Tinea Capitis in Refugee Children
Overview
Tinea capitis is a fungal infection of the scalp, common in prepubertal refugee children, especially those from sub-Saharan Africa.
Clinical Presentation
* Patches of alopecia with scaly or black-dot appearance
* Widespread scaling with subtle hair loss (can resemble seborrheic dermatitis)
* Cervical lymphadenopathy may be present
Diagnosis
Order a fungal culture to confirm the diagnosis.
Do not wait for results if the presentation is typical. Start treatment immediately. Close contacts, especially children, should also be examined.
Treatment
Oral terbinafine for 6 weeks (first-line)
Weight | Dose |
10-20 kg | 62.5 mg daily |
20-40 kg | 125 mg daily |
>40 kg | 250 mg daily |
Terbinafine is approved for children over 4 years old and has been used safely in younger children at the Calgary Refugee Health Program.
Microsporum infections may require a longer treatment course than 6 weeks.
Baseline Investigations
Order ALT and AST before starting treatment. Repeat ALT, AST, and CBC if treatment needs to extend beyond 6 weeks.
Follow-Up
Review at end of treatment to confirm clinical clearance. Complete hair regrowth occurs in most children after successful treatment.