Tinea capitis is a common pediatric problem. Because treatment requires eight to 12 weeks of oral antifungal medication, accurate diagnosis is essential. A fungal culture that yields Trichophyton tonsurans establishes the diagnosis with certainty.
Hubbard has described certain components of the clinical picture together with the positive predictive value of each (in parenthesis): scaling (1.1), alopecia (3.3), lymphadenopathy, usually in the occipital area (7.5), and pruritus (1.4). The study found that if only one of these components was present, no patient had a positive culture. The presence of two components increased culture positivity to 11%, three components to 92%, and all four components to 100% (Hubbard TW: The predictive value of symptoms in diagnosing childhood tinea capitis. Arch Pediatr Adolesc Med 1999;153[11]:1150).
In our pediatric walk-in clinic, we use the mnemonic SCALP (SCaling, Alopecia, Lymphadenopathy, Pruritus) to make sure all four clinical components are included when a child is evaluated for tinea capitis. Thus, if an intern says, "The patient is a 6-year-old boy with a SCaly circular lesion, 3 cm in diameter, Alopecia, Lymphadenopathy in the cervical area, and Pruritus," he (she) is expressing 100% certainty that the patient needs an antifungal agent.
FDA warns of serious potential reaction to levetiracetam and clobazam
November 30th 2023The reaction, called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), can start as a rash but can progress quickly, potentially resulting in injury to internal organs, hospitalization, and death.