Tinea capitis

Last Updated: 2020-06-01

Author(s): -

Herpes tonsurans, ringworm of the hair, ringworm of the scalp, scalp ringworm, and tinea tonsurans.

Fungal infection of the scalp.

Pathogen:

  • Microsporum canis (> 50%)
  • Trichophyton mentagrophytes (< 25%)
  • T. verrucosum (< 20%)
  • T. rubrum (approx. 10%)
  • Rarely: T. violaceum, tonsurans, soudanese, T. schoenleinii, M. audouinii
  • Depending on whether the fungus is located in the hair shaft or outside, it is called an ecto- or endotrix infection.
  • Depending on the depth of infiltration, a distinction can be made between tinea capitis superficialis and tinea capitis profunda.

Variable depending on pathogen: alopecia, deposits.

  • Pathogen detection by means of scaling, biopsy or hair removal.
  • Preparation of native potassium hydroxide solution: The obtained material is placed on a slide and dissolved with 20% potassium hydroxide solution. In case of a fungal infection, fungal threads can be seen microscopically.
  • Periodic acid ship staining (PAS): In the course of a dermatopathological examination the existence of fungal threads and spores (red) can be detected by means of PAS staining.
  • Fluorescence microscopy: Fluorescent dyes can be used to visualize the cell walls of fungi.
  • Wood light lamp: Shows fluorescence e.g. in favus, microspore, 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 a further differentiation between the different types of fungi.
  • Molecular diagnostics: PCR enables rapid multiplication. This method is very sensitive.
  • Control of the therapy by renewed culture is carried out after the end of the therapy.

  • If zoophilic dermatophytes are detected, all animals with which there has been contact should be examined.

  • In the case of anthrophilic pathogens, it is recommended to control contact persons as much as possible.

  • Therapy should be carried out with both topical and systemic antifungals.
  • Terbinafine (to be used mainly for trihophytes)

  • Itraconazole should be avoided due to reduced efficacy and should not be applied to trichophytes.
  • Fluconazole resistances exist against certain Trichophyton species (T. mentagrophytes var, T. verrucosum, T. granulosum).

  • Griseofulvin is permitted in children. 
    • Should not be used on trichophytes due to reduced effectiveness.
  • Children: Although only Griseofulvin is approved for children, we recommend Itraconazole (1313717, 2548967).

 

1st choice therapy according to Lebwohl

Level of evidence

Griseofulvin A
Terbinafin A
Itraconazole A
2nd choice therapy according to Lebwohl  
Fluconazole B

Short-term Terbinafin

B
Short-term Itraconazole B
3rd choice therapy according to Lebwohl  
 
2% Ketoconazole shampoo B
Selenium sulfite B
Prednisolone B

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

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