Tinea Capitis
Finding a Doctor: The American Academy of Dermatology has a Physician Referral Service. Go to aad.org. There you can type in your city and see a list of dermatologists in your area. Click each name and find the section labeled “Specialties”. If Alopecia or Hair Loss is not listed verbatim, read through the rest of their profile and see if it is mentioned. If you are unable to find a specialist in your area, make use of the AAD’s more broad Statewide Search. You will be presented with all the registered Dermatologists in your state by City. Some have profiles, some don’t, but all have contact information. It is worth the work to print out a list and call them one by one, and inquire as to the physicians experience with Alopecia Areata.
Laboratory diagnosis of Tinea Capitis depends on examination and culture of rubbings, scrapings, pluckings, or clippings from lesions. Infected hairs appearing as broken stubs are best for examination. They can be removed with forceps without undue trauma or collected by gentle rubbing with a moist gauze pad or toothbrush. Selected hair samples are cultured or allowed to soften in 10-20% potassium hydroxide (KOH) before examination under the microscope. Examination of KOH preparations (KOH mount) usually determines the proper diagnosis if a Tinea infection exists.
Microscopic examination of the infected hairs may provide immediate confirmation of the diagnosis of ringworm and establishes whether the fungus is small-spore or large-spore ectothrix or endothrix. Culture provides precise identification of the species for epidemiological purposes. Primary isolation is carried out at room temperature, usually on Sabouraud agar containing antibiotics (penicillin/streptomycin or choramphenicol) and cycloheximide (Acti-dione), which is an antifungal agent that suppresses the growth of environmental contaminant fungi. In cases of tender kerion, the agar plate can be inoculated directly by pressing it gently against the lesion.
Diagnosis takes about 2 weeks to be performed, In some cases, other tests involving nutritional requirements and hair penetration in are necessary to confirm the identification.
» Systemic administration of Griseofulvin is an effective oral therapy. » Selenium Sulfide Shampoo may reduce transmission to others. » Itraconazole and Terbafine are most commonly used as alternatives to Griseofulvin.
Dosages: Please be advised that these treatments are only recommended with the supervision of a qualified physician.
Griseofulvin has been the treatment of choice in all ringworm infections of the scalp. The effective dosage of griseofulvin often prescribed by specialists is 20-25 mg/kg/d for 6-8 weeks. Griseofulvin accumulates in keratin of the horny layer, hair, and nails, rendering them resistant to invasion by the fungus. Treatment must continue long enough for infected keratin to be replaced by resistant keratin, usually 4-6 weeks. In inflammatory lesions, compresses often are required to remove pus and infected scale. Therapy progress is monitored by regular clinical examination with the aid of a Wood lamp for fluorescent species.
Itraconazole as an alternative: continuous regimen (3-5 mg/kg/d with a full meal for 4-6 wk), Itraconazole pulse regimen with capsules (5 mg/kg/d for 1 wk times 3 pulses 3 wk apart), and Itraconazole pulse regimen with oral solution (3 mg/kg/d for 1 wk times 3 pulses, i.e., 1 wk per mo). The oral solution may cause diarrhea in children. In some children (weighing 20-40 kg), a single 100-mg capsule daily for 4-6 weeks has been used successfully. Please note that all treatments mentioned above must be administered and monitored by a physician.
