All to Know about Tinea capitis

What is Tinea capitis?


Tinea capitis is a disease caused by superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles (see the image below). The disease is considered to be a form of superficial mycosis or dermatophytosis. Several synonyms are used, including ringworm of the scalp and tinea tonsurans. In the United States and other regions of the world, the incidence of tinea capitis is increasing.




The key clinical symptom is loss of scalp hair (alopecia). Tinea capitis is the single greatest cause of alopecia in children and it occurs regardless of the species of fungus causing the infection. There are four clinical presentations of tinea capitis which may all occur singly or together in the same patient

1. Grey patches

  • The hair breaks close to the surface or a few millimetres above and there is scalp skin scaling;
  • Small well defined patches join together to form larger ones;
  • Hair loss is usually reversible but may be minimal and diffcult to see.;
  • Causative organisms are Microsporum (e.g. M. audouinii and M.canis) and Trichophyton.

2. Black dot

  • The hair breaks at the surface of the scalp, and appears as swollen black dots, the distribution is diffuse;
  • Hair loss is usually reversible;
  • Causative organisms are Trichophyton species (e.g. T.tonsurans and T.violaceum);
  • ‘These infections are always spread from child to child.

3. Kerion

  • Wet, purulent, inflamed and painful nodules and plaques;
  • The most inflammatory form of tinea capitis (often of animal origin);
  • Hairs do not fall out but can be pulled out without pain;
  • Heals but there may be some scarring.

4. Favus

  • Patches of redness and scaling over which there are disc or cup shaped yellow crusts (scutula) pierced by 1 or 2 hairs which do not break;
  • A foetid odour may be present;
  • After many years of infection atrophic patches develop causing permanent alopecia. Because of its chronicity, favus can be seen in adults;
  • These are most commonly seen in remote areas in central and east Africa;


  • Causative organism is T.schoenleinii.

In general the clinical symptoms are more inflammatory if the causative species is animal in origin rather than human.



Fungi are germs that can live on the dead tissue of the hair, nails, and outer skin layers. Tinea capitis is caused by mold-like fungi called dermatophytes.

The fungi grow well in warm, moist areas. A tinea infection is more likely if you: 

  • Have minor skin or scalp injuries
  • Do not bathe or wash your hair often
  • Have wet skin for a long time (such as from sweating)

Tinea capitis or ringworm can spread easily. It most often affects children and goes away at puberty. However, it can occur at any age.

You can catch tinea capitis if you come into direct contact with an area of ringworm on someone else's body. You can also get it if you touch items such as combs, hats, or clothing that have been used by someone with ringworm. The infection can also be spread by pets, particularly cats.

Call your doctor if:

Call for an appointment with your health care provider if you have symptoms of tinea capitis. Home care remedies do not effectively treat tinea capitis. Longer-term , prescription oral medications will probably be needed.

Treatment Options


Anti-fungal medications, taken by mouth, are used to treat the infection of the scalp. Agents applied topically, like creams, are not effective, as they do not penetrate to the fungal infection in the hair shaft.

  • Griseofulvin may be used for 6 to 8 weeks of therapy. Patients should take griseofulvin with a fatty meal to enhance absorption. Griseofulvin may lead to nausea or upset stomach in children.
  • Terbinafine, itraconazole, and fluconazole are other orally available antifungal options for tinea capitis; however, treatment periods for some of these drugs may be shorter, from 2 to 4 weeks, which may aid in compliance. Both ketoconazole and fluconazole may also cause stomach upset in children.
  • Many antifungal medications are available generically. Griseofulvin, terbinafine, itraconazole, and fluconazole are all available in the generic form, and because these medications are taken for prolonged periods of time, generic substitutes may be more cost effective.
  • For tinea capitis caused by Microsporum spp., griseofulvin has been shown to be superior for treatment in a 2013 meta-analysis (Gupta, et al), whereas terbinafine was superior for Trichophyton spp. infection.
  • In July, 2013 the FDA issued a drug safety communication warning for oral ketoconazole (Nizoral) about the possibility of severe liver injuries, adrenal gland problems and harmful drug interactions with other medications. As a result, ketoconazole oral tablets should not be a first-line treatment for any fungal infection. Oral ketoconazole should be used for the treatment of certain fungal infections, known as endemic mycoses, only when alternative antifungal therapies are not available or tolerated. The topical formulations of ketoconazole have not been associated with liver damage, adrenal problems, or drug interactions. These formulations include creams, shampoos, foams, and gels applied to the skin, unlike the ketoconazole (Nizoral) tablets, which are taken by mouth.


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