Tinea capitis

Tinea capillitii.

Fungal infection of the terminal hairy head.

• Pathogen
  • Microsporum canis (> 50%)
  • Trichophyton mentagrophytes (< 25%)
  • T. verrucosum (< 20%)
  • T. rubrum (ca. 10%)
  • Rarely: T. violaceum, tonsurans, soudanese, T. schoenleinii, M. audouinii

• Depending on whether the fungus is located in the hair shaft or outside, one speaks of an ecto- or  endotrix infection.

• Depending on the depth of infiltration, a distinction can be made between tinea capitis superficialis and tinea capitis profunda.

• Detection of pathogens by means of scale extraction, biopsy or hair epilation.
• Native potassium hydroxide preparation: The material obtained is placed on a slide and dissolved by means of 20% potassium hydroxide solution. In case of fungal infection, fungal filaments can be seen microscopically.

• Periodic acid-Schiff stain (PAS): In the context of a dermatopathological examination, the existence of fungal filaments and spores (red) can be detected by means of PAS staining.

• Fluorescence microscopy: Fluorescent dyes can be used to optically visualise the cell walls of fungi.

• Wood light lamp: Shows fluorescence in, for example,  favus, microsporiasis, tinea inguinalis.

• Culture (Gold standard): Cultural cultivation of fungi. Duration: Up to 4 weeks for dermatophytes, up to 2 weeks for moulds, approx. 3-4 days for yeasts.

• Microculture: This allows further differentiation between the various fungal species.

• Molecular diagnostics: Rapid amplification is achieved by PCR. The method is very sensitive.

• Control of therapy by renewed culture is carried out after the end of therapy
• If zoophilic dermatophytes are detected, all animals with which there has been contact should be examined. 
• For antrophilic pathogens, control of contact persons-as well as possible-is useful.
• Therapy should be carried out with both topical and systemic antifungals.

• Terbinafine (mainly used for trihophytes)
• Itraconazole Should not be used for trichophytes due to reduced efficacy.
• Fluconazole resistance exists against certain Trichophyton species (T. mentagrophytes var, T. verrucosum, T. granulosum).
• Griseofulvin approved in children. Should not be used in trichophytes due to reduced efficacy.

• Children: Although only griseofulvin is approved in children, we rather recommend the use of itraconazole (1313717, 2548967) with regard to data.

Lebwohl, Mark. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Elsevier, 2014. print.

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