Derm Cases · Dermatology / Paediatrics / Infectious Diseases
OSCE — scaly patchy hair loss in a child: tinea capitis
An 8-minute OSCE station on tinea capitis patterns, KOH/Wood's lamp approach, mandatory systemic antifungals with doses, kerion management without incision, carrier screening, and school/household advice.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on tinea capitis patterns, KOH/Wood's lamp approach, mandatory systemic antifungals with doses, kerion management without incision, carrier screening, and school/household advice.
Brief (to candidate)
An 8-year-old child has a 4-week history of a scaly, pruritic patch of hair loss on the scalp with broken hairs and occipital lymphadenopathy. A classmate has similar findings. The child is systemically well; there is no fluctuance. You have 8 minutes to diagnose, start correct systemic therapy, manage contacts, and counsel the family.
Candidate instructions
- Recognise tinea capitis clinical patterns (including kerion).
- Plan confirmation (KOH/plucked hairs, culture, Wood's lamp).
- Prescribe systemic antifungal — never topical alone — with dose and duration principles.
- Manage kerion correctly (no routine incision).
- Screen/treat household carriers and give shampoo adjuncts.
- School advice and scarring safety-net.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | Patchy alopecia with scale, broken hairs (black-dot/grey-patch), lymphadenopathy in a child = tinea capitis; dermatophyte invades hair shaft[1][2] |
| Diagnosis | Pluck hairs/scale from edge for KOH + culture; Wood's lamp green fluorescence suggests Microsporum (not T. tonsurans); trichoscopy if available |
| Systemic Rx mandatory | Topical monotherapy fails. Species-guided: griseofulvin ~20–25 mg/kg/day × 6–8 weeks (especially Microsporum) or weight-based oral terbinafine (better for Trichophyton, often 2–6 weeks depending on species) ± longer until mycological cure[3][4] |
| Adjuncts | Ketoconazole 2% or selenium sulphide shampoo 2–3× weekly to reduce shedding/transmission |
| Kerion | Boggy tender inflammatory mass = hypersensitivity, often sterile — do not I&D; continue systemic antifungal; consider prednisolone 0.5–1 mg/kg × 1–2 weeks to reduce scarring; antibiotics only if secondary bacterial infection |
| Contacts | Screen household (high asymptomatic T. tonsurans carriage); treat carriers with antifungal shampoo ± oral Rx in selected protocols; avoid shared combs/hats |
| Communication | Reassure most hair regrows if treated before scarring; return if boggy mass, fever, or persistent alopecia after full course |
Model key actions
- Diagnose tinea capitis and start oral griseofulvin or terbinafine (not topical alone).[1][3]
- Add antifungal shampoo; screen contacts; never incise a kerion as a first step.[2][4]
- Counsel duration of weeks and mycological follow-up when available.
Common errors
- Topical antifungal cream alone on the scalp.
- Incising a kerion as a bacterial abscess.
- Forgetting household carriers and shared combs.
- Stopping oral therapy at early clinical improvement (before adequate course).
- Missing adult tinea capitis as a clue to immunocompromise or infected child contact.
References4ShowHide
- [1]Gupta AK, Friedlander SF, Simkovich AJ. Tinea capitis: An update. Pediatric Dermatology, 2022.PMID 35075666
- [2]Leung AKC, Hon KL, Leong KF, et al. Tinea Capitis: An Updated Review. Recent patents on inflammation & allergy drug discovery, 2020.PMID 31906842
- [3]Gupta AK, Polla Ravi S, Wang T, et al. An update on tinea capitis in children. Pediatric Dermatology, 2024.PMID 39113245
- [4]Caplan AS, Gold JAW, Smith DJ, et al. Diagnosis and Management of Tinea Infections. American Family Physician, 2025.PMID 41118183