Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Tinea capitis

James R Treat, MD
Section Editors
Ted Rosen, MD
Moise L Levy, MD
Deputy Editor
Abena O Ofori, MD


Tinea capitis is a fungal infection of the scalp that most often presents with pruritic, scaling areas of hair loss. Trichophyton and Microsporum species of dermatophyte fungi are the major causes of tinea capitis. The infection is often contracted from another human or an animal through direct contact.

Tinea capitis primarily occurs in children. The most common clinical findings are single or multiple scaly patches with alopecia and patches of alopecia with black dots at follicular orifices that represent broken hairs (picture 1A-F). Other presentations include widespread scaling with subtle hair loss, a boggy edematous painful plaque called a kerion (picture 2), and favus, which characteristically exhibits multiple cup-shaped yellow crusts (scutula) (picture 3).

Oral antifungal therapy is the primary treatment for tinea capitis. Patients usually respond well to treatment.

The clinical features, diagnosis, and management of tinea capitis will be reviewed here. Other dermatophyte infections are reviewed separately. (See "Dermatophyte (tinea) infections".)


Tinea capitis is a common disorder. Children, particularly prepubertal children, are most likely to develop tinea capitis. Some studies have identified higher prevalences in male children than in female children [1-4]; however, other studies have not corroborated this finding [5]. Occasionally, adults develop tinea capitis [6-10].


