Superficial tinea capitis B35.0

Superficial, mostly little inflammatory and not leading to scarring alopecia, mycotic infection of the capillitium.

Microsporum - and trichophyton species; see below tinea capitis.

Infants and children aged 2-14 years.

Usually multiple, more rarely solitary, 0.5-7.0 cm large, roundish, usually aphlegmatic, slightly reddish or greyish, with fine scales densely covered, flat spots or plaques; usually with 0.2-0.3 cm long, broken off hairs (picture of badly mowed meadow). The hair stumps stuck in the follicles appear as black dots and are called "black dots" in English (black-dot mycosis). Patients often consult their doctor because of the clinically conspicuous hairlessness. See also microspore. Alopecia is not scarred and therefore reversible.

The initially superficial tinea caused by T. Schoenleinii(Favus) is more frequently observed in South-Eastern Europe. It is often transmitted within the family (hereditary bovine gland). If the disease persists for a longer period of time, invasion of deeper follicle parts and scarred alopecia occurs.

• Alopecia areata: No itching, no signs of inflammation, no scaling of the surface.
• Pityriasis amiantacea: blurred, greasy, micaceous, greyish-white scaling that encircles the hairs of the head in different lengths. The hairs can often be pulled out in tufts.
• Trichotillomania: zones of hair loss have jagged (unnatural) boundaries. No surface scaling; no itching.
• Psoriasis capillitii: Either circumscribed, white-scaly plaques, no alopecia, more rarely also diffuse small spotted scaling of the capillitium. Itching may be present. Often psoriatic foci in loco typico.
• Folliculitis decalvans: Rather rare differential diagnosis of follicular inflammation in the beard area. Eminently chronic clinical picture characterised by gradually spreading scarred hair loss. Initially disseminated, small follicular papules, later pustular transformation, crust formation. Peripheral progression of the foci, central scarred healing. Irregularly shaped scar foci with small spots of irreversible hair loss result. Formation of tuft hairs (typical for this disease).

• Notice! The diagnosis "Tinea capitis superficialis" must always be confirmed by microbial diagnostics (native and culture preparation). If necessary, histological evidence (PAS staining in sectional series) is also required.

• Externally, Ciclopirox (e.g. Batrafen cream), azole-containing creams and solutions such as ketoconazole (e.g. Nizoral cream) or clotrimazole (e.g. Canesten ointment, Canesten solution) are suitable overnight occlusively.
• Terbinafine, itraconazole and fluconazole can be used internally. The therapy usually lasts 10-12 weeks.

Grisefulvin, as an antimycotic of the "first hour", is the only oral antimycotic approved for the treatment of dermatophytosis in children in Germany! However, it is not currently on the market!

Some patients (especially children) are merely carriers of the pathogens without having clinical symptoms. For example, Tr. tonsurans and M. audouinii often only lead to discrete aphlemic scaling.

1. Effendi I (2010) Tinea capitis. In: Plettenberg A, Meigel W, Schöfer H (Eds) Infectious diseases of the skin. Thieme publishing house, Stuttgart

2. Müller VL et al. (2021) Tinea capitis et barbae caused by Trichophyton tonsurans: A retrospective cohort study of an infection chain after shavings in barber stores. Mycoses 64:428-436.