A six-year-old child presents with circular patches of baldness and hair that fluoresces yellow-green under a Wood’s lamp. What is the best treatment?

• A. Shaving the hair
• B. Oral griseofulvin
• C. Topical miconazole
• D. Lindane shampoo

Answer: (B)

This scenario shows a scalp fungal infection that penetrates the hair follicles, so treatment must reach the hair shaft systemically rather than just on the surface. The yellow-green fluorescence under a Wood’s lamp suggests Microsporum, a dermatophyte commonly causing tinea capitis in children. Because the infection resides within hair follicles and keratin, topical antifungals alone won’t eradicate it; systemic therapy is required to clear the infection as new hair grows.

Oral griseofulvin is absorbed and becomes incorporated into keratin, allowing it to reach the infected hair, skin, and nails and to inhibit fungal cell division, making it effective against tinea capitis in children. That’s why this option is preferred.

Shaving the hair might help with visibility but does not treat the underlying infection. Topical miconazole doesn’t adequately penetrate to treat scalp follicular infection. Lindane shampoo is used for head lice, not fungal scalp infections.