Tinea capitis: a painful scalp lesion
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A 9 year old girl presents to the emergency department with a painful lesion on her scalp. It was initially a small, erythematous, scaly, pruritic eruption but gradually increased in size over the previous six weeks despite several courses of antibiotics from her general practitioner. Physical examination showed a girl in good health, with a 15 cm by 15 cm extremely tender, boggy inflammatory mass on the crown of her head accompanied by localised alopecia (hair loss) and cervical lymphadenopathy (fig 1). She is apyrexial with a white cell count 16.5×109/l and C reactive protein 28 mg/l.
(2) The predominant pathogen causing tinea capitis in the United Kingdom is Trichophyton tonsurans, which is a dermatophyte fungus of the genus Trichophyton.
(3) Obtain plucked hairs and scalp brushings from the infected area and send for mycological analysis, and examine the infected area with a Wood’s lamp (table).
(4) Treatment consists of