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Tinea Capitis

Tinea capitis is a fungal infection that affects the scalp and hair. It usually occurs in very young children, though it can appear in all age groups. The fungi that cause tinea capitis can be passed from person to person. This is especially likely when groups of children are in close quarters, such as in a school or a day-care setting.

Many objects that commonly come in contact with the head—such as hats, combs, brushes, pillows, and headrests—can harbor infectious fungi. Pets can carry infectious fungi. Even a stray hair from someone with the infection can pass an organism. Fungi can live for weeks or months in a dormant state on hair samples.

The usual effect of tinea capitis is patchy hair loss (alopecia) with a scaly rash. Small spots of hair remain in a random pattern in the bare areas. This tends to spread to larger areas of the head. The lymph nodes in the back of the neck are usually swollen.

A more severe form of tinea capitis involves a mass called a kerion. The kerion is a large, bulky, oozing rash. The patient experiences pain, swelling, and, sometimes, fever. Without treatment, a kerion can leave permanent scarring and hair loss.

Because the infected hairs are deep in the follicle and topical medication cannot penetrate to the infected areas, treatment requires oral medication. Griseofulvin (about 20 milligrams per kilogram of body weight) is the most commonly prescribed therapy. Treatment lasts 1 to 3 months or until all signs of infection are eliminated. In cases with large, swollen, and inflamed areas, a short course of oral corticosteroids may be prescribed to reduce swelling and minimize scarring. Some doctors may consider surgery in extremely severe cases.

When tinea capitis is diagnosed, it is important that all family members be examined for signs of infection and to see if they are asymptomatic carriers. All brushes, combs, pillowcases, hats, and so on should be disinfected with antifungal shampoo. Affected individuals and their family members are encouraged to use antifungal shampoo for 2 weeks to minimize spreading infection. Since the fungi that cause tinea capitis can be transmitted from animals, especially kittens and puppies, all pets should be examined and treated if necessary.

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