Scalp Infections

Syphilis is a common, bacterial (Treponema pallidum) and sexually transmitted disease. It occurs at about the same frequency in men and women and more frequently at a young age. It is caused by the sexual transmission of bacteria (Treponema Pallidum). It is known as the “Great Mimicker” because it resembles many other dermatological diseases.

Alopecia Syphilitis is a component of secondary syphilis. Secondary syphilis may occur with other mucocutaneous symptoms, or rarely as the only manifestation of secondary syphilis, referred to as ‘secondary syphilitic alopecia’. About 2 years after the first transmission, the so-called 2nd period symptoms and indications that show mimicking all kinds of skin diseases emerge. These are rashes on the body, wounds on the palms and soles, white raised lesions in the mouth, puffy soft lesions on the skin in the anal area, and moth-eaten hair loss. However, it can also occur with scattered shedding similar to telogen effluvium. Findings occur in the early period of secondary syphilis, and the disease is contagious in this period as well.

Microscopically, there is an inflamed infiltrate, usually with lymphocytes and plasma cells. The diagnosis is made with a positive VDRL test and a single dose of penicillin is used in the treatment.

Tinea Capitis:

Tinea Capitis is the most common pediatric dermatophyte infection worldwide. Tinea capitis is caused by fungi of the species Trichophyton and Microsporum.

The hair shaft is held in three ways: endothrix, ectothrix and favus

Ectothrix involvement is characterized by the development of arthroconidia in the outer part of the hair shaft. The cuticle of the hair is destroyed and the infected hair produces a bright greenish yellow color fluorescence, usually under wood lamp ultraviolet light. The most common agents include, Microsporum canis, Microsporum gypseum, Trichophyton equinum, and Trichophyton verrucosum.

Endothrix hair invasion is characterized by the development of arthroconidia within the hair shaft only. The cuticle of the hair remains intact and the infected hair does not fluoresce under the wood lamp ultraviolet light. All agents that produce endothelium are anthropophilic (eg Trichophyton tonsurans, Trichophyton violaceum).

Favus hair invasion often causes favus-like crusts or scutula caused by T schoenleinii and related hair loss.

When tinea capitis is considered, clinical diagnosis must be confirmed by mycological examination. These include direct microscopic examination and fungal cultures. Wood light examination, on the other hand, is useful in some ectothrix infections such as Microsporum canis and Microsporum audinii, but this method is not suitable for final diagnosis.

1- Scaly Patches on the Scalp

• The hair breaks and leaves marks on the scalp.
• The flakes can be red, itchy, and dry.
• It is mainly caused by Microsporum and Trichophyton.

2- Dark spots on the scalp

• Hair breaks off, leaving a black bulging spot.
• Revert of hair loss.
• Mainly caused by Trichophyton species

3- Kerion

• Inflamed nodules can occur on the scalp that may be painful.
• Hair falls off by pulling.
• Falling hair can cause scalp wounds.

4- Favus

• Red spots with yellow crusts on the scalp.
• It may cause bad smell.
• It may cause permanent hair loss.

Treatment options for Tinea Capitis include oral antifungal drugs and medicated shampoos. Fungal infections may take up to a month to fully heal. You may need to visit your doctor after 4-5 weeks to see if the treatment is working.

The doctor may recommend starting oral antifungal drugs immediately after suspected Tinea Capitis infection. However, some doctors can wait for lab results that reveal the exact fungal species and begin treatment accordingly. Topical Antifungal will not work for Tinea Capitis as it cannot get into the hair or skin. Effective oral antifungal drugs for the treatment of tinea capitis include griseofulvin and terbinafine hydrochloride. The treatment is given for about 4-8 weeks. Terbinafine is not given to children as no efficacy and safety studies have yet been performed for this medicine. Both griseofulvin and terbinafine hydrochloride can cause side effects such as diarrhea and vomiting. Other antifungal treatments include itraconazole and fluconazole.

Shampoos contain antifungal agents such as ketoconazole or selenium sulfide can be used twice a week to prevent the spread of the fungal infection. It is also recommended when taking antifungal drugs, to stop the recurrence of the infection.

Because of ringworm of the scalp is contagious; you need to make sure that you have good hygiene habits around an infected person. Be sure to follow the treatment plan for Tinea Capitis infection to prevent relapse or further spread of an existing infection.

• Follow good hygiene habits
• Avoid close contact with the infected person
• Do not share belongings such as combs, towels, sheets, hats, etc..
• Take drugs regularly to prevent recurrence of the infection.
• Use medicated shampoos recommended by the doctor.
• Stay away from infected pets or livestock

Tinea Capitis can often be confused with other skin and hair conditions of the scalp such as dandruff, alopecia, dermatitis, eczema or psoriasis due to the similarity in some common symptoms.

Tinea Capitis infection can cause other simultaneous problems such as bacterial infection, painful papules. It can also cause inflammation in the neck area and swelling of the lymph nodes.

In rare cases, itchy papules can spread to the face, neck and body.

Treatment response should be monitored with repeated fungal examinations. Family members should be examined to prevent disease and eliminate asymptomatic carriage.

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