Question:
The clinical photograph shows a scalp lesion consistent with tinea capitis. What is the treatment of choice?
The clinical photograph shows a scalp lesion consistent with tinea capitis. What is the treatment of choice?
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Fungus inside the hair shaft cannot be reached by topical drugs.
Updated On: Jun 25, 2026
- Oral antifungals
- Antibiotics
- Methotrexate
- Topical steroids
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The Correct Option is A
Solution and Explanation
Step 1: Identify the condition. Tinea capitis is a dermatophyte infection of the scalp and hair shafts, commonly caused by Trichophyton and Microsporum species. It presents with scaly patches, broken hairs, alopecia and sometimes a boggy inflammatory mass (kerion).
Step 2: Understand why topical therapy fails. The fungus invades the hair shaft (endothrix/ectothrix). Topical agents cannot penetrate the hair follicle adequately, so they alone cannot eradicate the infection.
Step 3: Choose treatment. Systemic (oral) antifungals are mandatory. Griseofulvin and oral terbinafine are first-line; itraconazole and fluconazole are alternatives. A topical antifungal shampoo (e.g. selenium sulfide, ketoconazole) may be added to reduce spore shedding, but it is adjunctive.
Step 4: Why the others are wrong. Antibiotics treat bacterial infection, not fungi (used only for secondary bacterial superinfection). Methotrexate is an immunosuppressant with no antifungal role and would worsen infection. Topical steroids suppress local immunity and can cause tinea incognito. Hence, oral antifungals are the treatment of choice.
Step 2: Understand why topical therapy fails. The fungus invades the hair shaft (endothrix/ectothrix). Topical agents cannot penetrate the hair follicle adequately, so they alone cannot eradicate the infection.
Step 3: Choose treatment. Systemic (oral) antifungals are mandatory. Griseofulvin and oral terbinafine are first-line; itraconazole and fluconazole are alternatives. A topical antifungal shampoo (e.g. selenium sulfide, ketoconazole) may be added to reduce spore shedding, but it is adjunctive.
Step 4: Why the others are wrong. Antibiotics treat bacterial infection, not fungi (used only for secondary bacterial superinfection). Methotrexate is an immunosuppressant with no antifungal role and would worsen infection. Topical steroids suppress local immunity and can cause tinea incognito. Hence, oral antifungals are the treatment of choice.
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