This young boy presented for evaluation of black-dotted bald patches on scalp. He had a history of ring worm on face and neck which was successfully treated with topical antifungal creams. Parents were concerned that his bald patches were growing in size and number.
We have fungus among us!
He had tinea capitis, a fungal infection of the scalp that occurs primarily in children. The infection is contagious and most often contracted through direct contact with infected person or animal, or from contact with a contaminated object like comb, brush, or hat. It presents with itchy and scaly bald patches. The black dots, which give it the name of "black dot tinea capitis" are actually broken hair fibers from fungal infection going inside the hair shaft, a type of infection called endothrix. Sometimes infections get severe enough to form a boggy swollen, crusty and painful plaque called a kerion. Most common causes of tinea capitis are fungi called Trichophyton and Microsporum. Topical antifungal solutions, creams or shampoos are not enough to completely eradicate the fungus. Oral antifungal treatment, like griseofulvin and terbinafine, is the standard of care for children with tinea capitis and is continued for 6-12 weeks, depending on the type of fungus involved and medication used.
While causes of bald patches on scalp are many, including seborrheic dermatitis, psoriasis, alopecia areata, folliculitis decalvans and dissecting cellulitis, broken hair fibers on scaly bald patch are usually indicative of tinea capitis. Our patient did very well with the oral treatment and is happy with the hair regrowth on all bald patches.