Transcript Tinea Capitis - City and Hackney CCG

Tinea Capitis
Suzy Tinker
CNS Paediatric Dermatology
Homerton NHS Foundation Trust
Making a diagnosis of scalp
ringworm
 Suggested by presence of all or some of the following:
 Patches of scalp hair loss, thinning sometimes
 Scaling[minimal or thick scales may be present around hairs]
 Crusting or oozing
 Itching[of variable severity]
 Background erythema of scalp, or red scaly lesions, may also
occur on the body
 Post cervical lymphadenopathy
IMPORTANT TO BEGIN
TREATMENT AS SOON AS
CLINICAL DIAGNOSIS IS MADE
Laboratory Confirmation
 Mycology samples should be taken of scalp scrapings, and in
the case of Endothrix infections[within the hair shaft] a hair
sample with the root.
 Blunt forceps can be used to remove a hair and root, without
any trauma
 Samples should be transported in appropriate mycology pack or
black paper securely sealed.
 Majority of children in Hackney have Trichophyton Tonsurans as
the organism, causing the endothrix infection.Endothrix are
more difficult to treat, requiring oral anti fungals.
 Infection are usually anthrophilic rather than zoophilic.
 More easily spread from person to person
Treatment clinical cases
 BAD [British Association of Dermatologists] are changing
guidelines at present, from oral Griseofulvin syrup 15mg20mg/kg daily for 12 weeks., to Terbinafine tablets.
 On web site they still have both treatments.
 Terbinafine orally which comes in a 250mg tablet, and is
divided into appropriate dose for weight ,and can then be
crushed and given daily.
 Under 20 kg [1/4 a tablet ]= 62.5 mg daily for 4 weeks
 20kg to 40 kg [1/2 a tablet]=125mg daily for 4 weeks
 Over 40kg one tablet=250mg daily for 4 weeks
Family members
 Siblings or close relatives if they are children should wash
their hair twice a week with Nizoral [Ketaconazole shampoo]
for 4 weeks, even if they have no sign of infection.
 This may prevent them from catching the disease which is
spread from fungal spores.
 Many children are carriers of Tinea, a small proportion go on
to develop the infection, others lose the fungus, whilst the
rest remain carriers, thus spreading it in schools and
nurseries.
Complications Kerion
 A Kerion can develop on children's scalps.
 This is an abscess caused by a dramatic immune response to a
dermatophyte fungal infection, it is often misdiagnosed as a
bacterialy infected boil. Attempts to lance the Kerion are usually
unsuccesful, and cause scarring.
 To confirm the diagnosis scrapings and hair samples can be
taken from the affected area, bacterial swabs can also be taken,
as there may well be a secondary infection .
 Treatment is oral antifungals as before, oral antibiotics if
needed, antifungal shampoo Ketaconazole to reduce the risk of
spreading to others.
 Parents often get Tinea Corporis, and siblings may well get
Tinea capitis.
Id Reaction/ Autoeczematisation
 An Id reaction [autoeczematisation ]is an acute generalised
skin reaction to a variety of stimuli. The stimuli may be a preexisting or new eczema or skin infection with fungi, bacteria
viruses or parasites. The rash tends to occur at a site distant
from the original infection.
 If a child presents with a wide spread eczema to face , limbs
and body, more severe than they have ever had eczema, or
have never had eczema, look at the scalp.
 Scalp may well show the signs of Tinea Capitis .
 Treat both theTinea and theEczema, skin soon settles.
Tinea
Less obvious Tinea
Kerion
Resolving Tinea Capitis
Severe Tinea Capitis
Tinea capitis
Start of Tinea Capitis
2 Weeks Later
4 weeks later
9 days post treatment