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Patient Story
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An 11-year-old boy has a history of 2 months of progressive patchy hair loss (Figure 122-1). He has some itching of the scalp but his mother is worried about his hair loss. Physical examination reveals alopecia with scaling of the scalp and broken hairs looking like black dots in the areas of hair loss. A KOH preparation is created by scraping an area of alopecia onto a slide. A few loose hairs are added to the slide before the KOH and cover slip are placed. Fungal elements are seen under the microscope. After 6 weeks of griseofulvin, the tinea capitis is fully resolved.

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FIGURE 122-1

Tinea capitis in a young black boy. The most likely organism is Trichophyton tonsurans. (Used with permission from Richard P. Usatine, MD.)

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Introduction
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Tinea capitis is a fungal infection involving the scalp and hair. It is the most common type of dermatophytoses in children younger than 10 years of age. Common signs include hair loss, scaling, erythema, and impetigo-like plaques.

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Synonyms
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Ringworm of the scalp.

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Epidemiology
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  • Tinea capitis is more common in young, black boys as it has a preference for the follicles of short curly hairs.

  • Tinea capitis is the most common type of dermatophytoses in children younger than 10 years (Figures 122-1 to 122-5). It rarely occurs after puberty or in adults.1 The infection has a worldwide distribution.

  • Combs, brushes, couches, and sheets may harbor the live dermatophyte for a long period of time.

  • Spread from person to person with direct contact or through fomites.

  • Occasionally spread from cats and dogs to humans.

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FIGURE 122-2

Tinea capitis with patchy hair loss and scaling of the scalp in a young boy. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 122-3

A kerion resulting from inflammation of the tinea capitis on this young boy. The kerion looks superinfected but it is nothing more than an exuberant inflammatory response to the dermatophyte. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 122-4

Close-up of black dot alopecia in a 7-year-old girl showing the black dots where infected hairs have broken off. (Used with permission from Richard P. Usatine, MD.)

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FIGURE 122-5

Lymphadenopathy visible in the neck of this young boy with tinea capitis. The fungal infection shows more scaling and crusting than actual hair loss. The lymphadenopathy is a reaction to the tinea and not a bacterial superinfection. (...

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