+1Oxford Academicsingle-centre, retrospective cohort study of paediatric tinea capitis in ...cks nice org ukScenario: Management of fungal skin infection - scalp - CKS - NICE