Tinea capitis in the Americas: Epidemiological Trends and Etiological Distribution from a Systematic Review

Background: Tinea capitis remains one of the most common superficial fungal infections in children worldwide and represents an important public health concern due to its high prevalence, potential complications, and changing epidemiology. This study aimed to characterize the epidemiological trends and etiological distribution of tinea capitis across the Americas through a systematic review of the available literature. Methods: A systematic search was conducted in MEDLINE (PubMed), Scopus, SCILIT, and SciELO following PRISMA guidelines. A total of 250 records were identified, of which 75 duplicates were removed. After title and abstract screening and eligibility assessment, 90 studies were included. Observational studies, prevalence studies, case series, and case reports reporting epidemiological or etiological data on tinea capitis in countries of the American continent were considered eligible. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. No formal certainty-of-evidence assessment or meta-analysis was performed due to the descriptive nature and heterogeneity of the included studies. This review was not prospectively registered. Results: The 90 included studies comprised 506,086 reported cases of tinea capitis. Marked regional differences were identified in the distribution of dermatophyte species. Trichophyton tonsurans predominated in North America and several Caribbean countries, whereas Microsporum canis was the most frequently reported etiological agent in much of South America and parts of Central America, suggesting an important role of zoonotic transmission in these regions. Variations in prevalence and species distribution were also associated with geographic, socioeconomic, and demographic factors. Overall, the included studies demonstrated low-to-moderate methodological risk of bias. Conclusions: These findings demonstrate substantial heterogeneity in the epidemiology of tinea capitis throughout the Americas and highlight the importance of continuous surveillance, accurate mycological diagnosis, and region-specific public health strategies to improve disease control and guide appropriate therapeutic interventions.