Definition

Tinea capitis is a fungal infection of the head. It is contagious and is associated with other fungal infections, such as foot fungus (tinea pedis). Tinea capitis is also fairly common worldwide, especially in hot and humid regions such as Africa, Southeast Asia, and Central America.

Causes

Tinea capitis is caused by a group of fungi called dermatophytes. Dermatophytes comprise three fungi families: Trichophyton, Epidermophyton, and Microsporum. These fungi infect the outer part of the scalp and hair to feed on the keratin present in the skin and hair. This can lead to hair loss or breakage. The spread of fungal infections can occur as follows:

• Person to person (anthropophilic). The fungus can be transmitted through skin contact with an infected person
• Animal to person (zoophilic). The fungus can be transmitted when touching or grooming infected animals such as cats or dogs. The fungus is often found in kittens, puppies, cows, goats, pigs and horses
• Soil to person (geophilic). The fungus can also be spread when gardening or coming into contact with soil
• Object to person. The fungus can attach to objects or surfaces touched by infected people or animals, such as clothing, towels, sheets, combs, and brushes

Symptoms

The main symptoms of tinea capitis are divided into three types:

• Black dot. In this type of infection, the infection causes hair breakage
• Kerion. Kerion is an inflammation that leaves the scalp red, scaly, and oozing pus, and may lead to permanent baldness (alopecia scarring)
• Favus. In this type, inflammation also occurs but is accompanied by small pus-filled bumps, scales, and crusts. This is the most severe form of tinea capitis

All of these types are characterized by circular plaques and baldness, which may be one or more. These plaques are usually accompanied by varying degrees of itching, ranging from mild to severe itching. The infection can cause dandruff-like symptoms on various areas of the scalp. It may also affect the brows and eyelashes. There may also be enlarged lymph nodes in the neck.

In addition, there can also be a collection of symptoms called an id reaction. These symptoms are caused by the immune system's response to the fungus. This reaction occurs at a location other than the infected area, and the resulting appearance contains no fungus at all. It can also be triggered by antifungal treatment.

An id reaction can cause inflammation of the skin on the hands and feet. This inflammation can take the form of clear fluid-filled blisters that are itchy and occasionally painful. The blisters may also develop into what appears to be a red rash. The rash can also be ring-shaped or accompanied by reddish lumps on the skin.

Risk factor

Risk factors for tinea capitis are:

• Age. Tinea capitis is most common in children under five and school-age children
• Exposure to other children. Outbreaks are common in schools and daycare centers as children may come into contact with each other while playing together
• Exposure to pets. Pets such as cats and dogs can be infected with the fungus without symptoms. The child may become infected by touching the animal
• Weakened immune system. This can occur due to diseases such as diabetes mellitus, prolonged use of steroid drugs, cancer, or treatment that reduces the body's immune system such as organ transplant recipients or people with autoimmune diseases, and anemia (lack of red blood cells)

Diagnosis

The diagnosis of tinea capitis is based on the history, chief complaint, and various examinations. The doctor will look at the signs and symptoms in your body. In addition, the examination can be done using a Wood's lamp. This lamp will emit long-wave ultraviolet light onto your scalp. The doctor can use this lamp to estimate the fungus causing tinea capitis because each fungus emits different colors (fluorescence) or does not emit any color.

In addition, the doctor may perform a scalp scraping. The scalp is placed on a glass object and given a 20% potassium hydroxide (KOH) liquid. The administration of KOH destroys the skin cells present in the skin-scraping sample so that only fungal cells remain. Then, the sample is observed under a microscope to look for fungal cells.

Another examination can also include culture. In this examination, the scraped skin will be placed in a container containing a substance that can help breed the fungus. If the container is filled with fungi within a few days, the culture is positive. Usually, cultures are used for epidemiological records (patterns of disease spread, in this case caused by fungal infections).

Management

Tinea capitis is treated with oral antifungal medications. This drug therapy is typically administered for 4-8 weeks. Therapy with ointments or creams is usually not recommended because they are ineffective.

In cases of tinea capitis with inflammation, such as kerion and favus, your doctor may prescribe medications to reduce the inflammatory response and lower the risk of permanent baldness.

Your doctor may also recommend that you use antifungal shampoo to help reduce infection and prevent transmission. However, treatment with antifungal shampoos alone is not enough to completely eradicate the fungal infection, so medication is still required.

Before giving antifungal medications, your doctor may check your liver function as antifungal medications have the potential to increase liver enzyme levels.

Complications

Tinea capitis that is treated properly usually heal without leaving a mark. However, if tinea capitis reaches the kerion type, the hair follicles (where hair grows) can be damaged resulting in permanent baldness. Furthermore, in the kerion type, the fungus produces spores that can remain infectious for months. This complication is usually caused by noncompliance with therapy or inadequate treatment of the fungus.

Prevention

Tinea capitis is difficult to prevent. The fungus that causes tinea capitis is very prevalent and can be transmitted even before symptoms appear. However, you can do some of the following to lower your risk of tinea capitis:

• Alerting yourself and others. Be aware of the risk of transmitting the fungus from other people or pets. Teach your child about head fungus, what to look out for, and how to avoid infection
• Shampoo regularly. Make sure to wash your child's hair up to the scalp regularly, especially after a haircut. Some scalp conditioner products such as head oils and pomades with selenium can help prevent tinea capitis
• Keeping the skin clean and dry. Make sure your child washes their hands, including after playing with pets. You can also keep shared spaces clean, such as schools, daycare centers, sports facilities, and locker rooms
• Avoiding infected animals. Fungal infections can look like hairless plaques on the animal's skin. If you have a pet or know of other animals that often transmit the fungus, you can visit a veterinarian to have the animal examined
• Avoiding the use of shared personal items. You can teach your child not to share clothes, towels, combs, sports equipment, and other personal items

When to see a doctor?

Some diseases that affect the scalp can have signs and symptoms similar to tinea capitis. If you or your child has hair loss, scalp scales, unbearable itching, or scalp irregularities, you should consult with your doctor. An accurate diagnosis is essential for the fastest possible management. Creams, lotions, and powders will not cure tinea capitis.

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