Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Tinea Capitis
A common dermatophyte infection of the scalp hair shaft.
I. Etiology: Predominant pathogen is Trichophyton tonsurans.
II. Incidence
A. Children between ages 3 and 7 are most commonly infected.
B. Transmitted child to child. Organisms are viable on fomites such as combs, brushes, couches, etc. for long periods.
III. Incubation period: Unknown
IV. Subjective findings
A. Scaly scalp
B. Pruritis of varying degrees
C. Patchy hair loss
D. May be asymptomatic.
V. Objective findings
A. Scalp scaling
B. Alopecia: Patchy hair loss.
C. Adenopathy
1. Cervical
2. Occipital
D. Greyish, scaly round patches with broken hairs
E. Most commonly found on posterior scalp
F. Concomitant tinea corporis
G. Local infection
H. Kerion—a boggy mass, surrounded by pustular folliculitis.
VI. Assessment
A. Diagnosis is confirmed by fungal culture. Using a standard bacterial culturette, moisten with transport medium or water. Rub vigorously over affected areas.
1. Results take about 2 weeks.
2. Wood’s light examination is generally not of value in 90% of patients with tinea capitis. T. tonsurans, the most common causative organism does not fluoresce under Wood’s light.
B. Differential diagnosis
1. Seborrhea
2. Psoriasis
3. Atopic dermatitis
4. Bacterial abscess
VII. Plan
A. Griseofulvin oral suspension: 10–11 mg/kg/d for 6–8 weeks
1. Children 14–23 kg: 125 to 250 mg/d
2. Children over 23 kg: 250 to 500 mg/d
3. Continue treatment for 2 weeks after resolution of symptoms to effect both a clinical and mycological cure.
B. Fluconazole (Diflucan)
1. Available in liquid
2. Dose at 6 mg/kg/d for 20 days
3. Alternatively: 8 mg/kg/wk for 4 to 6 weeks
C. Antifungal shampoo
1. 2% Ketoconazole or
2. 1% Selenium sulfide
3. Apply to hair and scalp for 5 to 10 minutes, three times a week.
4. Prevents infection.
5. Eliminates asymptomatic carriage of fungal organisms.
VIII. Education
A. Griseofulvin
1. Take with whole milk or fatty meal.
2. Side effects
a. Headache
b. Gastrointestinal (GI) distress
3. Continue treatment for at least 2 weeks after clinical cure.
B. Check all family members for both tinea capitis and tinea corporis.
C. Asymptomatic family members:
1. 2% ketoconazole or 1% selenium sulfide shampoo.
2. May help prevent infection
3. May eradicate asymptomatic carriage
4. Apply to scalp for 5–10 minutes, three times a week.
D. May return to school once treatment is initiated
E. Do not share hats, combs, brushes.
F. If exposed to animals in the home, recommend veterinary exam.
IX. Follow-up
A. Call immediately if symptoms worsen or should there be any untoward response to medication.
B. In two weeks if no improvement
X. Consultation/referral
A. Treatment failure
B. Frequent recurrences