Article Type
Article
Changed
Tue, 10/11/2022 - 12:52
Display Headline
Tinea Capitis
Author(s)
Candrice R. Heath, MD
Richard P. Usatine, MD

THE COMPARISON

A Areas of alopecia with erythema and scale in a young Black boy with tinea capitis. He also had an enlarged posterior cervical lymph node (arrow) from this fungal infection.

B White patches of scale from tinea capitis in a young Black boy with no obvious hair loss; however, a potassium hydroxide preparation from the scale was positive for fungus.

C A subtle area of tinea capitis on the scalp of a Latina girl showed comma hairs.

Tinea capitis
Photographs courtesy of Richard P. Usatine, MD.

Tinea capitis is a common dermatophyte infection of the scalp in school-aged children. The infection is spread by close contact with infected people or with their personal items, including combs, brushes, pillowcases, and hats, as well as animals. It is uncommon in adults.

Epidemiology

Tinea capitis is the most common fungal infection among school-aged children worldwide.1 In a US-based study of more than 10,000 school-aged children, the prevalence of tinea capitis ranged from 0% to 19.4%, with Black children having the highest rates of infection at 12.9%.2 However, people of all races and ages may develop tinea capitis.3

Tinea capitis most commonly is caused by Trichophyton tonsurans and Microsporum canis. Dermatophyte scalp infections caused by T tonsurans produce fungal spores that may occur within the hair shaft (endothrix) or with fungal elements external to the hair shaft (exothrix) such as M canis. Microsporum canis usually fluoresces an apple green color on Wood lamp examination because of the location of the spores.

Key clinical features

Tinea capitis has a variety of clinical presentations: • broken hairs that appear as black dots on the scalp • diffuse scale mimicking seborrheic dermatitis • well-demarcated annular plaques • exudate and tenderness caused by inflammation • scalp pruritus • occipital scalp lymphadenopathy. Worth noting Tinea capitis impacts all patient groups, not just Black patients. In the United States, Black and Hispanic children are most commonly affected.4 Due to a tendency to have dry hair and hair breakage, those with more tightly coiled, textured hair may routinely apply oil and/or grease to the scalp; however, the application of heavy emollients, oils, and grease to camouflage scale contributes to falsenegative fungal cultures of the scalp if applied within 1 week of the fungal culture, which may delay diagnosis. If tinea capitis is suspected, occipital lymphadenopathy on physical examination should prompt treatment for tinea capitis, even without a fungal culture.5 Health disparity highlight A risk factor for tinea capitis is crowded living environments. Some families may live in crowded environments due to economic and housing disparities. This close contact increases the risk for conditions such as tinea capitis.6 Treatment delays may occur due to some cultural practices of applying oils and grease to the hair and scalp, camouflaging the clinical signs of tinea capitis.

References
  1. Gupta AK, Mays RR, Versteeg SG, et al. Tinea capitis in children: a systematic review of management [published online July 12, 2018]. J Eur Acad Dermatol Venereol. 2018;32:2264-2274. doi:10.1111/jdv.15088
  2. Abdel-Rahman SM, Farrand N, Schuenemann E, et al. The prevalence of infections with Trichophyton tonsurans in schoolchildren: the CAPITIS study [published online April 19, 2010]. Pediatrics. 2010;125:966-973. doi:10.1542/peds.2009-2522
  3. Silverberg NB, Weinberg JM, DeLeo VA. Tinea capitis: focus on African American women. J Am Acad Dermatol. 2002;46(2 suppl understanding):S120-S124. doi:10.1067/mjd.2002.120793
  4. Alvarez MS, Silverberg NB. Tinea capitis. In: Kelly AP, Taylor SC, eds. Dermatology for Skin of Color. McGraw Hill Medical; 2009:246-255.
  5. Nguyen CV, Collier S, Merten AH, et al. Tinea capitis: a singleinstitution retrospective review from 2010 to 2015 [published online January 20, 2020]. Pediatr Dermatol. 2020;37:305-310. doi:10.1111 /pde.14092
  6. Emele FE, Oyeka CA. Tinea capitis among primary school children in Anambra state of Nigeria [published online April 16, 2008]. Mycoses. 2008;51:536-541. doi:10.1111/j.1439-0507.2008.01507.x
Article PDF
CT110004226.pdf
Author and Disclosure Information

Candrice R. Heath, MD
Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA

Richard P. Usatine, MD
Family and Community Medicine, Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio

The authors reported no potential conflict of interest relevant to this article.

Simultaneously published in Cutis and The Journal of Family Practice.

Issue
Cutis - 110(4)
Publications
MDedge Dermatology
Cutis
Topics
Diversity in Medicine
Page Number
226-227
Sections
Dx Across the Skin Color Spectrum
Author(s)
Candrice R. Heath, MD
Richard P. Usatine, MD
Author(s)
Candrice R. Heath, MD
Richard P. Usatine, MD
Author and Disclosure Information

Candrice R. Heath, MD
Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA

Richard P. Usatine, MD
Family and Community Medicine, Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio

The authors reported no potential conflict of interest relevant to this article.

