A 7 Year old boy with boggy swelling of the scalp with multiple discharging sinuses with cervical lymphadenopathy with easily pluckable hair. What would be done for diagnosis -
<p>DERMATOPHYTOSIS Infection caused by dermatophytes. Classified based on site of involvement.Tinea capitis- scalp involvement. TINEA CAPITIS:-Infection can be either endothrix/ectothrix.Ectothrix involves both the inside and outside of hair shaft.Endothrix involves only the inside of hair shaft.Causative organism:-Trichophyton and microsporumEctothrix-M.canis,M.audouinii, M.distoum,M.ferrugineum,M.gypseum and T.verrucosum.Endothrix-T.tonsurans,T.violaceum, T.soudanenseFavus caused by T.schoenleinii Two types- inflammatory and non inflammatory. Non inflammatory-1. Dry scaling2. Black dot-Hair breaks at the surface of the scalp and appears as swollen black dots.3. Grey patch-Hair breaks close to the surface or a few mm above and there is skin scalp scaling. Inflammatory-1. Kerion- most inflammatory form of tinea capitis. Characterised by wet, purulent,boggy swelling with inflamed painful pustules,nodules and plaques. Hairs donot fall out but can be pulled out without pain.2. Favus- patches of redness and scaling with disc/ cup shaped yellow crusts (scutula) pierced by one/ two hairs which donot break. A fetid odour may be present. After many years,atrophic patches develop,causing permanent alopecia. Wood's lamp examination and KOH mound confirms the diagnosis. {Reference: IADVL textbook of dermatology, page 255
Pus for culture
KOH mount
Biopsy
Patch test
Fungal infections, Scabies, Pediculosis