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Tinea capitis

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of tinea capitis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2014), the Japanese Dermatological Association (JDA 2020), the British Association of Dermatologists (BAD 2014), and the European Society of Pediatric Dermatology (ESPD 2010).
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Diagnostic investigations

Microscopy and culture: as per BAD 2014 guidelines, collect samples from scalp lesions via scalpel scraping, hair pluck, brush, or swab in patients with suspected tinea capitis. Send all specimens for microscopy and culture where possible. Do not obtain susceptibility testing.
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Medical management

General principles: as per BAD 2014 guidelines, consider initiating treatment while awaiting confirmatory mycology in the presence of a kerion or ≥ 1 cardinal clinical signs (scale, lymphadenopathy, alopecia).
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  • Oral antifungals

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Specific circumstances

Pediatric patients: as per AAFP 2024 guidelines, offer oral terbinafine, itraconazole, fluconazole, or griseofulvin in pediatric patients with tinea capitis caused by Trichophyton infections.
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Preventative measures

Cleansing of fomites: as per BAD 2014 guidelines, cleanse hairbrushes and combs with disinfectants,
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such as simple bleach or a 2% aqueous solution of sodium hypochlorite containing 16.5% salt.
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Follow-up and surveillance

Assessment of treatment response: as per BAD 2014 guidelines, set mycological rather than clinical cure as the end point of treatment. Obtain repeat mycology sampling until the mycological clearance is achieved.
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