Simultaneously published in Cutis and The Journal of Family Practice.

Author and Disclosure Information

Candrice R. Heath, MD
Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA

Richard P. Usatine, MD
Family and Community Medicine, Dermatology and Cutaneous Surgery, University of Texas Health, San Antonio

The authors reported no potential conflict of interest relevant to this article.

Simultaneously published in Cutis and The Journal of Family Practice.

Article PDF
CT110004226.pdf
Article PDF
CT110004226.pdf

THE COMPARISON

A Areas of alopecia with erythema and scale in a young Black boy with tinea capitis. He also had an enlarged posterior cervical lymph node (arrow) from this fungal infection.

B White patches of scale from tinea capitis in a young Black boy with no obvious hair loss; however, a potassium hydroxide preparation from the scale was positive for fungus.

C A subtle area of tinea capitis on the scalp of a Latina girl showed comma hairs.

Tinea capitis
Photographs courtesy of Richard P. Usatine, MD.

Tinea capitis is a common dermatophyte infection of the scalp in school-aged children. The infection is spread by close contact with infected people or with their personal items, including combs, brushes, pillowcases, and hats, as well as animals. It is uncommon in adults.

Epidemiology

Tinea capitis is the most common fungal infection among school-aged children worldwide.1 In a US-based study of more than 10,000 school-aged children, the prevalence of tinea capitis ranged from 0% to 19.4%, with Black children having the highest rates of infection at 12.9%.2 However, people of all races and ages may develop tinea capitis.3

Tinea capitis most commonly is caused by Trichophyton tonsurans and Microsporum canis. Dermatophyte scalp infections caused by T tonsurans produce fungal spores that may occur within the hair shaft (endothrix) or with fungal elements external to the hair shaft (exothrix) such as M canis. Microsporum canis usually fluoresces an apple green color on Wood lamp examination because of the location of the spores.

Key clinical features

Tinea capitis has a variety of clinical presentations: • broken hairs that appear as black dots on the scalp • diffuse scale mimicking seborrheic dermatitis • well-demarcated annular plaques • exudate and tenderness caused by inflammation • scalp pruritus • occipital scalp lymphadenopathy. Worth noting Tinea capitis impacts all patient groups, not just Black patients. In the United States, Black and Hispanic children are most commonly affected.4 Due to a tendency to have dry hair and hair breakage, those with more tightly coiled, textured hair may routinely apply oil and/or grease to the scalp; however, the application of heavy emollients, oils, and grease to camouflage scale contributes to falsenegative fungal cultures of the scalp if applied within 1 week of the fungal culture, which may delay diagnosis. If tinea capitis is suspected, occipital lymphadenopathy on physical examination should prompt treatment for tinea capitis, even without a fungal culture.5 Health disparity highlight A risk factor for tinea capitis is crowded living environments. Some families may live in crowded environments due to economic and housing disparities. This close contact increases the risk for conditions such as tinea capitis.6 Treatment delays may occur due to some cultural practices of applying oils and grease to the hair and scalp, camouflaging the clinical signs of tinea capitis.

THE COMPARISON

A Areas of alopecia with erythema and scale in a young Black boy with tinea capitis. He also had an enlarged posterior cervical lymph node (arrow) from this fungal infection.

B White patches of scale from tinea capitis in a young Black boy with no obvious hair loss; however, a potassium hydroxide preparation from the scale was positive for fungus.

C A subtle area of tinea capitis on the scalp of a Latina girl showed comma hairs.

Tinea capitis
Photographs courtesy of Richard P. Usatine, MD.

Tinea capitis is a common dermatophyte infection of the scalp in school-aged children. The infection is spread by close contact with infected people or with their personal items, including combs, brushes, pillowcases, and hats, as well as animals. It is uncommon in adults.

Epidemiology

Tinea capitis is the most common fungal infection among school-aged children worldwide.1 In a US-based study of more than 10,000 school-aged children, the prevalence of tinea capitis ranged from 0% to 19.4%, with Black children having the highest rates of infection at 12.9%.2 However, people of all races and ages may develop tinea capitis.3

Tinea capitis most commonly is caused by Trichophyton tonsurans and Microsporum canis. Dermatophyte scalp infections caused by T tonsurans produce fungal spores that may occur within the hair shaft (endothrix) or with fungal elements external to the hair shaft (exothrix) such as M canis. Microsporum canis usually fluoresces an apple green color on Wood lamp examination because of the location of the spores.

