To the Editor.—
In regard to my article in JAMA (242:1765, 1979) and the accompanying editorial by Andrew H. Rudolph, MD (242:1770, 1979), concerning Trichophyton tonsurans tinea capitis, I recently had the opportunity to review the charts of 40 children with culturally proved T tonsurans scalp infections. Of these, 30 (75%) were originally misdiagnosed by the primary care physician (pediatrician, family practitioner) as chronic dandruff, impetigo, and seborrhea. After various prescribed treatments (dandruff and medicated shampoos, erythromycin, and tetracycline) with little or no improvement (in one case as long as two years of chronic flaking and hair loss), a culture was finally taken, and the problem resolved with griseofulvin therapy.This finding illustrates the difficulty in diagnosing these infections. Our dermatologists have suggested that all scalp problems in children should be considered tinea capitis until culturally proved otherwise.