Diagnosis and Treatment ofTinea CapitisBy:Aimie Farhanah Binti Zakaria C111 11 834Siti Fatimah Binti Othman C111 11 881Ahmad Yani Sukarso C111 11 152Adisor:dr! "aniSu#erisor:dr! Asna$i %ad&id' S#!((DefinitionIt is a disease caused by superficial fungal infection of the skin (dermatophyte) of the scalp, eyebrows, and eyelashes, with a propensity for attacking hair shafts and follicles.Seeral synonyms are including ringworm of the scalp. The term tinea meant parasitic infestation of the skin. ! Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. "pidemiologyTinea capitis occurs primarily in children and occasionally in other age groups.It is seen most commonly in children between # and $% years of age. #Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. )tio*o+yTinea capitis describes dermatophyte infection of hair and scalpTypically caused by Trichophyton and Microsporum species, with e&ception of Trichophyton concentricum. ,atho+enesisTheincubationperiodoftinea capitislasts!'%days,although theperiodishighlyariableand asymptomaticcarriersare common. Thehyphaegrowdownwardinto thefollicle,onthehair(ssurface, andtheintrafollicularhyphae break up into chains of spores. Thereisaperiodofspread(% daysto%months)duringwhich thelesionsenlargeandnew lesions appear. Reference:$illiam".#ames,4.G..,"irkM.5lston,Andrews'DiseasesoftheSkinClinicalDermatology,$."aniel,5ditor+,-,, Saunders 5lse6ier: 7nited Kingdom. p. +%./+1,,atho+enesis)tabout#weekshairs break off a few millimeters aboe the skin surface. *ithinthehair,hyphae descend to the upper limit ofthekeratogenous+one andhereform)damson ,fringe-onaboutthe$!th day. Reference:$illiam".#ames,4.G..,"irkM.5lston,Andrews'DiseasesoftheSkinClinicalDermatology,$."aniel,5ditor+,-,, Saunders 5lse6ier: 7nited Kingdom. p. +%./+1,,atho+enesis.onewlesionsdeelopduringtherefractoryperiod(% months to seeral years).Theclinicalappearanceisconstant,withthehostand parasite at e/uilibrium.Thisisfollowedbyaperiodofinolutioninwhichthe formation of spores gradually diminishes.Reference:$illiam".#ames,4.G..,"irkM.5lston,Andrews'DiseasesoftheSkinClinicalDermatology,$."aniel,5ditor+,-,, Saunders 5lse6ier: 7nited Kingdom. p. +%./+1,,atho+enesisIn ectothri& infections only thearthroconidiaonthe surfaceofthehairshaft maybeisuali+ed, althoughhyphaearealso presentwithinthehair shaft. Thecuticlecanbe destroyed. Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. ,atho+enesisInendothri&infections, arthroconidiaandhyphae remainwithinthehair shaft and leae the corte& and cuticle intact. )ppearanceof,black dots-whichrepresent brokenhairsatthe surface of the scalp. Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. ,atho+enesis0ausischaracteri+edbylongitudinallyarranged hyphae and air spaces within the hair shaft.)rthroconidia are not usually noted in infected hairs.Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. Clinical 0eaturesTinea capitis can occur in three distinctly different forms1 gray patch, black dot and kerion.$$ Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. $. 2ray 3atch Tinea Capitis It begins with an erythematous, scaling, well4demarcated patch on the scalp that spreads centrifugally for a few weeks or months, ceases to spread, and persists indefinitely, sometimes for years 0igure $. 5ound grayish, scaly pla/ues with progressie e&panding.$! Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. !. ,6lack dot- Tinea Capitis7sually begins as an asymptomatic, erythematous, scaling patch on the scalp, which slowly enlarges. 8esions may be single or multiple. "arly lesions are easily oerlooked and the disease is not usually noticed until areas of alopecia become eident. $# Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. !. ,6lack dot- Tinea Capitis$%Figure +.A round patch of alopecia 'ith o6erl8ing scale and 9:lack dots9 at the sites of follicular openings is presentReference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. #. 9erionThis is the inflammatory type of tinea capitis. The disease presence with painful, boggy mass in which hair is lose and broken off. 9erion may be followed by scarring and permanent alopecia in the areas of inflammation and suppuration. $: Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. #. 9erion0igure #. 9erion of the scalp$; Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. -ia+nosisThediagnosisofdermatophyteinfectioncanbe determined by looking at the clinical features.Confirmedbymicroscopicdetectionoffungal elements,byidentificationofthespeciesthrough culture,orbyhistologiceidenceofthepresenceof hyphae in the stratum corneum. Inaddition,fluorescencepatternsunder*ood(slight e&amination may support a clinical suspicion.Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. Other -ia+nosti. /oo*s$. *ood(s light"&amination inoled hair bearing areas, such as the scalp or beard, with a *ood(s lamp (#;: nm) may reeal pteridine fluorescence of hair infected with particular fungal pathogens. )TITISReference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. !. 3S=5I)SISReference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. DI00"5".TI)8 DI)2.=SIS#. )8=3"CI) )5")T)DI00"5".TI)8 DI)2.=SISReference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. T5")T>".T>"DIC)>".T=7ST=3IC)8S?ST">IC.=.4>"DIC)>".T=7SReference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. >"DIC)>".T=7ST=3IC)8 T5")T>".T 3oidone4iodine shampoo9etocona+ole !@ shampooSelenium4sulphide $@Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. Systemic treatment )nti mitotic 1 2riseofulin ($st line therapy)Terbinafine )+ole drugs1 ketocona+ole, itracona+ole, flucona+oleReference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. .=.4>"DIC)>".T=7S"D7C)TI=.)8SC5"".I.2"5)DIC)TI=. =0 3=T".TI)8 S=75C"Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. C=>38IC)TI=.Seere hair loss. Scarring alopecia ,bald areas- (7ntreated kerion). 3sychological impact (ridicule, bullying, isolation, emotional disturbance, family disruption).## Reference: SchiekeSM, Garg A.SuperficialFungalInfection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. 35=2.=SIS6onam1 under proper treatment Reference: SchiekeSM,Garg A.Superficial Fungal Infection. In: Goldsmith LA, KatzSI, Gilchrest A, !aller AS, Leffell "#,$olff K, editors. Fitzpatricks Dermatology in General Medicine. % ed. &e' (ork: Mc Gra' )ill* +,-+. p. ++../++%0, ++12/++13. Wassalamualaikum wr. wb.and Thank You