Dermatology resident in the Department of Medicine at McGill University in Montreal, Que.
The differential diagnosis for tinea capitis includes seborrheic dermatitis, atopic dermatitis, alopecia areata, folliculitis, and less commonly, psoriasis and tinea amiantacea. Possible complications of tinea capitis include id reaction, which presents as a pruritic papular or vesicular eruption that typically begins on the face and then spreads to the trunk.5 Other possible complications are erythema nodosum and scarring alopecia if the inflammatory types are not treated.
Culture is the criterion standard test. A scraping might be cultured on Sabouraud dextrose agar or Mycosel agar. Dermatophyte test medium is another appropriate culture medium with a colour indicator that changes from yellow to red in the presence of dermatophytes. The culture should be incubated for 30 days before being labeled as negative for dermatophytes. A quick method of testing for dermatophytes is to prepare a scraping with potassium hydroxide on a slide and examine it for hyphae.5 Carriers will usually have positive cultures for T tonsurans and T violaceum, but they are asymptomatic.
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