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Fungal Infections

Disease name and synonyms

Tinea capitis, including kerion and favus. (Scalp ringworm)

Fungi responsible (links to these)

Microsporum audouinii, M. canis, M. gypseum and several species of Trichophyton including Trichophyton interdigitale, Trichophyton verrucosum, T. tonsurans, T. soudanense and T. violaceum. Favus is caused by T. schoenleinii.

Disease description

Tinea capitis appears as hair loss (alopecia) with little apparent inflammation. Well defined patches of hair loss start small and increase in size. One type is ‘black dot’ tinea capitis in hair breaks just above the scalp, and diffuse swollen black dots appear. The clinical diagnosis requires the presence of broken hairs accompanied by scaling on the scalp, but can be difficult. Kerion is an inflammatory mass of hair, exudate, fungus and granulation tissue that can mimic a squamous cell carcinoma, and is more common in children. Favus is associated with red patches and scaling overlain by disc or cup shaped yellow crusts (scutula) pierced by 1 or 2 hairs which do not break, with a distinctive, unpleasant odour.

Frequency and global burden

Tinea capitis is worldwide in distribution, is more common in blacks and children with a global prevalence of 200 million cases. It is quite contagious and outbreaks may occur. In a recent US survey, tinea capitis was found in 6.6% children with ranges from 0% to 19.4%. It is more common in deprived areas. Favus is most common in remote areas of central and east Africa.

Underlying problems and at risk patients

Malnourished and deprived children are at greatest risk. Untreated infections may persist into adult life.

Diagnostic testing

Microscopy of hair roots and culture

Treatments

Topical treatments are ineffective as they do not reach the inside of the infected hair shaft. The oral antifungals terbinafine, itraconazole and griseofulvin have similar efficacy, given for 2-6 weeks. M. canis infections are more difficult to treat and are refractory to terbinafine.

Outlook and prognosis

Recurrence can occur if infected family cats or dogs are not tested and treated if infected. Hair loss (alopecia) is usually reversible, but may be permanent if the infection is longstanding, or with kerion or favus.

External link:  TInea capitis Guidelines, 2015     http://www.ifd.org/protocols_tineacapitis.htm

Article: John et al. 2016

Images

An example of tinea capitis with substantial erythema and local inflammation.

A severe example of tinea capitis in a child [From University Hospital of Nantes]

Another example of tinea capitis in a child, showing marked hair loss.

Another example of tinea capitis in a Ugandan child.

 

 



An example of tinea capitis in an older woman, also immunocompromised with prednisolone for rheumatoid arthritis. Her dermatology diagnosis is central centrifugal cicatricial alopecia and the causative organism was Trichophyton tonsurans. [From Chiang et al, Dermatology Online Journal, Nov 2008].


An example of kerion, or inflammatory tinea capitis.





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