TOACS FCPS Station · Hair Loss in Tinea Capitis

📷 Clinical Photograph – Tinea Capitis

Clinical photograph showing patchy hair loss, scaling, and broken hairs (black dots) on the scalp, characteristic of tinea capitis

Figure 1 · Tinea Capitis · Dermatophyte infection (scalp)

🔍 Key clinical features:

✓ Patchy alopecia – well-demarcated areas of hair loss
✓ Broken hairs ('black dots') – hairs broken off at the scalp
✓ Scaling and erythema – often with mild inflammation
✓ Kerion – boggy, tender, inflamed mass with pustules
✓ Most common in children – 3-7 years of age

📋 Clinical scenario (examiner prompt)

A 5‑year‑old boy is brought to the clinic with a patch of hair loss on the scalp that has been slowly enlarging over the past 2 weeks. The area is scaly and has several broken hairs at the scalp. The child has no significant medical history and has a pet dog at home. On examination, there is a well-circumscribed, scaly, hypopigmented patch with multiple broken hairs and mild erythema. No lymphadenopathy is present.

Patchy scalp alopecia Broken hairs (black dots) Scaling, mild erythema Pet dog at home

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the clinical image and context.

2. Describe the clinical features (patchy alopecia, broken hairs, scaling, erythema).

3. Explain the etiology and transmission (dermatophytes – Trichophyton tonsurans most common in US, Microsporum canis from pets).

4. Discuss diagnosis and management (KOH, Wood lamp, oral terbinafine/griseofulvin, kerion management).

⚠️ Key concept: Tinea capitis is a fungal infection of the scalp that presents with patchy alopecia, broken hairs ('black dots'), scaling, and erythema. It is most common in children 3-7 years. The most common organism in the US is Trichophyton tonsurans (endothrix, no fluorescence); Microsporum canis (ectothrix, green fluorescence) is acquired from pets. Systemic antifungal therapy (terbinafine or griseofulvin) is required – topical agents are ineffective. Kerion is an inflammatory boggy mass with pustules that may scar; treat with systemic antifungals ± corticosteroids.

🎯 Expected answers (for examiners)

• Diagnosis: Tinea capitis (scalp ringworm)
• Clinical features: Patchy alopecia (hair loss), broken hairs at scalp surface ('black dots'), scaling, erythema, pruritus; may have lymphadenopathy; kerion (inflammatory boggy mass with pustules) in some cases
• Etiology: Dermatophytes: Trichophyton tonsurans (most common in US, endothrix, no fluorescence), Microsporum canis (from pets, ectothrix, green fluorescence under Wood lamp), Microsporum audouinii
• Transmission: Direct contact with infected humans (T. tonsurans) or animals (M. canis); fomites (combs, hats, barber tools)
• Diagnosis: Clinical; KOH prep of hair/scales (hyphae, spores); Wood lamp (green fluorescence for Microsporum); fungal culture (definitive)
• Treatment: Systemic oral antifungals: terbinafine (weight-based x 6 weeks) or griseofulvin microsize (20-25 mg/kg/day x 8+ weeks); itraconazole or fluconazole as alternatives. Adjunctive: antifungal shampoo (selenium sulfide/ketoconazole) to reduce shedding.
• Kerion: Systemic antifungals + short course corticosteroids (prednisone 1-2 mg/kg/day) if significant inflammation to prevent scarring

📌 Tinea capitis – key points:
• Age: 3-7 years (most common)
• US organism: Trichophyton tonsurans (endothrix, no Wood lamp fluorescence)
• Animal source: Microsporum canis (Wood lamp positive, green fluorescence)
• Treatment: Systemic antifungals only (topicals ineffective)
• First-line: Terbinafine (6 weeks) or griseofulvin (8+ weeks)
• Kerion: Add corticosteroids to prevent scarring

⚡ Quick FCPS‑style MCQ

A 5-year-old child presents with patchy scalp hair loss, broken hairs at the scalp ('black dots'), and scaling. The most appropriate treatment is:

A. Topical clotrimazole cream B. Oral terbinafine or griseofulvin C. Selenium sulfide shampoo alone D. Oral corticosteroids alone

📌 Topic summary · Tinea Capitis (Hair Loss)

Definition
Fungal infection of scalp hair follicles

Age
Children 3-7 years

Pathogens
T. tonsurans (US), M. canis (pets)

Diagnosis
KOH, Wood lamp, culture

Treatment
Oral terbinafine/griseofulvin

Kerion
Add corticosteroids

Feature	Tinea Capitis
Pathogens	Trichophyton tonsurans (most common in US), Microsporum canis (pets), Microsporum audouinii
Transmission	Direct contact (humans/animals), fomites (combs, hats)
Clinical presentation	Patchy alopecia, broken hairs ('black dots'), scaling, erythema, pruritus; kerion (boggy, tender, inflamed mass with pustules)
Wood lamp	Green fluorescence: Microsporum canis, M. audouinii (ectothrix); no fluorescence: T. tonsurans (endothrix)
KOH prep	Arthrospores and hyphae within/around hair shaft
Treatment – First-line (T. tonsurans)	Terbinafine weight-based: 125 mg (<25 kg), 187.5 mg (25-35 kg), 250 mg (>35 kg) daily ×6 weeks
Treatment – Alternative (M. canis)	Griseofulvin microsize 20-25 mg/kg/day ×8+ weeks (better for Microsporum)
Adjunctive therapy	Selenium sulfide 2% or ketoconazole 2% shampoo twice weekly to reduce shedding
Kerion management	Systemic antifungals + prednisone (1-2 mg/kg/day) ×1-2 weeks to reduce inflammation and scarring

🍄 TOACS FCPS Station · Hair Loss in Tinea Capitis

📷 Clinical Photograph – Tinea Capitis

🧑‍⚕️ Examiner tasks · TOACS

📌 Topic summary · Tinea Capitis (Hair Loss)