Tinea Capitis - Treatment, Picture and Symptoms of Tinea Capitis

Tinea Capitis is rather uncommon in India and the other Asiatic countries except in Kashmir. The causative fungi are the different species of microsporum and trichophyton. Infection takes place from both affected human beings and animals.The occipital and temporal regions are the sites of choice.

Symptoms of Tinea Capitis

There are three varieties:

The scaly variety is the commonest; it is caused by microsporum. The salient features are: a circular patch or patches of partial alopecia with thin greyish scales; broken luster-less stumps of hair, with, may be, a grayish film around them; a greenish fluorescence seen under Wood's light and a positive scraping for fungus. The fungus grows in the stratum corneum of the epidermis, entering the hair follicles through their mouths. Penetrating the cuticle and cortex of the hair, it grows inside the hair as well.

Consequently, the hair weakens and breaks, producing alopecia, which is usually partial, and broken stumps can be seen. A microscopic examination will show (he irregular broken end of the hair, the disturbed hair structure and the mosaic pattern of the mycelill of fungus, both inside the hair and also in the scales. It is not just a coincidence that tinea capitis (particularly the scaly variety caused by microsporum) does not affect individuals after puberty. There is a scientific explanation for it, namely, there is an alteration in the function of sebaceous glands at puberty.

The black-dot variety is caused by a species of trichophyton (endothrix) in which the mycelia of the fungus grow inside the hair; the hair breaks off flush with the surface of the skin, thereby producing the appearance of black dots. The alopecia may look almost complete, but the black dots can always be detected at the periphery of the lesion.

Wood's lamp examination may not show any fluorescence in the black-dot variety of tinea capitis.

Differential diagnosis of Tinea Capitis

In tinea capitis, the differential diagnosis is made from other causes of patchy alopecia such as syphilis and alopecia areata. The features of ringworm of the scalp are typical; Wood's lamp and microscopic examinations will help further to establish the diagnosis.

Syphilitic alopecia has an irregular, moth-eaten appearance. Usually affecting the occipital and temporal regions it is accompanied by other features of secondary syphilis. Alopecia 'areata is characterized by well-defined patches of complete alopecia, absence of dull, broken hair and greyish scales, and the presence of "exclamation mark" hair.

Treatment of Tinea Capitis

Griseofulvin (fine particle) in doses of 125 mg four times a day for 6 to 8 weeks is very effective. Fungicides like miconazole, tinaderm (P), and econazole are useful topically.

Patients are instructed to keep a linen or paper cap on the child's head day and night; to wash the scalp every morning with soap and hot water, to scrub the affected part with a soft nail brush all over the scalp; to report any undue irritation and to come for a check-up with the ointment removed, every fortnight.