Tinea capitis: Difference between revisions
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*Infection caused by dermatophytes that feed on keratin | *Infection caused by dermatophytes that feed on keratin | ||
== | {{Tinea types}} | ||
==Clinical Features== | |||
[[File:Teigne tondante enfant.jpg|thumb|Tinea capitis]] | |||
[[File:TineaCapit-001.jpg|thumb|Tinea Capitis]] | [[File:TineaCapit-001.jpg|thumb|Tinea Capitis]] | ||
*Scaly, variable pruritus | *[[Rash|Scaly]], variable [[pruritus]] | ||
*Patchy alopecia | *Patchy [[alopecia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Neonatal rashes DDX}} | ||
==Evaluation== | |||
*Clinical diagnosis | |||
*Can be complicated by development of [[kerion]] | |||
{{ | ==Management== | ||
{{Tinea capitis treatment}} | |||
== | ==Disposition== | ||
* | *Discharge | ||
==See Also== | ==See Also== | ||
*[[Tinea]] | *[[Tinea]] | ||
== | ==References== | ||
<References/> | |||
[[Category: | [[Category:Dermatology]] | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:ID]] |
Latest revision as of 21:18, 8 September 2020
Background
- Infection caused by dermatophytes that feed on keratin
Tinea Types
- Tinea capitis (head)
- Tinea corporis (body)
- Tinea pedis (foot)
- Tinea cruris (groin)
Clinical Features
Differential Diagnosis
Neonatal Rashes
- Atopic dermatitis
- Candidiasis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Neonatal acne
- Psoriasis
- Seborrheic dermatitis
- Tinea capitis
- Impetigo
- Contact dermatitis
- Perianal streptococcal dermatitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Pustular melanosis
- Sucking blisters
Evaluation
- Clinical diagnosis
- Can be complicated by development of kerion
Management
- Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetrating of hair follicles and may miss sites of subclinical infection
- Griseofulvin (first line)
- No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
- Microsize formulation: 20-25 mg/kg per day (max daily dose 1000mg per day) for 6-12 weeks
- Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 weeks
- Ultramicrosize formulation: 10-15 mg/kg (max daily dose 750mg per day) per day for 6-12 weeks
- Typical initial dose 10mg/kg per day for 6-8 weeks, if partial response increase to 15mg.kg per day for 12 weeks
- Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
- Terbinafine is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
- 10 to 20 kg: 62.5 mg daily for four to six weeks
- 20 to 40 kg: 125 mg daily for four to six weeks
- Above 40 kg: 250 mg daily for four to six weeks
- Second line (both below with limited efficacy data):
- Fluconazole 6mg/kg PO (max daily dose 400mg)per day x 3-6 weeks
- Itraconazole 3-5mg/kg PO (max daily dose 400mg) per day x 4-6 weeks
- Adjunctive interventions
- Selenium sulfide 1 or 2.5%, ciclopirox 1%, or ketoconazole 2% shampoo at least twice weekly to decrease shedding of fungal spores
- Use of antifungal shampoo by other household members may also decrease the risk for reinfection
- Combs and hair trimming equipment be cleaned mechanically and disinfected (eg, with household bleach)
Disposition
- Discharge