A 6-year-old boy has scalp inflammation and hair loss. The condition began several weeks ago, at which time he was treated at another clinic. Ketoconazole shampoo was prescribed but has proven ineffectual. The child experiences occasional pruritus. Examination of the scalp reveals a well-demarcated zone of erythema and alopecia. Several pustules are also noted, as is an enlarged posterior cervical lymph node.
Tinea capitis is common in children. The condition is caused by keratinophilic fungi called dermatophytes. Two species are responsible: Trichophyton and Microsporum. Some individuals experience a vigorous inflammatory response known as a kerion, characterized by erythema, pustules and hair loss. Regional lymphadenopathy is common. Topical therapy is ineffectual; treatment with an oral antifungal agent should be instituted early in the course of disease to prevent permanent alopecia. Griseofulvin administered for at least 4 weeks is the drug of choice. Alternative therapies include terbinafine and itraconazole.
Dr. Schleicher is director of DermDOX Center in Hazleton, Pennsylvania, a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine and Kings College in Wilkes-Barre, Pennsylvania, and an associate professor of medicine at the Commonwealth Medical School in Scranton, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