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Jul 28, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Mirmirani P, Tucker LY. Epidemiologic trends in pediatric tinea capitis: a population-based study from Kaiser Permanente Northern California. J Am Acad Dermatol 2013; 69:916.
  2. Emele FE, Oyeka CA. Tinea capitis among primary school children in Anambra state of Nigeria. Mycoses 2008; 51:536.
  3. Fulgence KK, Abibatou K, Vincent D, et al. Tinea capitis in schoolchildren in southern Ivory Coast. Int J Dermatol 2013; 52:456.
  4. Mapelli ET, Cerri A, Bombonato C, Menni S. Tinea capitis in the paediatric population in Milan, Italy: the emergence of Trichophyton violaceum. Mycopathologia 2013; 176:243.
  5. Zhan P, Geng C, Li Z, et al. Evolution of tinea capitis in the Nanchang area, Southern China: a 50-year survey (1965-2014). Mycoses 2015; 58:261.
  6. Keisham C, Sarkar R, Khurana N, et al. Black dot tinea capitis caused by trichophyton rubrum in an adult female presenting with cicatricial alopecia. Indian J Dermatol Venereol Leprol 2015; 81:224.
  7. El-Khalawany M, Shaaban D, Hassan H, et al. A multicenter clinicomycological study evaluating the spectrum of adult tinea capitis in Egypt. Acta Dermatovenerol Alp Pannonica Adriat 2013; 22:77.
  8. Mebazaa A, Oumari KE, Ghariani N, et al. Tinea capitis in adults in Tunisia. Int J Dermatol 2010; 49:513.
  9. Hillary T, Suys E. An outbreak of tinea capitis in elderly patients. Int J Dermatol 2014; 53:e101.
  10. Takwale A, Agarwal S, Holmes SC, Berth-Jones J. Tinea capitis in two elderly women: transmission at the hairdresser. Br J Dermatol 2001; 144:898.
  11. Abdel-Rahman SM, Farrand N, Schuenemann E, et al. The prevalence of infections with Trichophyton tonsurans in schoolchildren: the CAPITIS study. Pediatrics 2010; 125:966.
  12. Romano C. Case reports. Four paediatric cases of tinea capitis due to unusual agents. Mycoses 1999; 42:421.
  13. Fuller LC, Child FC, Midgley G, Higgins EM. Scalp ringworm in south-east London and an analysis of a cohort of patients from a paediatric dermatology department. Br J Dermatol 2003; 148:985.
  14. Kelly BP. Superficial fungal infections. Pediatr Rev 2012; 33:e22.
  15. Fuller LC. Changing face of tinea capitis in Europe. Curr Opin Infect Dis 2009; 22:115.
  16. Kawachi Y, Ikegami M, Takase T, Otsuka F. Chronically recurrent and disseminated tinea faciei/corporis--autoinoculation from asymptomatic tinea capitis carriage. Pediatr Dermatol 2010; 27:527.
  17. Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014; 12:188.
  18. Mao L, Zhang L, Li H, et al. Pathogenic fungus Microsporum canis activates the NLRP3 inflammasome. Infect Immun 2014; 82:882.
  19. Shy R. Tinea corporis and tinea capitis. Pediatr Rev 2007; 28:164.
  20. Isa-Isa R, Arenas R, Isa M. Inflammatory tinea capitis: kerion, dermatophytic granuloma, and mycetoma. Clin Dermatol 2010; 28:133.
  21. Zaraa I, Hawilo A, Aounallah A, et al. Inflammatory Tinea capitis: a 12-year study and a review of the literature. Mycoses 2013; 56:110.
  22. Ilkit M. Favus of the scalp: an overview and update. Mycopathologia 2010; 170:143.
  23. Cheng N, Rucker Wright D, Cohen BA. Dermatophytid in tinea capitis: rarely reported common phenomenon with clinical implications. Pediatrics 2011; 128:e453.
  24. Morrone A, Calcaterra R, Valenzano M, et al. Erythema nodosum induced by kerion celsi of the scalp in a woman. Mycoses 2011; 54:e237.
  25. Castriota M, Ricci F, Paradisi A, et al. Erythema nodosum induced by kerion celsi of the scalp in a child: a case report and mini-review of literature. Mycoses 2013; 56:200.
  26. Zaraa I, Trojjet S, El Guellali N, et al. Childhood erythema nodosum associated with kerion celsi: a case report and review of literature. Pediatr Dermatol 2012; 29:479.
  27. Patel GA, Schwartz RA. Tinea capitis: still an unsolved problem? Mycoses 2011; 54:183.
  28. Nenoff P, Krüger C, Schaller J, et al. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2014; 12:749.
  29. Mapelli ET, Gualandri L, Cerri A, Menni S. Comma hairs in tinea capitis: a useful dermatoscopic sign for diagnosis of tinea capitis. Pediatr Dermatol 2012; 29:223.
  30. Ekiz O, Sen BB, Rifaioğlu EN, Balta I. Trichoscopy in paediatric patients with tinea capitis: a useful method to differentiate from alopecia areata. J Eur Acad Dermatol Venereol 2014; 28:1255.
  31. Slowinska M, Rudnicka L, Schwartz RA, et al. Comma hairs: a dermatoscopic marker for tinea capitis: a rapid diagnostic method. J Am Acad Dermatol 2008; 59:S77.
  32. Hughes R, Chiaverini C, Bahadoran P, Lacour JP. Corkscrew hair: a new dermoscopic sign for diagnosis of tinea capitis in black children. Arch Dermatol 2011; 147:355.
  33. Lacarrubba F, Verzì AE, Micali G. Newly described features resulting from high-magnification dermoscopy of tinea capitis. JAMA Dermatol 2015; 151:308.
  34. Nasir S, Ralph N, O'Neill C, et al. Trends in tinea capitis in an Irish pediatric population and a comparison of scalp brushings versus scalp scrapings as methods of investigation. Pediatr Dermatol 2014; 31:622.
