Tinea Capitis

Zikry Sitania (2017-84-028)

Supervisor:
Dr. Novriyani Masuku, Sp.KK, M.Kes.
PRESENTED AS ASSIGNMENT TO FULFILL REQUIREMENT OF CLINICAL CO-
ASSISTANCE IN DEPARTEMENT OF DERMATOVENEOROLOGY RSUD DR. M.
HAULUSSY MEDICAL FACULTY OF PATTIMURA UNIVERSITY
AMBON
2017
 DEFINITION SYNONYMS

Tinea capitis : Dermatophyte

infection of hair and scalp,
Synonyms of Tinea are
typically caused by Trichophyton
ringworm, kurap, teigne, and
and Microsporum species, with
herpes circinatus
exception of Trichophyton
concentricum
 EPIDEMIOLOGY

Most commonly observed in children between 3-14 years of age

Boys have tinea capitis more frequently than girls
The most prevalent species found in the USA T. tonsurans
Europa M. cannis
 CLASIFICATION

Grey patch ringworm Black dot ringworm

Kerion
 ETIOLOGY
Inflammatory Noninflammatory Black Dot
(Kerion) (Grey patch ringworm)

M.audouinii M.audouinii T.tonsurans

M.canis M.canis T.violaceum
M.gypseum M.ferrugineum
M.nanum T.tonsurans
T.mentagrophytes
T.scholeinii
T.tonsurans
T.verrucosum
 PATHOGENESIS
Transmission Person-to-person, animal to-person, via fomites.
The incubation period Least 2-4 days
Infection of hair follows 3 main patterns ectothrix, endothrix,
and favus
 Diagnosis
The clinical appearance of tinea capitis depends of clinical
clasification (Grey patch ringworm, Black dot ringworm, kerion)
Woods light fluororecence Yellow-green
Microscopic examination of hairs and skin scrapings using KOH
10% demonstrating ectrothrix or endothix pattern with
multiple long hyphae.
Fungal Culturegold standard for diagnosis
M. canis fluorescence Microscopic examination of
under Wood lamp plucked hairs and skin scrapings from the
same patient using KOH 10%

M. canis culture, T. Menthagrophytes culture,

macroscopic colony and macroscopic colony and
microscopic observation microscopic observation
 Differential Diagnosis

Gray Patch: Seborrheic dermatitis, psoriasis, atopic dermatitis, lichen

simplex chronicus, alopecia areata.
Black Dot: Seborrheic dermatitis, psoriasis, atopic dermatitis, lichen
simplex chronicus, chronic cutaneous lupus erythematosus, alopecia
areata.
Kerion: Cellulitis, furuncle, carbuncle
 Treatment
Topical therapy : povidoneiodine, ketoconazole 2% and selenium
sulfide 1% shampoos have all shown efficacy in this context. Used
2-4 times weekly for 2-4 weeks

Oral therapy :
First line therapy : Griseofulvin, Terbinafine,
Second-line therapy : Itraconazole, Ketokonazole
Steroid
Antibiotic
 Griseofulvin dose by body weight
Body weight Dose and duration

<50 kg 15-20 mg/kg per day (single or divided

dose) for 6-8 weeks

> 50 kg 1 g per day (single or divided dose) for 6-8

weeks

Dose: 20-25 mg/kg per day for 8 weeks (Fitzpatricks)

Terbinafine dose by body weight

Body weight Dose and duration
<20 kg 62-5 mg per day for 2-4 weeks

20-40 kg 125 mg per day for 2-4 weeks

> 40 kg 250 mg per day for 2-4 weeks

Dose: 3-6mg/kg/day, 2-4 weeks to eradication richophyton and 4-

8 weeks for Microsporum (Fitzpatricks)
 Itraconazole dose and duration
Dose Duration
50-100 mg per day 4 weeks
or or
5 mg/kg 2-4 weeks

Dose:3-5mg/kg per day for 4-6weeks (Fitzpatricks)

Ketoconazole dose and duration

Adult dose: 200 mg - 400 mg per day

Pediatric dose 5 mg/kg
Duration: 4-6 weeks

Steroid
Prednisone 1-2 mg/kg per day for 14 days
 Prognosis

Patients with immunocompetent, general prognosis bonam

patients with immunocompromised, quo ad sanationam

become dubia ad bonam
 Prevention
Education about proper hygiene techniques
and prompt treatment
Restran from sharing hairbrushes, combs, hat,
hair accessories
Hand washing and hair hygiene should be
emphasized.