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Picture of Tinea Capitis - What Group of People does Tinea Capitis Often Affect

Overview

Tinea capitis is a fungal infection of the skin of the scalp, eyebrows, and eyelashes. This disease also has the potential to attack the shafts and follicles of the hair, and is a form or dermatophytosis. It is also called ringworm of the scalp and tinea tonsurans. All over the world, the frequency of tinea capitis is on the increase.

This disease has several distinct clinical entities, which are based on the body structure and causes that are involved. The clinical make up of these conditions include the following:
Tinea capitis
Tinea favosa
Tinea corporis
Tinea imbricate
Tinea cruris
Tinea unguium
Tinea pedis
Tinea barbae
Tinea manuum

The visual effects of tinea capitis varies from that of a scaly uninflamed lesions which appears to look like seborrheic dermatitis to an inflamed scalp with scaly and red lesions. It may also involve severe hair loss that progresses to a much more serious inflammation which is called kerion. This condition carries with it the potential to cause scarring and permanent loss of hair.

Originally the term “tinea” was use to indicate the eggs of insects that made meals out of clothing and books, but it has been revised to mean an infestation of the skin by a parasite. By the middle of the 16th century, the term described diseases of the hairs of the scalp. Any skin disease, including tinea that took on a ring-like form was referred to as ringworm. The causes of the various tinea infections of the beard and scalp were first identified in the 1830’s, and about fifty years later, it was shown that several types of fungi cause the tinea capitis infection. In 1904, it was discovered that griseofulvin was an effective treatment for the infection.

Pathophysiology

Throughout the world tinea capitis is a very common dermophyte infection among children. It is believed that the predisposition toward children results from the presence of Pityrosporum orbiculare that exist in the periods prior to puberty. In addition, the fungistatic properties of fatty acids are believed to be a contributing factor.

The dermatophytes are the most common infectious disease agents known to invade humans. As a whole, the group of diseases is know as dermatophytosis, and once they begin to grow, they continue downward into the hair, invading newly formed keratin. The fungi then extend upward at the rate of hair growth, and are visible above the surface of the skin within 12-14 days. The infected hairs become brittle, and by the third week, one is able to see evidence of broken hairs. The infection continues for approximately eight to ten weeks, long enough to spread farther and involve other hairs. By that time, the infected area is approximately 3.5-7.0 cm in diameter.

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Frequency

Though it is known to be widespread, since the disease is no longer registered with public health agencies, the true incidence is unknown. It is, however, believed that the greatest number of incidence occurs in school-aged black males. Tinea capitis is the cause of dermatophytoses in 92.5% of children under the age of ten. It is rare in adults, though it may occasionally be found in the elderly. It is quite frequent in some of the urban areas of the Americas (North America, Central America, and South America). It is also quite common in areas of Africa and India, though in Southeast Asia the rate of infection has been reported to be on the decline from 14% to 1.2% over the last fifty years. The disease occurs sporadically in northern Europe.

Sex/Age

The frequency of tinea capitis varies by sex based on the type of fungus that is involved in the infection. In some fungal organisms, as many as five times more boys than girls are affected in pre-puberty, but the reverse tends to be true after the onset of puberty, possibly due to hormonal changes or as a result of more children being exposed to infected women in those adolescent years. In other fungal organisms, girls are affected at a higher rate than boys, so it depends largely on the type of fungal organism that has invaded the scalp whether more males or females will be affected.

Tinea capitis is mostly a disease that affects children younger than ten years, though occasionally other age groups may be affected. The ages where the most incidences are found are between three and seven years.

History

The first sign of the infection is a reddened papule found around a hair shaft on the scalp, eyebrows, or eyelashes. After a few days, the papule appears paler and takes on a scaly appearance, while the hairs become discolored, brittle, and lack luster. They also break off just above the skin surface of the scalp. As the lesion spreads, it forms numerous papules within the typical ring formation. These ring-formed lesions may also combined with other areas that have already become infected. Hair loss is quite common in infected areas of the scalp.

Medical Care

Topical treatments are usually ineffective for tinea capitis. The most effective treatment for ringworm of the head has been proven to be griseofulvin. Selenium sulfide shampoo such as found in Selsum Blue may be effective in the early stages of treatment to prevent the spread of the disease.


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