Clinical Review Lesson of the week

Tinea capitis in adults

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7246.1389 (Published 20 May 2000) Cite this as: BMJ 2000;320:1389
  1. Deirdre A Buckley, specialist registrar (BillP@doctors.org.uk),
  2. L Claire Fuller, consultant,
  3. Elisabeth M Higgins, consultant,
  4. Anthony WP du Vivier, consultant
  1. Department of Dermatology, King's College Hospital, London SE5 9RS
  1. Correspondence to: D A Buckley, Department of Dermatology, Ealing Hospital, Southall, Middlesex UB1 3HW
  • Accepted 7 October 1999

Tinea capitis should be considered in all adults with a patchy inflammatory scalp disorder

Tinea capitis (scalp ringworm) is uncommon after puberty. When it occurs in adults the clinical features may be atypical and this may delay the diagnosis.1 Unless the possibility of dermatophyte infection is considered, unnecessary investigations may be performed and inappropriate treatment prescribed, as illustrated in the four cases described below.

Case reports

Case 1

A 45 year old Afro-Caribbean woman had had an itchy pustular eruption of the scalp with associated hair loss for several months. Her general practitioner had treated it unsuccessfully with neomycin and gramicidin ointment and oral flucloxacillin and metronidazole. During this period the woman underwent lymph node aspiration and chest radiography because she had an enlarged but painless cervical lymph node. Cytological examination showed a mixed population of lymphocytes, indicating reactive changes; in addition, the surgical house officer observed that the woman had “quite a nasty rash on her scalp.”

At the time of her referral to the dermatology clinic she had circumscribed areas of hair loss over the crown, with peripheral inflammation, pustules, and scaling (fig 1). Culture of bacterial swabs had negative results and a presumptive diagnosis …

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