Tinea Capitis

FigureThis circular lesion on the scalp of a 3-week-old infant is tinea capitis-a rare disorder in a neonate. A 2003 epidemiological survey revealed a striking increase in tinea capitis among African American children. The study showed that the carrier rate for scalp fungus with cultures that are positive for dermatophytes was up to 13% among African American children in elementary school.

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In this infant, microscopic examination of a potassium hydroxide preparation of scalp scrapings revealed Trichophyton tonsurans, which is the most common causative organism in North America.

Treatment of tinea capitis is variable. Most medications are not FDA-approved, and few published trials discuss treatment for very young children. Most experts use high-dose oral griseofulvin (20 to 25 mg/kg/d for 6 to 8 weeks) as first-line therapy, because lower dosages have been proved to have higher treatment failures. Several other equally effective therapies, such as terbinafine, itraconazole, and fluconazole (at 3 to 6 mg/kg/d for 2 to 4 weeks), have been used outside the United States and off-label; however, these treatments cost significantly more.² There is one report of a 16-day-old infant who did well after treatment with topical bifonazole 1%.³ Selenium sulfide shampoo can be used as adjunctive therapy.

In this infant, treatment with griseofulvin (20 mg/d for 6 weeks) led to complete resolution of the lesion with no side effects.

References:

• Ghannoum M, Isham N, Hajjeh R, et al. Tinea capitis in Cleveland: survey of elementary school students. J Am Acad Dermatol. 2003;48:189-193.
  

• Roberts BJ, Friedlander SF. Tinea capitis: a treatment update. Pediatr Ann. 2005;34:191-200.

• Mosseri R, Finkelstein Y, Garty BZ. Topical treatment of tinea capitis in a neonate. Cutis. 2002;69:88-90.