Tinea Capitis (scaly gray patch type)

Diagnosis: Tinea Capitis (scaly gray patch type)

Patch of alopecia with scales (hairs break off a few millimeters above the scalp skin surface)

Clinical Presentation

Patch of alopecia with scales (hairs break off a few millimeters above the scalp skin surface)

Clinical History

Submitted by Alaa Saad. Originally posted September 4, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Alopecia areata • Seborrheic dermatitis • Psoriasis (scalp) • Trichotillomania • Discoid lupus erythematosus • Impetigo of scalp • Bacterial folliculitis

Key Learnings

• Most common dermatophyte infection in children — Trichophyton tonsurans predominates in North America • "Black dot" pattern: T. tonsurans (endothrix — breaks hair at scalp surface) • Kerion: intense inflammatory response — boggy, purulent mass (not an abscess — do not I T. tonsurans does NOT • Systemic antifungals REQUIRED — topical antifungals alone do not penetrate hair follicle • Griseofulvin has been standard therapy; terbinafine increasingly used • Id reaction (dermatophytid): generalized papulovesicular eruption during treatment — not an allergy to medication

Tags: tinea, capitis, scaly, gray, patch, type, alaa saad