Tinea capitis in adult women masquerading as bacterial pyoderma

Tinea capitis is generally thought to be a common disease in children but not in adults. Adults with tinea capitis generally present with scale and alopecia. We report 3 adults with inflammatory tinea capitis caused by Trichophyton tonsurans that resembled a bacterial infection. Of these patients, 2 were initially given a diagnosis of bacterial pyoderma. All patients were successfully treated with oral antifungal agents. One patient had significant eosinophilia that resolved with treatment. We conclude that tinea capitis should remain in the differential diagnosis of adults with alopecia and pyoderma-like presentations. A biopsy specimen was helpful in making the diagnosis in 2 of the 3 patients, but fungal culture confirmed the diagnosis in all cases.