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Tinea capitis must be treated with systemic antifungal agents because topical agents do not penetrate the hair shaft. However, concomitant treatment with 1% or % selenium sulfide (Selsun) shampoo or 2% ketoconazole shampoo should be used for the first two weeks because it may reduce transmission. 12 , 13 For many years, the first-line treatment for tinea capitis has been griseofulvin because it has a long track record of safety and effectiveness. However, randomized clinical trials have confirmed that newer agents, such as terbinafine and fluconazole (Diflucan), have equal effectiveness and safety and shorter treatment courses 14 – 16   ( Table 4 ) . 2 , 12 , 17 – 20 Terbinafine may be superior to griseofulvin for Trichophyton species, whereas griseofulvin may be superior to terbinafine for the less common Microsporum species. 21 , 22 Culture results are usually not available for two to six weeks, but 95% of tinea capitis cases in the United States are caused by Trichophyton , making terbinafine a reasonable first choice. 23 However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen. 2 , 17 Failure to treat kerion promptly can lead to scarring and permanent hair loss. 2

Vitamin D
Vitamin D, which we produce naturally from sun exposure, is essential to the healthy functioning of every organ in the body. Vitamin D deficiency has become an epidemic of modern indoor living, so a supplement is necessary. Look for naturally sourced (from lanolin or fish liver oil) Vita min D3 (cholecalciferol) , which is the type of Vitamin D made in skin in response to sunlight. It is more biologically active than Vitamin D2 ( ergocalciferol ). However, it is NOT vegetarian. Vegetarians should use Vitamin D2, which is derived from plant sources and will be labeled "vegetarian vitamin D." For the latest research on Vitamin D, go to .

Presentation [ 2 ] History

  • Itching, rash and nail discolouration are the most common symptoms of tinea infection.
  • Hair loss occurs with tinea capitis (mainly a disease of children).
  • Complications such as secondary infection (cellulitis and impetigo) can lead to symptoms.
  • It is common in people who play contact sports.
  • It occurs in immunocompromised patients.
Examination
  • Tinea pedis: [ 6 ]
    • It particularly affects the web of the toe where skin may be macerated and erythematous.
    • It commonly affects the plantar surface of the foot. Erythema, vesicles and pustules can occur.
     
  • Tinea capitis: [ 7 ]
    • It can cause hair loss with broken hairs at the surface (as distinct from alopecia areata).
    • Clinical appearance is variable.
  • Tinea unguium (onychomycosis): [ 8 ]
    • Onycholysis or separation of the nail from the nail bed commonly occurs.
    • Nail dystrophy with thickening and discoloration of the nail develops.
  • Tinea corporis: [ 9 ]
    • The skin lesions have annular scaly plaques with raised edges.
    • There may be vesicles and pustules.
    • Typically lesions are on exposed skin of the trunk, arms and legs (see 'Differential diagnosis', below).
    • More unusually the lesions can appear as overlapping concentric circles (tinea imbricate) or even herpetiform subcorneal vesicles or pustules (bullous tinea corporis).
     
  • Tinea manuum:
    • Usually with tinea pedis.
    • Typically just affects one hand.
    • Scaling and redness are prominent.
    • Incorrect diagnosis and use of steroid may eventually exacerbate the infection.
     
  • Tinea cruris: [ 10 ]
    • Usually occurs in men.
    • Often tolerated for some time before presentation.
    • Typically erythematous with central clearing and raised edge.
  • Tinea barbae: [ 11 ]
    • Affects the beard area.
    • Redness, scaling and pustules are common.
Differential diagnosis [ 9 ]

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