A 7-year-old black girl comes to
your office with a 10-week history
of scaling and scalp redness,
and hair loss. About 3 weeks before
the visit, the child's mother
first noticed a boggy, draining
yellow plaque on her daughter's
parietal scalp. A different physician
shampoo. At 1-week follow-up,
the symptoms had not abated;
the clinician then prescribed oral
cephalexin as well as a topical mixture of the antifungal agent, clotrimazole, and the high-potency topical
corticosteroid, betamethasone. After 2 weeks of therapy, the symptoms were no better.
The girl's mother reports that the scalp lesion has grown larger, despite therapy (Figure 1). You note
that the child has cervical adenopathy.
WHAT WOULD YOU DO NOW?
A. Order a Tzanck smear and viral culture.
B. Order a swab for bacterial culture.
C. Perform a potassium hydroxide preparation or dermatophyte culture.
D. Perform a skin biopsy and tissue culture.
E. Order a deep fungal and atypical
1. Friedlander SF, Aly R, Krafchik B, et al. Terbinafine in the treatment of
Trichophyton tinea capitis: a randomized, double-blind, parallel-group, durationfinding
study. Pediatrics. 2002;109:602-607.
2. Chen BK, Friedlander SF. Tinea capitis update: a continuing conflict with an
old adversary. Curr Opin Pediatr. 2001;13:331-335.
3. Gupta AK, Adam P, Hofstader SL, et al. Intermittent short duration therapy
with fluconazole is effective for tinea capitis. Br J Dermatol. 1999;141:304-306.
4. Abdel-Rahman SM, Powell DA, Nahata MC. Efficacy of itraconazole in
children with Trichophyton tonsurans tinea capitis. J Am Acad Dermatol. 1998;38: