FIGURE 66.12 Tinea capitis Alopecia with the “black dot” sign of broken hairs (Reprinted with permission from Fleisher GR, Ludwig S, Baskin MN Atlas of Pediatric Emergency Medicine Philadelphia, PA: Lippincott Williams & Wilkins; 2004.) In North America, tinea capitis is most commonly caused by infection with Trichophyton tonsurans or Microsporum canis Infection can manifest as scaling patches of alopecia, areas of distinct alopecia with broken hairs that manifest as “black dots” ( Fig 66.12 ), diffuse scaling with little alopecia, or an acute boggy plaque (kerion) ( Fig 66.13 ) Tinea capitis and other dermatophyte infections of hair-bearing areas (eyebrow, beard, etc.) usually require systemic therapy because these are deeper infections of the hair shaft and follicle Four to weeks of griseofulvin (children over years) or to weeks of terbinafine (children over years) are commonly used therapies In children under years, oral fluconazole can be used, but topical therapy with an azole (e.g., clotrimazole) or an allylamine (e.g., terbinafine) may be effective if the hairs are fine