Tinea capitis in adults

Background. Tinea capitis is a rare infections occurring in adults, as after puberty the fungistatic sebum activity and the thicker hair caliber protect from scalp dermatophytes colonization. Several predisposing factors have been suggested, mainly hormonal variations in menopausal women and immunosuppression, especially HIV related. Besides, a recent alarming increase has been reported in young immunocompetent adult, due to more resistant dermatophytes strains, able to survive and parasites the post-pubertal scalp, such as Trycophyton tonsurans. Changes in epidemiology due to globalization and migration fluxes favor the diffusion of African and Caribbean species in the Western countries. Methods. Critical revision on current knowledge and published literature. Results. Clinical presentation is usually atypical in adult’s tinea capitis, mimicking any scalp dermatitis, from mild to severe inflammatory conditions, with ill-defined hairloss patches, normal appearing hairs mixed with black dots or irregularly broken hairs, variable scaling and pustules. More severe cases have scarring and atrophic evolution, simulating decalvans folliculitis, dissecting cellulitis. Responsible dermatophytes are the same of children’s tinea capitis. Contagion from asymptomatic dermatophyte carriers or tinea capitis affected children in the household should be considered. Agropastoral environment and close contact with domestic animals might be relevant in some patients. Conclusions. Medical awareness of this rare entity is mandatory to avoid diagnostic delay, unnecessary investigations and possible inappropriate treatment. Mycological samples should be sent to reference laboratory whenever a patchy hair loss occurs in adults, especially when previous treatment for common dermatitis have been disappointing.