Tinea capitis, the most common dermatophytosis in children, is an infection of the scalp and hair follicle. Transmission is fostered by poor hygiene and overcrowding and can occur through contaminated hats, brushes, and pillowcases. After being shed, affected hairs can harbor viable organisms for more than 1 year. Tinea capitis is characterized by irregular or well-demarcated alopecia and scaling (Fig. 33-49). Cervical and occipital lymphadenopathy may be prominent. When hairs fracture a few millimeters from the scalp, "black dot" alopecia is produced. Tinea scalp infection also may result in a cell-mediated immune response termed a kerion, which is a boggy, sterile, inflammatory scalp mass
(Fig. 33-50). A kerion does not require antibiotics or incision and drainage. If a kerion does not respond to oral antifun-gals alone, an oral steroid may be added for a short course.
Oral griseofulvin daily for 6 to 8 weeks is a proven treatment for tinea capitis, even if it requires a somewhat longer course than the newer antifungal agents (Fleece et al., 2004). It is available in a liquid form for children. Also, consider 4 weeks of oral terbinafine daily; it was as effective as 8 weeks of griseofulvin after 8 weeks, but at week 12 the efficacy of griseofulvin decreased to 44%, whereas the efficacy of terbinafine was 76% (Caceres-Rios et al., 2000). Consider oral flu-conazole as an option because it is available in liquid form and appears to be effective and safe, but fewer clinical trials have been done (Foster et al., 2005).
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