Disease Description (Causes and Symptoms)
- Definition: Tinea capitis is a contagious fungal disease caused by dermatophyte infection of the hair roots (hair follicles and hair shafts).
- Causes: Mainly infection with dermatophytes (the genera Microsporum and Trichophyton). It can be transmitted through direct contact with an infected person, indirect contact with hair clippers, hats, and similar items, or from infected pets (mainly cats and dogs).
- Pathophysiology: The fungi penetrate the pores and areas around the hair roots, weakening and breaking the hair and causing inflammation. Severe inflammation may lead to nodular lesions (kerion) and scarring hair loss.
- Main symptoms: Well-demarcated, round or oval, scaly lesions; localized hair loss (hair breaks easily); itching; and dandruff-like scales that fall onto the shoulders. In severe cases, pain and purulent discharge (secondary bacterial infection) may occur.
Treatment Methods
- Systemic antifungal drugs (basic treatment)
- Oral treatment is essential (healing is difficult with topical treatment alone). The choice of drug and treatment duration vary depending on the fungal species.
- Commonly used drugs include terbinafine, griseofulvin, itraconazole, and fluconazole. (The drug, dose, and duration are determined according to age and the infecting fungus.)
- Treatment duration: Usually several weeks to several months (at least 4–8 weeks), continuing until the fungus has cleared.
- Topical adjunctive treatment
- Antifungal shampoos (such as ketoconazole and selenium sulfide) may be used together to reduce transmission and reinfection.
- Topical ointments are used as an adjunct (inappropriate as stand-alone treatment).
- Management of complications and special situations
- Antibiotics are administered in cases of secondary bacterial infection.
- For severe inflammatory nodules (kerion), a short course of oral steroids may be considered in some cases to prevent scarring.
- Lifestyle management and hygiene
- Cutting the hair in the affected area short (or trimming the surrounding hair) may help with application of topical treatment (including traditional recommendations).
- Disinfect or replace combs, hats, pillowcases, and hair-cutting tools. Examination and treatment of pets suspected of being infected are recommended.
- Precautions during treatment
- Oral antifungal drugs may cause hepatotoxicity and drug interactions → liver function tests before and during treatment and confirmation of concurrent medications are necessary.
- Using topical steroids alone may worsen symptoms and delay diagnosis.
Checklist Before an Outpatient Visit (Including Items to Bring and Example Questions)
- Items to bring (recommended)
- A list of all medications and supplements currently being taken (including prescription drugs and OTC products).
- Past medical history (including liver disease and drug allergies) and a history of previous antifungal use.
- The time symptoms began, photos showing changes (if possible), and records of itching, pain, or the presence of an abscess.
- Whether there has been contact with pets and whether any family members or cohabitants have similar symptoms.
- Test results that are helpful to provide at the outpatient visit
- Results of any previous fungal culture or microscopic examination (if available).
- Information that must be reported
- Whether the patient is pregnant or breastfeeding (certain drugs may be contraindicated), and the child's weight in pediatric cases.
- Example questions to ask the doctor (brief):
- What is the first-choice medication recommended for this patient, and what is the expected treatment duration?
- What tests should be performed while taking the medication? (For example, liver function tests)
General Example Questions to Ask the Doctor
- What are the expected side effects of this medication, and what should be monitored?
- How long will treatment take, and when will I no longer be contagious?
- Do household members or pets also need to be examined or treated?
- What medications or foods should be avoided during treatment (drug interactions)?
Disease-Specific Example Questions
- Which fungal species was identified in me (or my child) (Microsporum vs. Trichophyton)? Does the choice of medication differ accordingly?
- I currently have a pet (cat or dog). Does the animal need to be examined and treated, and how should it be managed?
Additional information: The diagnosis is confirmed through KOH preparation after collecting hair, fungal culture (PCR if necessary), and Wood's lamp examination (yellow-green fluorescence may be observed with some Microsporum species). The treatment plan and choice of medication should be discussed with the treating physician, taking into account age, fungal species, extent of the lesions, and underlying conditions (such as liver disease).