A child is brought to the clinic by his mother because he has patches of hair loss as well as knots in the back of his scalp

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Definition. Tinea capitis is a dermatophyte infection of the scalp usually caused by Trichophyton tonsurans, and at times Microsporum canis.

Risk Factors/Etiology. It more commonly found in Hispanic and black children.

Presentation. The presentation varies; however, most children are brought to a physician because of hair loss or scalp pruritus.

Physical Examination. Occipital adenopathy may be present. Small circular patches of alopecia with hairs broken off close to the scalp, the "black dot" sign, is seen with infection by T. tonsurans.

Diagnostic Tests. The Wood's lamp may be helpful in the diagnosis of tinea capitis. Hairs infected with the Microsporum species fluoresce blue-green; most Trichophyton species do not fluoresce. Cultures of the infected material and KOH preparations are also used.

Treatment. Griseofulvin is the treatment of choice for all forms of tinea capitis. Treatment should continue until the fungal culture is negative; and may be necessary for 2-3 months.

Complications. An inflammatory reaction may produce a boggy granulomatous mass called a kerion. This is an id reaction and is treated with griseofulvin plus a tapering dose of steroid.

Differential Diagnosis. Seborrheic dermatitis, alopecia areata, trichotillomania, and psoriasis may be mistaken for tinea capitis.

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