Patchy hair loss in school children: Tinea capitis re-assessed

Patchy hair loss in children remains a cosmetic problem for several parents in Africa, Nigeria inclusive. Tinea capitis constitutes one of the commonest acquired causes of this form of alopecia in children. The continual emergence of new mycologic flora, varying with time and from place to place formed the basis of this study; with a view to reflect the current prevalence of tinea capitis and its clinico-etiologic correlation, amongst school children of Southeastern Nigeria. Three hundred children from seven streams of primary schools were randomly selected. A structured questionnaire was administered once parental consent was obtained. This was followed by examination of the scalp with collection of samples using the brush method. One hundred and thirty nine (48.4%) pupils had evidence of scalp infections on clinical examination such as scalines in 118 (41.1%), alopecia 19 (6.6%), kerion 9 (3.1%) while 148 (51.6%) had nothing on the scalp. Dermatophytosis concurrently affecting other sites of the body occurred in 31 (10.8%) particularly those with Tricophyton soudanense infection. Infection rate per school ranged from 5.4% to 59.3% with mean of 51.7%. Isolated dermatophytes included Microsporum audouinii (31.1%), which was associated with patchy scaly tinea capitis; T. soudanense (22.6%) and Trichophyton tonsurans (13.2%) were mostly linked to the black dot type. Other isolated species included Trichophyton yaoundei (5.6%) and Microsporum canis (1.9%) while three pupils had a mixed isolate of T. soudanense and M. audouinii. Anthropophilic organisms are still prevalent etiologic agents for tinea capitis in our region however high levels of clinical unapparent infections are still amongst some of the challenges of tinea capitis for the region. Health protocols for primary schools should endeavor to include screening for tinea capitis from time to time ensure early identification and prompt management particularly when the number of children presenting with patchy hair loss becomes significant over a period of time.