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Giornale Italiano di Dermatologia e Venereologia 2000 February;135(1):71-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Tinea capitis: clinical features and differential diagnosis

Albanese G. C. ¹, Aste N. ², Biggio P. ², Difonzo E. M. ³, Di Silverio A. ⁴, Lasagni A. ⁵, Pau M. ², Terragni L. ⁶, Tosti A. ⁷

Gruppo Italiano Micologia Dermatologica (GIMDE) 1 Ospedale S. Gerardo - Monza (Milano) Divisione Dermatologia 2 Università degli Studi - Cagliari Clinica Dermatologica 3 Università degli Studi - Firenze Clinica Dermatologica 4 Università degli Studi - Pavia Clinica Dermatologica 5 Specialista di Dermatologia - Milano 6 Ospedale S. Antonio Abate - Gallarate (Milano) Divisione Dermatologica 7 Università degli Studi - Bologna Clinica Dermatologica

The clinical manifestations of tinea capitis depend on the modality of hair shaft invasion, on the etiologic agent and on the patient’s immunological response. On the basis of the etiologic agent and of the type of hair parasitization, tinea capitis is divided into three main forms: Microsporosis, Trichophytosis and favus of the scalp. From a strictly clinical point of view, a slow torpid evolutive form and an acute inflammatory form can be distinguished. The inflammatory pattern is called Kerion celsi. The microsporic and trichophytic forms affect almost exclusively children and usually recover spontaneously at puberty with complete restitutio ad integrum. Rarely these kinds of infections are observed in adults, mainly women in post-menopausal age. Favus affects both the child and the adult, doesn’t heal at puberty and in its evolution causes permanent scarring alopecia. Differential diagnosis in tinea capitis includes many different diseases of the scalp, in which the presence of erythema, scaling, broken or brittle hair shafts, diffusely or arranged in patches can simulate a tinea tonsurans. Moreover, the inflammatory form has to be differentiated from other vesicular-pustular diseases of the scalp. Often it is sufficient an accurate clinical examination to make the differential diagnosis, but it is always better to perform the Wood’s lamp observation of the scalp and the direct microscopic examinations, because tinea capitis can sometimes occur with very atypical and leading astray clinical patterns, especially in adults.