Diagnosis and Management of Tinea Capitis

Clinical Presentation and Diagnosis

The British Journal of Dermatology recommends a systematic physical examination to assess for specific clinical patterns of tinea capitis, including non-inflammatory and inflammatory variants, followed by Wood's lamp examination and dermoscopy when available, with specimen collection for mycological confirmation being essential before initiating treatment 1, 2
The physical examination should identify non-inflammatory variants such as grey patch, black dot, and diffuse scale presentations, which are typically caused by ectothrix infections (Microsporum species) or endothrix infections (Trichophyton species) 3
Inflammatory variants such as kerion, favus, and diffuse pustular variant should be identified, with kerion being a painful, boggy, inflammatory mass with associated alopecia, and favus being a chronic inflammatory variant with yellow, crusted, cup-shaped lesions 1, 3

The British Journal of Dermatology suggests using Wood's lamp to identify fluorescence in M. canis infections and favus (T. schoenleinii), with affected hairs being specifically plucked for specimen collection 1, 2, 3
Dermoscopy is recommended as a highly sensitive adjunctive diagnostic tool to visualize black dot hair stubs, comma-shaped hairs, and corkscrew hairs 1

Multiple sampling methods, including scalp scraping, hair plucking, brush sampling, and gauze swabs, should be performed during the initial examination to increase diagnostic yield 1, 2
Specimens should be collected in paper or card packs, not plastic, and sent for microscopy and culture on Sabouraud agar with cycloheximide 1, 2
Post-treatment sampling is necessary to ensure mycological clearance, as clinical improvement alone is insufficient 1, 4

Oral systemic antifungal therapy is required for tinea capitis, with griseofulvin being the treatment of choice for Microsporum infections, and terbinafine being preferred for Trichophyton infections 4
Adjunctive antifungal shampoos can reduce spore transmission but are not curative alone 4
Treatment should be continued until mycological clearance is documented, and not stopped based on clinical improvement alone 4, 5