Tinea Capitis
I feel very lucky that I am talking about tineas corporis this week because coincidently, one of my patients this week during clinical was diagnosed with having tinea corporis on his little scalp. This is a five-year-old boy who recently started kindergarten this year. His mother complaints that ever since the patient started school, it has been one thing after another, if it’s not a cold and runny nose, it’s some stomach bug, and when it’s not that he comes home with a scratch. She worries that the school is not clean and sanitize enough and she even brought it to the attention of the school staff.
In any case, this handsome little fellow came in and the mother complaints that he has been scratching his scalp a lot more and noticed several areas that appear to be very irritated. My preceptor and myself both agreed after careful examination of the patient’s scalp that he suffers from tinea corporis, better known as “ringworm”. Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval, or circular, mildly erythematous, scaly patch or plaque with a raised leading edge. Mild pruritus is common. The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids. Tinea corporis, is a superficial dermatophyte infection of the skin, other than on the hands (tinea manuum), feet (tinea pedis), scalp (tinea capitis), bearded areas (tinea barbae), face (tinea faciei), groin (tinea cruris), and nails (onychomycosis or tinea unguium).1 (Links to an external site.) Tinea corporis is most commonly caused by dermatophytes belonging to one of the three genera, namely, Trichophyton (which causes infections on skin, hair, and nails), Microsporum (which causes infections on skin and hair), and Epidermophyton (which causes infections on skin and nails). (Leung et al., 2020)
An antifungal cream is usually used for the treatment and management of Tinea corporis and in this case Tinea capitis. For superficial or localized tinea corporis, topical antifungals are recommended and generally effective. My preceptor ordered Ketoconazole in liquid form for the patient, it is a single dose. However, she also recommended medicated shampoo and an antifungal treatment for the patient’s scalp. Burns et al. (2017) As fungi thrive best in moist and warm environments, patients should be advised to wear light and loose-fitting clothing. The skin should be kept clean and dry. Systemic antifungal treatment is indicated if the lesion is extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment; if the patient is immunodeficient; or if there are multiple site lesions. Oral antifungal agents used for the treatment of tinea corporis include itraconazole, fluconazole, terbinafine granules, and terbinafine tablets. The duration of treatment varies, depending on the response. The usual duration of treatment is 2–4 weeks but may take longer for recalcitrant cases. (Leung et al., 2020)
Tinea capitis is a superficial cutaneous fungal infection or dermatophytosis of the scalp. The infection originates from a variety of sources including humans, animals and soil. It remains the most common cutaneous fungal infection in children, most prevalent between 3 and 7 years of age. The diagnosis of tinea capitis is made by a focused history, physical exam, trichoscopy and microscopy test. Gupta et al. (2018) Because of the multiple way one could contracts this fungal infection, we educated the patient’s parent on the possibility that playgrounds and playing with other children may have caused the appearance of the infection in the patient.
References
Burns, C. E., Dunn, A. M., Brady, M. A., Blosser, C. G., Starr, N. B., & Garzon, D. L. (2017). Pediatric Primary Care. Elsevier Gezondheidszorg.
Gupta, A., Mays, R., Versteeg, S., Piraccini, B., Shear, N., Piguet, V., Tosti, A., & Friedlander, S. (2018). Tinea capitis in children: a systematic review of management. Journal of the European Academy of Dermatology and Venereology, 32(12), 2264–2274. https://doi.org/10.1111/jdv.15088
Leung, A. K., Lam, J. M., Leong, K. F., & Hon, K. L. (2020). Tinea corporis: an updated review. Drugs in Context, 9, 1–12. https://doi.org/10.7573/dic.2020-5-6
0 comments