Tinea Capitis
Tinea capitis is a common disorder in prepubertal refugees, especially those from the African continent. It will usually present with patches of alopecia (with scaly or black dots appearance), although widespread scaling with subtle hair loss is also possible (which can resemble seborrheic dermatitis).
DermNet NZ. Tinea capitis.
Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand)
We recommend a fungal culture to confirm the diagnosis, but if a child presents with typical tinea capitis lesions, treatment should be started right away without waiting for the culture results. Close contacts (especially children) should also be examined to look for tinea capitis lesions.
TREATMENT
The treatment of choice is oral terbinafine for 6 weeks*. Here are the recommended doses of terbinafine tablets based on weight:
Baseline ALT and AST should be ordered prior to initiating treatment (to rule out preexisting liver disease) and should be repeated with the addition of a CBC if treatment has to be extended beyond 6 weeks. |
* 6 weeks for Trichophyton infections. Microsporum infections may require a longer regimen.
** Terbinafine is technically only approved in children ≥4 years old, but we have used it in younger children with no adverse effects.
Griseofulvin (the other commonly used first-line therapy) is no longer available in Canada. If terbinafine is not available or fails to cure the infection, other treatment options include fluconazole and itraconazole.
Follow-up should be performed at the end of the treatment to ensure clinical clearance. Complete hair regrowth occurs in most children with hair loss after successful treatment. A routine fungal culture after treatment is not recommended, but it should be repeated in patients who appear to have failed treatment.