Key clinical features

Tinea capitis has a variety of clinical presentations: • broken hairs that appear as black dots on the scalp • diffuse scale mimicking seborrheic dermatitis • well-demarcated annular plaques • exudate and tenderness caused by inflammation • scalp pruritus • occipital scalp lymphadenopathy. Worth noting Tinea capitis impacts all patient groups, not just Black patients. In the United States, Black and Hispanic children are most commonly affected.4 Due to a tendency to have dry hair and hair breakage, those with more tightly coiled, textured hair may routinely apply oil and/or grease to the scalp; however, the application of heavy emollients, oils, and grease to camouflage scale contributes to falsenegative fungal cultures of the scalp if applied within 1 week of the fungal culture, which may delay diagnosis. If tinea capitis is suspected, occipital lymphadenopathy on physical examination should prompt treatment for tinea capitis, even without a fungal culture.5 Health disparity highlight A risk factor for tinea capitis is crowded living environments. Some families may live in crowded environments due to economic and housing disparities. This close contact increases the risk for conditions such as tinea capitis.6 Treatment delays may occur due to some cultural practices of applying oils and grease to the hair and scalp, camouflaging the clinical signs of tinea capitis.

References
  1. Gupta AK, Mays RR, Versteeg SG, et al. Tinea capitis in children: a systematic review of management [published online July 12, 2018]. J Eur Acad Dermatol Venereol. 2018;32:2264-2274. doi:10.1111/jdv.15088
  2. Abdel-Rahman SM, Farrand N, Schuenemann E, et al. The prevalence of infections with Trichophyton tonsurans in schoolchildren: the CAPITIS study [published online April 19, 2010]. Pediatrics. 2010;125:966-973. doi:10.1542/peds.2009-2522
  3. Silverberg NB, Weinberg JM, DeLeo VA. Tinea capitis: focus on African American women. J Am Acad Dermatol. 2002;46(2 suppl understanding):S120-S124. doi:10.1067/mjd.2002.120793
  4. Alvarez MS, Silverberg NB. Tinea capitis. In: Kelly AP, Taylor SC, eds. Dermatology for Skin of Color. McGraw Hill Medical; 2009:246-255.
  5. Nguyen CV, Collier S, Merten AH, et al. Tinea capitis: a singleinstitution retrospective review from 2010 to 2015 [published online January 20, 2020]. Pediatr Dermatol. 2020;37:305-310. doi:10.1111 /pde.14092
  6. Emele FE, Oyeka CA. Tinea capitis among primary school children in Anambra state of Nigeria [published online April 16, 2008]. Mycoses. 2008;51:536-541. doi:10.1111/j.1439-0507.2008.01507.x
References
  1. Gupta AK, Mays RR, Versteeg SG, et al. Tinea capitis in children: a systematic review of management [published online July 12, 2018]. J Eur Acad Dermatol Venereol. 2018;32:2264-2274. doi:10.1111/jdv.15088
  2. Abdel-Rahman SM, Farrand N, Schuenemann E, et al. The prevalence of infections with Trichophyton tonsurans in schoolchildren: the CAPITIS study [published online April 19, 2010]. Pediatrics. 2010;125:966-973. doi:10.1542/peds.2009-2522
  3. Silverberg NB, Weinberg JM, DeLeo VA. Tinea capitis: focus on African American women. J Am Acad Dermatol. 2002;46(2 suppl understanding):S120-S124. doi:10.1067/mjd.2002.120793
  4. Alvarez MS, Silverberg NB. Tinea capitis. In: Kelly AP, Taylor SC, eds. Dermatology for Skin of Color. McGraw Hill Medical; 2009:246-255.
  5. Nguyen CV, Collier S, Merten AH, et al. Tinea capitis: a singleinstitution retrospective review from 2010 to 2015 [published online January 20, 2020]. Pediatr Dermatol. 2020;37:305-310. doi:10.1111 /pde.14092
  6. Emele FE, Oyeka CA. Tinea capitis among primary school children in Anambra state of Nigeria [published online April 16, 2008]. Mycoses. 2008;51:536-541. doi:10.1111/j.1439-0507.2008.01507.x
Issue
Cutis - 110(4)
Issue
Cutis - 110(4)
Page Number
226-227
Page Number
226-227
Publications
MDedge Dermatology
Cutis
Publications
MDedge Dermatology
Cutis
Topics
Diversity in Medicine
Article Type
Article
Display Headline
Tinea Capitis
Display Headline
Tinea Capitis
Sections
Dx Across the Skin Color Spectrum
Disallow All Ads
Content Gating
No Gating (article Unlocked/Free)
Alternative CME
Disqus Comments
Default
Gate On Date
Mon, 10/10/2022 - 15:45
Un-Gate On Date
Mon, 10/10/2022 - 15:45
Use ProPublica
CFC Schedule Remove Status
Mon, 10/10/2022 - 15:45
Hide sidebar & use full width
render the right sidebar.
Conference Recap Checkbox
Not Conference Recap
Clinical Edge
Display the Slideshow in this Article
Medscape Article
Display survey writer
Reuters content
Disable Inline Native ads
WebMD Article
Teaser Media
Tinea capitis
Article PDF Media