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Tinea Capitis Treatment & Management

  • Author: Marc Zachary Handler, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: May 13, 2016

Medical Care

Choice of treatment for tinea capitis is determined by the species of fungus concerned, the degree of inflammation, and in some cases, by the immunologic and nutritional status of the patient.

After microscopic or culture confirmation, medical therapy should be initiated. Systemic administration of griseofulvin provided the first effective oral therapy for tinea capitis, and resistance to the medication has remained minimal.[22, 23, 24] Dosing in the pediatric population is weight based. Recommended dosing is 20-25 mg/kg/day in single or two divided doses for microsized griseofulvin or 15-20 mg/kg/day in single dose or two divided doses for ultramicrosized griseofulvin.[25] The duration of treatment should be between 4 and 6 weeks.

Topical treatment alone usually is ineffective and is not recommended for the management of tinea capitis.

Newer antifungal medications, such as itraconazole, terbinafine, and fluconazole, have been reported as effective alternative therapeutic agents for tinea capitis.[22, 23] Of these agents, itraconazole and terbinafine are used most commonly. There may be some advantage to giving itraconazole with whole milk to increase absorption.[26]

Selenium sulfide shampoo may reduce the risk of spreading the infection early in the course of therapy by reducing the number of viable spores that are shed.



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.



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.

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.[27] 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.


Long-Term Monitoring

Household contacts of tinea capitis patients should be screened for clinically silent fungal carriage on the scalp.[28] 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.[29]

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.

Contributor Information and Disclosures

Marc Zachary Handler, MD Chief Resident, Department of Dermatology, Rutgers New Jersey Medical School

Marc Zachary Handler, MD is a member of the following medical societies: American Medical Association, Dermatological Society of New Jersey, New York Academy of Medicine

Disclosure: Nothing to disclose.


Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Matthew P Stephany University of Nebraska College of Medicine

Matthew P Stephany is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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, International Society of Dermatopathology

Disclosure: Nothing to disclose.

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

  1. Fu M, Ge Y, Chen W, Feng S, She X, Li X, et al. Tinea faciei in a newborn due to Trichophyton tonsurans. J Biomed Res. 2013 Jan. 27(1):71-4. [Medline]. [Full Text].

  2. Abdel-Rahman SM, Farrand N, Schuenemann E, Stering TK, Preuett B, Magie R, et al. The prevalence of infections with Trichophyton tonsurans in schoolchildren: the CAPITIS study. Pediatrics. 2010 May. 125 (5):966-73. [Medline].

  3. Mirmirani P, Tucker LY. Epidemiologic trends in pediatric tinea capitis: a population-based study from Kaiser Permanente Northern California. J Am Acad Dermatol. 2013. 69(6):916-21. [Medline].

  4. Hogewoning A, Amoah A, Bavinck JN, Boakye D, Yazdanbakhsh M, Adegnika A, et al. Skin diseases among schoolchildren in Ghana, Gabon, and Rwanda. Int J Dermatol. 2013 Apr 4. [Medline].

  5. Pai VV, Hanumanthayya K, Tophakhane RS, Nandihal NW, Kikkeri NS. Clinical study of Tinea capitis in Northern Karnataka: A three-year experience at a single institute. Indian Dermatol Online J. 2013 Jan. 4(1):22-6. [Medline]. [Full Text].

  6. Fulgence KK, Abibatou K, Vincent D, Henriette V, Etienne AK, Kiki-Barro PC, et al. Tinea capitis in schoolchildren in southern Ivory Coast. Int J Dermatol. 2013 Apr. 52(4):456-60. [Medline].

  7. Thakur R. Tinea capitis in Botswana. Clin Cosmet Investig Dermatol. 2013. 6:37-41. [Medline]. [Full Text].

  8. Leiva-Salinas M, Marin-Cabanas I, Betlloch I, Tesfasmariam A, Reyes F, Belinchon I, et al. Tinea capitis in schoolchildren in a rural area in southern Ethiopia. Int J Dermatol. 2015 Jul. 54 (7):800-5. [Medline].

  9. Nasir S, Ralph N, O'Neill C, Cunney R, Lenane P, O'Donnell B. Trends in Tinea Capitis in an Irish Pediatric Population and a Comparison of Scalp Brushings Versus Scalp Scrapings as Methods of Investigation. Pediatr Dermatol. 2013 Feb 22. [Medline].

  10. Fuller LC, Child FJ, Midgley G, Higgins EM. Diagnosis and management of scalp ringworm. BMJ. 2003 Mar 8. 326 (7388):539-41. [Medline].

  11. Jain N, Doshi B, Khopkar U. Trichoscopy in alopecias: diagnosis simplified. Int J Trichology. 2013 Oct. 5(4):170-8. [Medline]. [Full Text].

  12. Park J, Kim JI, Kim HU, Yun SK, Kim SJ. Trichoscopic Findings of Hair Loss in Koreans. Ann Dermatol. 2015 Oct. 27 (5):539-50. [Medline].

  13. Lacarrubba F, Micali G, Tosti A. Scalp Dermoscopy or Trichoscopy. Curr Probl Dermatol. 2015 Feb. 47:21-32. [Medline].

  14. Sahin GO, Dadaci Z, Ozer TT. Two cases of tinea ciliaris with blepharitis due to Microsporum audouinii and Trichophyton verrucosum and review of the literature. Mycoses. 2014 Apr 13. [Medline].

  15. Seebacher C, Bouchara JP, Mignon B. Updates on the epidemiology of dermatophyte infections. Mycopathologia. 2008 Nov-Dec. 166(5-6):335-52. [Medline].

  16. Kondo M, Nakano N, Shiraki Y, Hiruma M, Ikeda S, Sugita T. A Chinese-Japanese boy with black dot ringworm due to Trichophyton violaceum. J Dermatol. 2006 Mar. 33(3):165-8. [Medline].

  17. Akbaba M, Ilkit M, Sutoluk Z, Ates A, Zorba H. Comparison of hairbrush, toothbrush and cotton swab methods for diagnosing asymptomatic dermatophyte scalp carriage. J Eur Acad Dermatol Venereol. 2008 Mar. 22(3):356-62. [Medline].

  18. Friedlander SF, Pickering B, Cunningham BB, Gibbs NF, Eichenfield LF. Use of the cotton swab method in diagnosing Tinea capitis. Pediatrics. 1999 Aug. 104(2 Pt 1):276-9. [Medline].

  19. Bonifaz A, Isa-Isa R, Araiza J, Cruz C, Hernández MA, Ponce RM. Cytobrush-culture method to diagnose tinea capitis. Mycopathologia. 2007 Jun. 163(6):309-13. [Medline].

  20. Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. 2006 Feb. 77(2):93-9. [Medline].

  21. Slowinska M, Rudnicka L, Schwartz RA, et al. Comma hairs: a dermatoscopic marker for tinea capitis: a rapid diagnostic method. J Am Acad Dermatol. 2008 Nov. 59(5 Suppl):S77-9. [Medline].

  22. Shemer A, Plotnik IB, Davidovici B, Grunwald MH, Magun R, Amichai B. Treatment of tinea capitis - griseofulvin versus fluconazole - a comparative study. J Dtsch Dermatol Ges. 2013 Apr 10. [Medline].

  23. Shemer A, Plotnik IB, Davidovici B, Grunwald MH, Magun R, Amichai B. Treatment of tinea capitis - griseofulvin versus fluconazole - a comparative study. J Dtsch Dermatol Ges. 2013 Apr 10. [Medline].

  24. Bhanusali D, Coley M, Silverberg JI, Alexis A, Silverberg NB. Treatment outcomes for tinea capitis in a skin of color population. J Drugs Dermatol. 2012 Jul. 11 (7):852-6. [Medline].

  25. Elewski BE. Cutaneous mycoses in children. Br J Dermatol. 1996 Jun. 134 Suppl 46:7-11: discussion 37-8. [Medline].

  26. Chen S, Ran Y, Dai Y, Lama J, Hu W, Zhang C. Administration of Oral Itraconazole Capsule with Whole Milk Shows Enhanced Efficacy As Supported by Scanning Electron Microscopy in a Child with Tinea Capitis Due to Microsporum canis. Pediatr Dermatol. 2015 Oct 8. [Medline].

  27. Williams JV, Honig PJ, McGinley KJ, Leyden JJ. Semiquantitative study of tinea capitis and the asymptomatic carrier state in inner-city school children. Pediatrics. 1995 Aug. 96(2 Pt 1):265-7. [Medline].

  28. White JM, Higgins EM, Fuller LC. Screening for asymptomatic carriage of Trichophyton tonsurans in household contacts of patients with tinea capitis: results of 209 patients from South London. J Eur Acad Dermatol Venereol. 2007 Sep. 21(8):1061-4. [Medline].

  29. Pomeranz AJ, Sabnis SS, McGrath GJ, Esterly NB. Asymptomatic dermatophyte carriers in the households of children with tinea capitis. Arch Pediatr Adolesc Med. 1999 May. 153(5):483-6. [Medline].

