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Tinea
Capitis
A look at the causes and the only proven treatments for Tinea Capitis,
a skin level fungal infection characterized by bare patches of skin
on the scalp.
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If you or a loved one is suffering from Tinea Capitis, it is important
that you educate yourself on the condition. We have all the important
information here.
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Tinea Capitis
A disease caused by fungal infection of the skin of the scalp,
eyebrows, and eyelashes, with a propensity for attacking hair
shafts and follicles. It is also called "ringworm of
the scalp". It is most commonly found in children ages
10 and under, even though it can occur in older people.
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Tinea Capitis
- A Little Background
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Tinea Capitis is a disease caused by a fungal infection of the
skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking
hair shafts and follicles. It is also known by names such as ringworm
of the scalp and Tinea tonsurans. In the US and other regions of the world,
the incidence of Tinea Capitis is increasing.
Symptoms of Tinea Capitis can vary from a scaly non-inflamed
area of skin resembling seborrheic dermatitis, all the way to an inflammatory
disease with scaly lesions and hair loss or Alopecia that may progress
to severely inflamed deep abscesses, with the potential for scarring and
permanent hair loss. The extent of the condition depends mostly on the
way the affected individual's body reacts to the fungus.
The term Tinea originally indicated larvae of insects that fed on clothes
and books. Subsequently, it meant parasitic infestation of the skin. By
the mid 16th century, the term was used to describe diseases of the scalp.
The term ringworm referred to skin diseases that assumed a ring form,
including Tinea The causative agents of Tinea infections of the beard
and scalp were described first by Remak and Schönlein, then by Gruby,
during the 1830s. Approximately 50 years later, in Sabouraud's dissertation,
it was established that multiple species of fungi cause the disease. Simple
ways to identify the type of fungus were defined, and treatment using
x-ray epilation was reported in 1904.
Effective treatment of Tinea Capitis by griseofulvin became available
in the 1950s.
Incidence of Tinea Capitis is no longer part of the required reporting
to health agencies by physicians in the US, so exact numbers are not available.
Internationally, the incidence of TC has dropped from 14% to 1.2% primarily
due to improved hygiene and sanitary conditions. The incidence of infection
has been reported at 5 times greater in boys than in girls before puberty,
with a reversal of these numbers post-puberty.
TC is usually the result of person-to-person transmission. The
organism remains viable on combs, brushes, couches, and sheets for long
periods. Certain species of TC Fungi are found only in particular parts
of the world.
Minor bruising of the scalp occasionally provides an entry for the microscopic
fungus. Infection begins as a small papule around a hair shaft on the
scalp, eyebrows, or eyelashes. Within a few days, the red papule becomes
paler and scaly, and the hairs appear discolored, lusterless, and brittle.
They break off a few millimeters above the scalp skin surface. The lesion
spreads, forming numerous papules in a typical ring form. Ring-formed
lesions may coalesce with other infected areas. Pruritus usually is minimal
but may be intense at times. Hair loss is common in infected areas. Inflammation
may be mild or severe.
It is important that you find a qualified dermatologist to diagnose your
condition.
Finding a Doctor: The American Academy
of Dermatology has a Physician
Referral Service. There you can type in your city and see a list of
dermatologists in your area. Click each name and find the section labeled
"Specialties". If Alopecia or Hair Loss is not listed verbatim,
read through the rest of their profile and see if it is mentioned. If
you are unable to find a specialist in your area, make use of the AAD's
more broad Statewide
Search. You will be presented with all the registered Dermatologists
in your state by City. Some have profiles, some don't, but all have contact
information. It is worth the work to print out a list and call them one
by one, and inquire as to the physicians experience with Alopecia Areata.
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Laboratory diagnosis of Tinea Capitis depends on examination
and culture of rubbings, scrapings, pluckings, or clippings from lesions.
Infected hairs appearing as broken stubs are best for examination. They
can be removed with forceps without undue trauma or collected by gentle
rubbing with a moist gauze pad or toothbrush. Selected hair samples
are cultured or allowed to soften in 10-20% potassium hydroxide (KOH)
before examination under the microscope. Examination of KOH preparations
(KOH mount) usually determines the proper diagnosis if a Tinea infection
exists. Microscopic examination of the infected hairs may provide immediate
confirmation of the diagnosis of ringworm and establishes whether the
fungus is small-spore or large-spore ectothrix or endothrix. Culture
provides precise identification of the species for epidemiological purposes.
Primary isolation is carried out at room temperature, usually on Sabouraud
agar containing antibiotics (penicillin/streptomycin or choramphenicol)
and cycloheximide (Acti-dione), which is an antifungal agent that suppresses
the growth of environmental contaminant fungi. In cases of tender kerion,
the agar plate can be inoculated directly by pressing it gently against
the lesion.
Diagnosis takes about 2 weeks to be performed, In some cases, other
tests involving nutritional requirements and hair penetration in are
necessary to confirm the identification.
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Treatments for
Tinea Capitis
» Systemic
administration of Griseofulvin is an effective oral therapy.
» Selenium Sulfide Shampoo may reduce transmission
to others.
» Itraconazole and Terbafine are most commonly
used as alternatives to Griseofulvin.
Dosages: Please be advised that these treatments
are only recommended with the supervision of a qualified physician.
Griseofulvin has been the treatment of choice in all ringworm
infections of the scalp. The effective dosage of griseofulvin
often prescribed by specialists is 20-25 mg/kg/d for 6-8 weeks.
Griseofulvin accumulates in keratin of the horny layer, hair,
and nails, rendering them resistant to invasion by the fungus.
Treatment must continue long enough for infected keratin to
be replaced by resistant keratin, usually 4-6 weeks. In inflammatory
lesions, compresses often are required to remove pus and infected
scale. Therapy progress is monitored by regular clinical examination
with the aid of a Wood lamp for fluorescent species.
Itraconazole as an alternative: continuous regimen (3-5 mg/kg/d
with a full meal for 4-6 wk), Itraconazole pulse regimen with
capsules (5 mg/kg/d for 1 wk times 3 pulses 3 wk apart), and
Itraconazole pulse regimen with oral solution (3 mg/kg/d for
1 wk times 3 pulses, i.e., 1 wk per mo). The oral solution
may cause diarrhea in children. In some children (weighing
20-40 kg), a single 100-mg capsule daily for 4-6 weeks has
been used successfully. |
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Please note that all treatments mentioned above must be administered
and monitored by a physician.
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Tinea
Capitis - Recommended Resources |
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