TINEA CAPITIS

Scalp ringworm is common in children. The fungus has grown into the
hair follicle and will not be removed by topical treatment only. Severe
pustular forms exist with follicular pustules and nodules and often massive
purulent secretion. Lymph nodes in the neck swell and the patient
may have a fever and headache. There may be bacterial superinfection.
Systemic treatment is necessary to prevent scarring leading to permanent
bald patches.
Management of tinea capitis
- Griseofulvin 500 mg once daily for 8-12 weeks in adults.
- Griseofulvin 10-15 mg/kg once daily for 8-12 weeks in children.
- Add Whitfield’s ointment or miconazole twice daily topically for 4 weeks.
- Continue treatment after 12 weeks if the infection has not cleared completely.
- Alternative: Ketaconazole 200 mg twice daily or terbinafine 250 mg once daily or
itraconazole 200 mg (2 tabs) once daily for 4-8 weeks in adults.
- Ask for signs of infection in siblings or friends of affected children or in pets or
farm animals (bald patches, rash) and have these treated.
- In case of bacterial superinfection: antiseptics and / or antibiotics.

FUNGAL / YEAST INFECTIONS

Fungal infections may occur at any age. Children may easily infect each
other or get infected by animals / pets. The most common fungal infection
is "athlete’s foot" = infection of the interdigital spaces of the toes.
Skin, nails and / or hair may be infected. When a fungal infection is treated
incompletely or too short it will almost certainly recur. In
immunosuppressed patients fungal infections may be more widespread
and take longer to treat than normal. Always ask your patient to come for
review when his or her treatment is about to be completed, If you then
see any remaining sign of infection continue the treatment, as it is likely
to recur if you do not.
MYCIDS
A hyperergic reaction to the fungus may occur in the course of fungal
infections. These are usually itchy eruptions of small blisters at a site distant
from the fungal infection, often the hands and fingers (pompholyx). No fungi
are found within these "mycids". They disappear when the causative fungal
infection is treated. Sometimes the itching is so severe that treatment is
advisable: a strong steroid cream under wet dressings for a couple of days.