  35. Friedlander SF, Pickering B, Cunningham BB, et al. Use of the cotton swab method in diagnosing Tinea capitis. Pediatrics 1999; 104:276.
  36. Shvarts S, Sevo G, Tasic M, et al. The tinea capitis campaign in Serbia in the 1950s. Lancet Infect Dis 2010; 10:571.
  37. Tey HL, Tan AS, Chan YC. Meta-analysis of randomized, controlled trials comparing griseofulvin and terbinafine in the treatment of tinea capitis. J Am Acad Dermatol 2011; 64:663.
  38. Gupta AK, Drummond-Main C. Meta-analysis of randomized, controlled trials comparing particular doses of griseofulvin and terbinafine for the treatment of tinea capitis. Pediatr Dermatol 2013; 30:1.
  39. Gupta AK, Cooper EA. Update in antifungal therapy of dermatophytosis. Mycopathologia 2008; 166:353.
  40. Elewski BE, Cáceres HW, DeLeon L, et al. Terbinafine hydrochloride oral granules versus oral griseofulvin suspension in children with tinea capitis: results of two randomized, investigator-blinded, multicenter, international, controlled trials. J Am Acad Dermatol 2008; 59:41.
  41. Foster KW, Friedlander SF, Panzer H, et al. A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis. J Am Acad Dermatol 2005; 53:798.
  42. Grover C, Arora P, Manchanda V. Comparative evaluation of griseofulvin, terbinafine and fluconazole in the treatment of tinea capitis. Int J Dermatol 2012; 51:455.
  43. Gupta AK, Adam P, Dlova N, et al. Therapeutic options for the treatment of tinea capitis caused by Trichophyton species: griseofulvin versus the new oral antifungal agents, terbinafine, itraconazole, and fluconazole. Pediatr Dermatol 2001; 18:433.
  44. Dastghaib L, Azizzadeh M, Jafari P. Therapeutic options for the treatment of tinea capitis: griseofulvin versus fluconazole. J Dermatolog Treat 2005; 16:43.
  45. American Academy of Pediatrics. Committee on Infectious Diseases. Tinea Capitis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.778.
  46. Shemer A, Plotnik IB, Davidovici B, et al. Treatment of tinea capitis - griseofulvin versus fluconazole - a comparative study. J Dtsch Dermatol Ges 2013; 11:737.
  47. Gupta AK, Dlova N, Taborda P, et al. Once weekly fluconazole is effective in children in the treatment of tinea capitis: a prospective, multicentre study. Br J Dermatol 2000; 142:965.
  48. López-Gómez S, Del Palacio A, Van Cutsem J, et al. Itraconazole versus griseofulvin in the treatment of tinea capitis: a double-blind randomized study in children. Int J Dermatol 1994; 33:743.
  49. Jahangir M, Hussain I, Ul Hasan M, Haroon TS. A double-blind, randomized, comparative trial of itraconazole versus terbinafine for 2 weeks in tinea capitis. Br J Dermatol 1998; 139:672.
  50. Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000; 42:1.
  51. Chen C, Koch LH, Dice JE, et al. A randomized, double-blind study comparing the efficacy of selenium sulfide shampoo 1% and ciclopirox shampoo 1% as adjunctive treatments for tinea capitis in children. Pediatr Dermatol 2010; 27:459.
  52. Greer DL. Successful treatment of tinea capitis with 2% ketoconazole shampoo. Int J Dermatol 2000; 39:302.
  53. Winge MC, Chryssanthou E, Wahlgren CF. Combs and hair-trimming tools as reservoirs for dermatophytes in juvenile tinea capitis. Acta Derm Venereol 2009; 89:536.
  54. Keipert JA. Beneficial effect of corticosteroid therapy in microsporum canis kerion. Australas J Dermatol 1984; 25:127.
  55. Proudfoot LE, Higgins EM, Morris-Jones R. A retrospective study of the management of pediatric kerion in Trichophyton tonsurans infection. Pediatr Dermatol 2011; 28:655.
  56. Gilaberte Y, Rezusta A, Gil J, et al. Tinea capitis in infants in their first year of life. Br J Dermatol 2004; 151:886.
  57. Michaels BD, Del Rosso JQ. Tinea capitis in infants: recognition, evaluation, and management suggestions. J Clin Aesthet Dermatol 2012; 5:49.
  58. Zaraa I, Hawilo A, Trojjet S, et al. Letter: Tinea capitis in infants in their first 2 years of life: A 12-year study and a review of the literature. Dermatol Online J 2012; 18:16.
  59. Elewski BE, Hughey LC, Sobera JO. Fungal diseases. In: Dermatology, 3rd ed, Bolognia JL, Jorizzo JL, Schaffer JV (Eds), Elsevier Limited, Philadelphia; London 2012. Vol 2, p.1251.
  60. Graber MA, Randles BD, Monahan J, et al. What questions about patient care do physicians have during and after patient contact in the ED? The taxonomy of gaps in physician knowledge. Emerg Med J 2007; 24:703.
  61. Ely JW, Rosenfeld S, Seabury Stone M. Diagnosis and management of tinea infections. Am Fam Physician 2014; 90:702.
  62. Cafarchia C, Romito D, Capelli G, et al. Isolation of Microsporum canis from the hair coat of pet dogs and cats belonging to owners diagnosed with M. canis tinea corporis. Vet Dermatol 2006; 17:327.
  63. Rojat P, Hennequin C, Zaharia D, et al. Accidental Trichophyton mentagrophytes fungemia during the course of kerion celsi. Mycoses 2012; 55:e29.