Tinea Capitis

Tinea capitis is an infection of the scalp by mold-like fungi called dermatophytes. Tinea capitis can appear as scaly and itchy areas of bald skin on the head. Severe infection and inflammation can lead to scarring or permanent hair loss.

What causes tinea capitis and who is at risk?

Tinea capitis (also called ringworm of the scalp) is a skin disorder that usually affects only children younger than age ten. It can be persistent and is highly contagious; it is not due to an infection by a worm. Ringworm gets its name from the appearance of the round lesions that occur on the scalp.

The fungi that cause tinea infections thrive in warm, moist areas. You have an increased risk for tinea infection if you have poor hygiene, prolonged wetness of the skin (such as from sweating), and minor skin or scalp injuries.

Other types of tinea infections that can occur include tinea corporis (on the body), tinea cruris ('jock itch' in the groin area), tinea barbae (beard), tinea unguium (nails), or tinea pedis ('athletes' foot).

Tinea infections are contagious. You can catch the skin disorder if you come into direct contact with someone who has the condition, or if you touch contaminated items such as combs, hats, clothing, or similar surfaces. The infection can enter through cut or broken skin. The infection can also be spread by pets, particularly cats or dogs. Horses, pigs and cows can transmit ringworm, too. Missing patches of hair on an animal may be a sign of ringworm, and the animal should be seen by a veterinarian.

Good general hygiene is important in the prevention and treatment of all tinea infections. The scalp should be shampooed regularly, especially after haircuts.

Avoid contact with infected pets or individuals. Headgear, combs, brushes, and similar items should not be shared. Children sharing sleeping mats at daycare have contracted tinea capitis, as well.

Symptoms

Symptoms of tinea capitis include round, scaly lesions on the scalp. These areas may be red or swollen (inflamed). The patient may also have areas that appear bald (alopecia), due to hair that has broken off. There may be small black dots on the scalp.

Itching of the scalp may be slight, or may not occur at all. Sometimes, there may be pus-filled lesions on the scalp (kerions).

Diagnosis

The diagnosis is suspected primarily based on the appearance of the scalp. A skin lesion biopsy with microscopic examination or culture may show dermatophytes. This test is often not necessary to diagnose tinea capitis. A Wood's lamp test may be performed to confirm the presence of a fungal scalp infection.

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.

Oral Antifungal Treatments for Tinea Capitis

Drug Oral Formulations* Patient Information
Griseofulvin
  • Gris-PEG (ultramicrosized)
  • Grifulvin V (microsized)
  • Generics available
  • Gris-PEG: 125, 250 tablets (ultramicrosize)

  • Grifulvin V: 500 mg tablet (microsize)
  • Fulvicin P/G: 330 mg tablet
  • 125 mg/5 mL oral suspension (microsize)
  • Generics: 250 mg oral capsule; 125 mg/5 mL oral suspension; 125, 250, 500 mg oral tablet
  • Avoid exposure to sunlight or tanning beds.; use sunscreen.

  • May cause stomach upset, rash, headache.
  • Griseofulvin should be given with a high fat meal for better absorption.
  • Use reliable contraception during and for up to one month (women) and six months (men) after use.
  • Avoid alcohol consumption.
Terbinafine (Lamisil)

  • Generics available

  • Off-label use

  • Lamisil: 250 mg tablet; 125 mg and 187.5 mg granule packet (for pediatric dosing)

  • Generics: 250 mg tablet
  • Avoid exposure to sunlight or tanning beds.; use sunscreen.

  • May cause stomach upset, diarrhea; take capsules with a full meal.
  • Report rash, dark urine, stomach pain, or yellowing of eyes or skin to doctor immediately.
  • Report changes in smell or taste to doctor.
  • Granules can be sprinkled on soft, non-acidic food like pudding or mashed potatoes; swallow without chewing.
Itraconazole (Onmel, Sporanox)

    • Generics available
    • Off-label use
  • 100 mg capsule; 200 mg tablet

  • 10 mg/mL oral solution
  • Subject to multiple, possibly serious drug interactions; consult with pharmacist if new prescription, over-the-counter, or herbal meds.

  • Use reliable contraception during and for two months after therapy.
  • Discuss breastfeeding with doctor.
  • May cause stomach upset, diarrhea, fatigue.
  • Report rash, dark urine, stomach pain, or yellowing of eyes or skin to doctor immediately.
  • Take capsules, tablets with full meal.
Fluconazole (Diflucan)

    • Generics available
    • Off-label use
  • 50, 100, 150, 200 mg tablet

  • 10, 40, 50, 200 mg/mL oral powder for suspension
  • May cause stomach upset or headache.

  • Report skin rash to doctor immediately.
Ketoconazole

    • generics available
  • Not recommended; see FDA update July 2013.
  • Ketoconazole oral tablets should not be a first-line treatment for any fungal infection. See FDA Drug Safety Communication.

*See Dosage (http://www.drugs.com/dosage/) for additional information.

Keep the area clean. A medicated shampoo, such as one containing selenium sulfide or ketoconazole may reduce the spread of infection. Other family members and pets should be examined and treated, if necessary.

See Also:

References

  • Trovato MJ, Schwartz RA, Janniger CK. Tinea capitis: current concepts in clinical practice. Cutis. Feb 2006;77:93-9.
  • Gupta AK, et al. Meta-analysis of randomized, controlled trials comparing particular doses of griseofulvin and terbinafine for the treatment of tinea capitis. Pediatr Dermatol. 2013;30:1-6. doi: 10.1111/j.1525-1470.2012.01866.x.
  • Last updated: 2014-05-08 by L. Anderson, PharmD

    Hide
    (web1)