eMedicine Specialties > Dermatology > Fungal Infections

Tinea Capitis: Follow-up

Author: Grace F Kao, MD, Clinical Professor of Dermatopathology, Department of Dermatology, University of Maryland School of Medicine and George Washington University Medical School; Director, Dermatopathology Section, Department of Pathology and Laboratory Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
Contributor Information and Disclosures

Updated: Sep 11, 2009

Follow-up

Further Outpatient Care

  • Household contacts of tinea capitis patients should be screened for clinically silent fungal carriage on the scalp.18 Asymptomatic carriers, including adults and siblings in the family of patients with tinea capitis and patient caretakers and playmates, require active treatment, since they may act as a continuing source of infection.19
    • Shampoo and oral antimycotic therapy have been advocated for eradication of the carrier state.
    • Studies have shown that most children who received griseofulvin plus biweekly shampooing with 2.5% selenium sulfide were negative for fungi on scalp culture after 2 weeks.
    • Shampoo containing povidone-iodine has been shown to be more effective in producing negative cultures than shampoos containing econazole and selenium sulfide and than Johnson's Baby Shampoo. Therapeutic shampoos are applied twice weekly for 15 minutes for 4 consecutive weeks. Both povidone-iodine and selenium shampoos require further clinical study for the control of fungal spore loads in infected children and asymptomatic carriers.
  • Classrooms with young children (ie, kindergarten through second grade) must be evaluated for tinea capitis infection, since these children are most susceptible and have a greater risk of disease transmission.
  • Playmates in close physical contact with patients can spread tinea capitis organisms by sharing toys or personal objects including combs and hairbrushes. These individuals need to be evaluated for the presence of infection.

Deterrence/Prevention

  • Asymptomatic carriers should be detected and treated, since they are the continuous source of infection. Siblings and playmates of patients should avoid close physical contact and sharing of toys or other personal objects, such as combs and hairbrushes, since organisms can spread from one person to another and infectious agents can be transported to different classrooms within the same or in different schools. Shared facilities and objects also may promote spread of disease, both within the home and the classroom.

Complications

  • The causative fungal organisms of tinea capitis destroy hair and pilosebaceous structures, resulting in severe hair loss and scarring alopecia. Since tinea capitis is the most common dermatophyte infection in the pediatric population in the United States, without accurate diagnosis and proper treatment, the disease is detrimental, both physically and mentally, to children who are affected. Young patients with itchy scalp and patchy or total hair loss frequently are ridiculed, isolated, and bullied by classmates or playmates. In some cases, the disease can cause severe emotional impairment in vulnerable children and can destabilize family relationships.

Prognosis

  • Continuous shedding of fungal spores may last several months despite active treatment; therefore, keeping patients with tinea capitis out of school is impractical. The causes of treatment failure include reinfection, relative insensitivity of the organism, suboptimal absorption of the medication, and lack of compliance with the long courses of treatment. T tonsurans and Microsporum species are typical offending agents in persistent positive cases. If fungi can still be isolated from the lesional skin at the completion of treatment, but clinical signs have improved, the recommendation is to  continue the original regimen for another month.

Patient Education

  • Patient education is paramount in eradicating tinea capitis. The current recommendations of the Committee on Infectious Diseases of the American Academy of Pediatrics state that "Children receiving treatment for tinea capitis may attend school. Haircuts, shaving of the head, wearing a cap during treatment are not necessary."

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize the characteristic skin lesions on the scalp, identify the causative fungal organisms on KOH preparation (with or without a Wood fluorescent lamp), and perform biopsy examination of the affected skin (with or without fungal culture) may result in destruction of hair and pilosebaceous structures with severe hair loss and scarring alopecia. Since tinea capitis is the most common dermatophyte infection in the pediatric population in the United States, lack of accurate diagnosis and proper treatment may result in serious cosmetic impairment in young patients who are affected. The tragic detrimental effects on them are both physical and psychological. Young victims with scalp pruritus and patchy or total hair loss frequently are ridiculed and bullied by classmates or playmates. In some cases, the disease can cause emotional devastation in vulnerable uncoached children.
  • Failure to identify and institute therapy in dermatophyte carriers, eg, caretakers, parents, siblings, and playmates, may hinder remedy of the disease further.

Special Concerns

  • Public health measures regarding the source of infection should be a concern for controlling tinea capitis.
  • The source of some zoophilic species often is difficult to trace. Outbreaks of M canis can be extensive. Patients' cats and dogs must be inspected under a Wood lamp and referred for treatment. At times, animal control agencies are contacted to round up stray dogs and cats. T mentagrophytes may follow known contact with rodents, but often, no source can be identified.
  • As many as 14% of asymptomatic children have been found to be carriers of causative dermatophyte for tinea capitis in a primary school in Philadelphia.20 Without therapy, 4% developed symptoms of infection, 58% remained culture positive, and 38% became culture negative within an average 2.3-month follow-up period.
 


More on Tinea Capitis

Overview: Tinea Capitis
Differential Diagnoses & Workup: Tinea Capitis
Treatment & Medication: Tinea Capitis
Follow-up: Tinea Capitis
Multimedia: Tinea Capitis
References
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Further Reading

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Keywords

tinea capitis, ringworm of the scalp, tinea tonsurans, herpes tonsurans, superficial fungal infection of skin of scalp, superficial fungal infection of skin of eyebrows, superficial fungal infection of skin of eyelashes, superficial mycosis, dermatophytosis, scaly noninflamed dermatosis, scaly erythematous lesions, hair loss, alopecia, kerion, kerion celsi, parasitic infestation of skin, Trichophyton, Microsporum, dermatophyte infection
Pityrosporum orbiculare, Pityrosporum ovale, keratinophilic fungi, ectothrix infection, arthroconidia, endothrix infections, Microsporum audouinii, Microsporum canis, favus, tinea favosa, Trichophytonschoenleinii, Trichophyton violaceum, Microsporum gypsum, scutula, black dot tinea capitis, dermatophyte idiosyncratic reactions, id reactions

acute vesicular dermatitis, Trichophyton mentagrophytes, annular erythema, erythema nodosum, intradermal trichophytin, Microsporum ferrugineum, Epidermophyton floccosum, Trichophyton concentricum, anthropophilic fungi

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Contributor Information and Disclosures

Author

Grace F Kao, MD, Clinical Professor of Dermatopathology, Department of Dermatology, University of Maryland School of Medicine and George Washington University Medical School; Director, Dermatopathology Section, Department of Pathology and Laboratory Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
Grace F Kao, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and International Society of Dermatopathology
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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