Inflammatory tinea capitis caused by Microsporum gypseum in a five-year-old girl

An otherwise healthy five-year-old girl presented for evaluation of a large patch of erythematous scaling alopecia on the vertex of her scalp. Previous attempts to treat this with various topical agents resulted in no improvement. Our evaluation included examination of fungal cultures, which grew out a colony with characteristic morphology of Microsporum gypseum, supported by lactolphenol blue tease mounts, demonstrating the characteristic conidia for this fungus. Treatment was begun with oral griseofulvin, and evidence of inflammation resolved along with conversion to negative cultures for M. gypseum, although an area of scarring alopecia from the kerion remains. The epidemiologic basis, clinical presentation, differential diagnosis, evaluation, and treatment principles for this important geophilic organism are reviewed. Physicians need to be aware of this agent of tinea capitis, since it is destructive and only responsive to oral therapy.