Tinea capitis in infants: recognition, evaluation, and management suggestions

Abstract

Tinea capitis is a reasonably common infection among the pediatric population; however, it is still a relatively rare entity among infants less than one year of age. As such, a high index of suspicion is necessary for diagnosis among infants and an appropriate diagnostic work up should be employed in any case where a dermatophyte infection is suspected. Several methods are available for diagnosis. In addition, proper identification of the specific dermatophyte genera involved should be considered as treatment options may be altered based on the causative pathogen identified.

Figure 1

Infant girl (8 months of age) presenting with erythematous, ill-defined patches and thin plaques with scaling and focal hyperkeratosis diffusely involving thescalp

Figure 2A

Microscopic examination of plucked hairs and skin scrapings from the same patient using KOH 10% with DMSO demonstrating ectrothrix pattern of hair invasion. Note the round spores lined up on the outer surface of the hair shaft on the upper right portion of the field. Multiple long hyphae are also noted externally around the hair shaft and within scale from skin scrapings along the horizontal diameter at the central aspect of the field. This latter finding is less consistently observed in tinea capitis.

Figure 2B

Close up of KOH examination from Figure 2A demonstrating primarily the multiple long branched hyphae

Figure 3A

Complete clinical clearance of tinea capitis after eight weeks of oral griseofulvin therapy in the same patient(8-month-old infant girl)

Figure 3B

Closer view of complete clinical clearance of tinea capitis after eight weeks of oral griseofulvin therapy in the same patient (8-month-old infant girl)

Figure 4

Microscopic examination of plucked hairs and skin scrapings from a three-year-old African boy presenting with multiple scaly patches on the scalp (from same patient as shown in Figure 5). Slide was prepared using KOH 10% with DMSO. Note the endothrix pattern of hair invasion with multiple round spores present within the hair shaft (“bag of marbles”). There is absence of long branched hyphae, which is usually the case on KOH exam with both endothrix and ectothrix hair invasion.

Figure 5

A three-year-old African boy presenting with multiple round-oval patches of silver-gray scaling devoid of inflammation with little-to-no hair loss. KOH examination from this patient is shown in Figure 4 (endothrix). A fungal culture confirmed dermatophyte growth. This clinical presentation isreferred to as “gray-type tinea capitis.”