  30. Gupta AK, Cooper EA, Bowen JE. Meta-analysis: griseofulvin efficacy in the treatment of tinea capitis. J Drugs Dermatol. 2008 Apr. 7(4):369-72. [Medline].

  31. Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004 Nov. 114(5):1312-5. [Medline].

  32. Gonzalez U, Seaton T, Bergus G, Jacobson J, Martinez-Monzon C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007 Oct 17. CD004685. [Medline].

  33. Gupta AK, Hofstader SL, Adam P, Summerbell RC. Tinea capitis: an overview with emphasis on management. Pediatr Dermatol. 1999 May-Jun. 16(3):171-89. [Medline].

  34. Koumantaki-Mathioudaki E, Devliotou-Panagiotidou D, Rallis E, et al. Is itraconazole the treatment of choice in Microsporum canis tinea capitis?. Drugs Exp Clin Res. 2005. 31 Suppl:11-5. [Medline].

  35. Friedlander SF, Aly R, Krafchik B, et al. Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study. Pediatrics. 2002 Apr. 109(4):602-7. [Medline].

  36. Krafchik B, Pelletier J. An open study of tinea capitis in 50 children treated with a 2-week course of oral terbinafine. J Am Acad Dermatol. 1999 Jul. 41(1):60-3. [Medline].

  37. Ghannoum MA, Wraith LA, Cai B, Nyirady J, Isham N. Susceptibility of dermatophyte isolates obtained from a large worldwide terbinafine tinea capitis clinical trial. Br J Dermatol. 2008 Sep. 159(3):711-3. [Medline].

  38. Elewski BE, Caceres HW, DeLeon L, et al. Terbinafine hydrochloride oral granules versus oral griseofulvin suspension in children with tinea capitis: results of two randomized, investigator-blinded, multicenter, international, controlled trials. J Am Acad Dermatol. 2008 Jul. 59(1):41-54. [Medline].

  39. Tey HL, Tan AS, Chan YC. Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis. J Am Acad Dermatol. 2011 Apr. 64(4):663-70. [Medline].

  40. Friedlander SF, Aly R, Krafchik B, et al. Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study. Pediatrics. 2002 Apr. 109(4):602-7. [Medline].

  41. Gupta AK, Lyons DC. The Rise and Fall of Oral Ketoconazole. J Cutan Med Surg. 2015 Jul-Aug. 19 (4):352-7. [Medline].

Gray-patch ringworm (microsporosis) is an ectothrix infection or prepubertal tinea capitis seen here in an African American male child. Gray patch refers to the scaling with lack of inflammation, as noted in this patient. Hairs in the involved areas assume a characteristic dull, grayish, discolored appearance. Infected hairs are broken and shorter. Papular lesions around hair shafts spread and form typical patches of ring forms, as shown. Culture from the lesional hair grew Microsporum canis.
Typical lesions of kerion celsi on the vertex scalp of a young Chinese boy. Note numerous bright yellow purulent areas on skin surface, surrounded by adjacent edematous, erythematous, alopecic areas. Culture from the lesion grew Trichophyton mentagrophytes. Courtesy of Skin Diseases in Chinese by Yau-Chin Lu, MD. Permission granted by Medicine Today Publishing Co, Taipei, Taiwan, 1981.
Discrete patches of hair loss or alopecia caused by Trichophyton violaceum infection of the vertex scalp of a young Taiwanese boy. Courtesy of Skin Diseases in Chinese by Yau-Chin Lu, MD. Permission granted by Medicine Today Publishing Co, Taipei, Taiwan, 1981.
Photomicrograph depicting an endoectothrix invasion of a hair shaft by Microsporum audouinii. Intrapilary hyphae and spores around the hair shaft are seen (hematoxylin and eosin stain with Periodic acid-Schiff counterstain, magnification X 250).
Fungal hyphae and yeast cells of Trichophyton rubrum seen on the stratum corneum of tinea capitis. Periodic acid-Schiff stain, magnification 250X.
Pronounced inflammatory tissue reaction with follicular pustule formation surrounding a hair follicle seen in a patient with clinical form of infection, termed kerion celsi. No fungal hyphae or spores were identified in the lesion in either tissue sections or culture. Fluorescein-labeled Trichophyton mentagrophytes antiserum cross-reacted with antigens of dermatophyte in the infected hairs within the pustule (hematoxylin and eosin stain, magnification X 75).
Wood lamp examination of a gray-patch area on the scalp. In Microsporum canis infection, scalp hairs emit a diagnostic brilliant green fluorescence. Trichophyton tonsurans does not fluoresce with Wood lamp.
Tinea capitis, presenting as alopecia with scale, in an African American child.
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