Medicosnext
-Dr. Samyam Bickram Pathak
-MBBS (KIST Medical College), TU Gold Medalist
-ECFMG Certified USMLE aspirant
-Outstanding Fundaraising Volunteer Award winner
– Currently, Volunteer Doctor at Johns Hopkins Medicine-Suburban Hospital
INTRODUCTION
Tinea capitis is a cutaneous fungal infection involving the hair follicles and shaft of the scalp. It is
primarily caused by dermatophytes in the genera Trichophyton and Microsporum that invade the hair
shaft. The existing reports of tinea capitis in infants are rare, which may be attributable to the lack of
reporting at this stage of life. In infancy, the presentation of alopecia, scaling, and flaking associated
with tinea capitis are often misdiagnosed as eczema or seborrheic dermatitis. There are currently limited
treatment guidelines and no standard of care for children less than two years of age presenting with
tinea capitis in the United States.
CASE PRESENTATION
A case of 12-day old infant was encountered when I was posted for a US clinical rotation at one of the
hospital in Wisconsin. The skin lesion over the scalp was examined. Then, the examination of the
specimen obtained included:
a. KOH Preparation which indicated broken hairs, spores, and an endothrix infection on the residual hair
b. Fungal cultures which were positive for Microsporum species
TREATMENT
The patient was then prescribed 15 mg/kg/day of Griseofulvin ultra-micro size tablets which were
crushed, mixed with water and taken orally for 10 weeks. No any side effects were reported.
Furthermore, the patient exhibited clearance with no recurrence at the time of 3 months follow-up.
Clinical presentation KOH mount fungal culture showing Microsporum species
DISCUSSION
The American Association of Pediatrics Red Book reports that griseofulvin is FDA approved for children
two years and older and terbinafine is approved for the use in those four years and older. The case
above shows the successful use of griseofulvin in the treatment of tinea capitis in a 12-day old infant. In
support of this, a literature review on the treatment of tinea capitis in infants reported that children less
than two years of age treated with an oral antifungal agents had nearly 100% cure rated without
recurrence at the time of the time of follow up. Therefore, it is clear that tinea capitis is a curable and
treatable condition in the infants.
PREVENTION
As ‘prevention is always better than cure’, tinea capitis can also be prevented by various measures.
Washing towels in warm, soapy water after each use, washing hands after touching pets and animals
and use of some OTC dandruff shampoos (Selenium sulphide) can help prevent the spread of the fungus
in children of all age group.
CONCLUSION
Tinea capitis is a very common condition, but rare in infant. Thus, proper knowledge, attitude and
practice about this cutaneous fungal infection should be present among the parents so that timely
diagnosis and proper treatment can be provided to their children of all age group to get rid of it
