Tinea capitis is a common infection of the scalp hair shaft.  It primarily affects preadolescent children.  The predominant pathogen varies by geographical location.  In North America, more than 90% of cases are caused by the fungus, Trichophyton tonsurans. 

Tinea capitis is a great “masquerader” in that it can present in a variety of ways that can be confused with other disorders.  When it presents in a non-inflammatory way, it may appear like simple dandruff with some pruritus (itchiness) and subtle hair loss.  This is often mistake for seborrhea, The presence of inflamed lymph nodes in the head/neck region may help correct the diagnosis.  Other presentations include:  boggy, oozing pustular masses (also called kerions) with significant hair loss (an inflammatory form of the disease), and absence of any symptoms at all.  Asymptomatic carriers (they harbor the organism, but lack the disease) of this fungus have been found among school colleagues and family members of patients with known tinea capitis.  Comb-sharing and co-sleeping may be important factors in the disease spread.  If a patient is unresponsive to treatment, it is important to evaluate family members.

Tinea capitis should always be diagnosed with a fungal culture before treatment is initiated.  Results of a culture take approximately 2 weeks.  Often, oral treatment is deferred until after a culture is confirmed as positive. 

Anti-fungal creams and other topical agents are ineffective, as they are unable to penetrate to the hair shaft where the fungal organism resides.  The only FDA approved treatment is oral griseofulvin.  Newer oral antifungal medications (e.g., terbinafine, itraconazole, fluconazole) are also effective and have the advantage of shorter treatment duration and therefore better patient compliance. 

Ketoconazole and Selenium Sulfide shampoo reduce surface colony counts.  This likely reduces transmission of the disease to other individuals and is often recommended as an adjuvant for those with the infection and for household contacts (who share personal items such as combs, hats, brushes) and to eliminate the carrier state. 

(Roberts BJ, Friedlander SF.  Pediatric Annals 2005; 34(3):191-200.) 

Comment:  The American Academy of Pediatrics states that children receiving treatment for tinea capitis may attend school.  Haircuts, shaving of the head, or wearing a cap during treatment are not necessary.  – H.T.