Tinea capitis is a disease caused by superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles (see the image below). The disease is considered to be a form of superficial mycosis or dermatophytosis. Several synonyms are used, including ringworm of the scalp and tinea tonsurans. In the United States and other regions of the world, the incidence of tinea capitis is increasing.
Causative organisms are Microsporum (e.g. M. audouinii and M.canis) and Trichophyton.
‘These infections are always spread from child to child.
Heals but there may be some scarring.
In general the clinical symptoms are more inflammatory if the causative species is animal in origin rather than human.
Fungi are germs that can live on the dead tissue of the hair, nails, and outer skin layers. Tinea capitis is caused by mold-like fungi called dermatophytes.
Tinea capitis or ringworm can spread easily. It most often affects children and goes away at puberty. However, it can occur at any age.
You can catch tinea capitis if you come into direct contact with an area of ringworm on someone else's body. You can also get it if you touch items such as combs, hats, or clothing that have been used by someone with ringworm. The infection can also be spread by pets, particularly cats.
Call for an appointment with your health care provider if you have symptoms of tinea capitis. Home care remedies do not effectively treat tinea capitis. Longer-term , prescription oral medications will probably be needed.
Anti-fungal medications, taken by mouth, are used to treat the infection of the scalp. Agents applied topically, like creams, are not effective, as they do not penetrate to the fungal infection in the hair shaft.
Griseofulvin may be used for 6 to 8 weeks of therapy. Patients should take griseofulvin with a fatty meal to enhance absorption. Griseofulvin may lead to nausea or upset stomach in children.
Terbinafine, itraconazole, and fluconazole are other orally available antifungal options for tinea capitis; however, treatment periods for some of these drugs may be shorter, from 2 to 4 weeks, which may aid in compliance. Both ketoconazole and fluconazole may also cause stomach upset in children.
Many antifungal medications are available generically. Griseofulvin, terbinafine, itraconazole, and fluconazole are all available in the generic form, and because these medications are taken for prolonged periods of time, generic substitutes may be more cost effective.
For tinea capitis caused by Microsporum spp., griseofulvin has been shown to be superior for treatment in a 2013 meta-analysis (Gupta, et al), whereas terbinafine was superior for Trichophyton spp. infection.
In July, 2013 the FDA issued a drug safety communication warning for oral ketoconazole (Nizoral) about the possibility of severe liver injuries, adrenal gland problems and harmful drug interactions with other medications. As a result, ketoconazole oral tablets should not be a first-line treatment for any fungal infection. Oral ketoconazole should be used for the treatment of certain fungal infections, known as endemic mycoses, only when alternative antifungal therapies are not available or tolerated. The topical formulations of ketoconazole have not been associated with liver damage, adrenal problems, or drug interactions. These formulations include creams, shampoos, foams, and gels applied to the skin, unlike the ketoconazole (Nizoral) tablets, which are taken by mouth.