TUTORIAL KLINIK

TINEA CAPITIS
DEFINISI

fungal infection of the scalp that

• Tinea capitis is a

most often presents with pruritic, scaling areas of

hair loss.
EPIDEMIOLOGI

• Tinea capitis primarily occurs in children, prepubertal

children
• Proposed theories to explain the infrequency in adults include effects
related to the fungistatic properties of short- and medium-chain fatty
acids in postpubertal sebum and the colonization of adults by
commensal yeasts, such as Pityrosporum, that may inhibit infection
with dermatophytes
ETIOLOGI

•Trichophyton and Microsporum species

PATOGENESIS
• Acquisition of the fungus may result from direct contact with an
infected individual or animal or from contact with a contaminated
object (eg, comb, brush, or hat)
• mannan glycoproteins in dermatophyte cell walls promote adherence
of dermatophytes to keratin-containing host tissue
• production of proteolytic enzymes, such as keratinase, by the
dermatophytes enables invasion of the cytokeratin-containing tissues
of the skin and hair
• The infection progresses from the stratum corneum of the epidermis,
extending down the follicle and to the hair. Biofilms can form, which
may make therapy more difficult
KLASIFIKASI INFEKSI DERMATOFITA BERDASARKAN
LOKASI TERHADAP FOLIKEL RAMBUT
• InEndothrix infections, arthroconidia (fungal spores) are
found within the hair shaft on direct microscopic examination

•Ectothrix infections, arthroconidia primarily surround the

outside of the hair shaft. M.Canus

•Favus is a unique presentation in which hyphae and air spaces

are found within hair shafts.
MANIFESTASI KLINIS TERSERING
• Pruritus • Cervical
• Scaly patches with Lymphadenopathy
alopecia
 KLASIFIKASI TINEA KAPITIS BERDASAR
Characteristic "black dots" that can occur in
MANIFESTASI endothrix tinea capitis
Scaly patches with alopecia

localized inflamed, tender, boggy plaque on the scalp is

suspicious for kerion
classic scutula of favus
DDX
• Bacterial Folliculitis  DDX utama Kerion
• Multiple pustules on the scalp.
• Psoriasis
• Scaly erythematous plaque on the scalp
• Dermatitis Seborrhoic
• Prepubertal children usually do not develop seborrheic dermatitis.
• Alopecia Areata
• Scale is absent. Exclamation point hairs (short hairs up to a few millimeters in
length with tapered proximal ends) are a common feature of alopecia areata
that may be confused with broken hairs of tinea capitis
PEMERIKSAAN PENUNJANG

• Wood Light 
bewarna kuning
• Pada jamur
penyebab Favus bisa
bewarna biru
• Dermoscopy
• broken hairs, dystrophic hairs,
corkscrew hairs, comma hairs,
and black dots
HISTOPATOLOGI
• (arthroconidia or hyphae) within or surrounding hair shafts
• Perifollicular mononuclear infiltrate in the dermis
• Multinucleated giant cells in the dermis
TREATMENT
• Griseofulvin
• Adult: 0.5-1 g daily in single or divided doses. Treatment duration: 2-8 wk (hair and
skin infections); up to 6 mth (fingernail infections); ≥12 mth (toenail infections).
Child: 10 mg/kg daily in divided doses.
• Ketoconazole (Hepatotoxic)
• Adult: 200 mg once daily; may increase to 400 mg once daily if clinical response is
insufficient. Continue treatment until symptoms have cleared and cultures have
become negative.
Child: ≥2 yr 3.3-6.6 mg/kg once daily. Treatment duration: 1-2 wk for candidiasis; at
least 4 wk in recalcitrant dermatophyte infections and up to 6 mth for other systemic
mycoses.
• Antifungal shampoo by all household members for two to four weeks.
Person with tinea capitis should avoid sharing hair care tools and headwear
PROGNOSIS
• The prognosis of tinea capitis is excellent, with complete clearance
occurring in most patients after a course of treatment.
• Complete hair regrowth occurs in most children with hair loss
• Pasien An. RS (7 th) Berat 25 KG

• Muncul bercak keputihan pada kepala, gatal. Dibawa berobat ke klinik dr

umum ditegakkan diagnosis infeksi jamur. Di kasih antibiotic puyer,
Gentamicin salep, anti gatal. Membaik dan kering. Pemeriksaan hifa
negative.
• Memiliki riwayat kutu kepala
• Status DV
• Tampak plak eritem tertutup skuama kuning kecoklatan. Kesan lesi oozing
(vesikel yang biasanya mudah pecah sehingga basah). Tampak rambut
patah (diatas lesi). Pada beberapa tempat tampak plak eritema multiple
berukuran +- 2 cm dengan skuama di atasnya.
• D: Kerion Celsi
PxPenunjang: KOH (+), Gram: PMN (+), Coccus (+), Gram (+)
• Tx:
Griseofulvin 250mg / hari
Cetirizin
NaCl
Ketomed SS 3x/minggu
Cream Mupirocin