Ringworm of the Scalp (Tinea capitis)

What Is Tinea Capitis?

Tinea capitis is a fungal infection of the scalp and hair. It is also called "scalp ringworm." Even though it has the word "worm" in its name, it is not caused by a worm. It is caused by a type of fungus.

The fungus gets into the hair follicles and shafts on the scalp. Sometimes it can also affect the eyebrows and eyelashes. Tinea capitis is very common in children between the ages of 3 and 14, but it can happen at any age.

There are two main types of tinea capitis:

• Non-inflammatory type: This is the milder form. It causes flaky, scaly patches and hair loss, but the hair usually grows back with treatment.

• Inflammatory type: This is a more serious form. It can cause painful, swollen, pus-filled bumps on the scalp called a "kerion." A kerion is caused by the body's reaction to the fungus. If not treated early, this type can lead to scarring and permanent hair loss.

What Causes Tinea Capitis?

Tinea capitis is caused by fungi called dermatophytes. These fungi like warm, moist places and can live on the skin, hair, and nails.

Your child can get tinea capitis in several ways:

• From other people: Direct contact with someone who has the infection, even if that person has no symptoms.

• From animals: Touching pets or animals that carry the fungus, such as cats, dogs, or guinea pigs.

• From objects: Sharing items like hats, hairbrushes, combs, helmets, pillows, towels, or bedding that have the fungus on them. The fungus can live on these objects for a long time.

Tinea capitis spreads easily, especially among children in schools, daycare centers, and during contact sports.

What Are the Symptoms of Tinea Capitis?

Symptoms of tinea capitis can look different from child to child. Common signs include:

• Round, scaly patches on the scalp that may slowly get bigger

• Redness or irritation of the scalp

• Dry, flaky skin that looks like dandruff

• Itching

• Patches of hair loss (bald spots)

• Black dots on the scalp where hair has broken off at the surface

• Crusty bumps or sores

• Swollen glands (lymph nodes) in the neck

• Low fever (in some cases)

In more serious cases, your child may develop a kerion — a tender, swollen area on the scalp that may ooze pus. A kerion is not a bacterial infection - it is the body's immune response to the fungus.

If tinea capitis is not treated, it can keep spreading across the scalp and may lead to permanent hair loss.

Gray Patch Scalp Ringworm	Black Dot Scalp Ringworm	Round scaly patches

How Is Tinea Capitis Treated?

Tinea capitis must be treated with antifungal medicine taken by mouth. Creams and ointments applied to the scalp alone will not cure this infection because the fungus lives deep inside the hair follicles where topical treatments cannot reach.

Here is what to expect with treatment:

• Oral antifungal medicine: Your child's healthcare provider will prescribe an antifungal medicine such as griseofulvin or terbinafine. Your child will need to take this medicine for at least 6 to 8 weeks, or until the provider confirms the infection is gone. It is very important to finish all of the medicine, even if the scalp looks better. Stopping too early can cause the infection to come back.

  • If your child takes griseofulvin, give it with a fatty food like whole milk or ice cream. This helps the body absorb the medicine better.

• Medicated shampoo: Your provider may also recommend a special shampoo (such as selenium sulfide or ketoconazole shampoo). Lather the shampoo and leave it on the scalp for 10 minutes before rinsing. Use it 2 to 3 times per week. This shampoo helps reduce the spread of the fungus but will not cure the infection on its own.

• Treatment for kerion: If your child has a kerion, the provider may also prescribe a short course of a steroid medicine (such as prednisone) to reduce swelling and lower the risk of scarring and permanent hair loss. This is given along with the antifungal medicine.

Important things to know about treatment:

• Do not use over-the-counter antifungal creams alone to treat scalp ringworm. These may work for ringworm on the body, but not on the scalp.

• You don’t need to shave your child's head to try to treat the infection.

• The scalp usually looks normal again in about 4 to 8 weeks. Hair typically grows back within 3 to 6 months after treatment is finished.

• Your child can return to school 24 hours after starting the oral antifungal medicine.

• Some antifungal medications can affect the liver, your child's provider might want a blood test to check liver function before and/or during treatment.

How Can I Prevent Tinea Capitis?

Because tinea capitis spreads easily, taking steps to prevent it is important. Here is what you can do:

• Do not share personal items. Teach your child not to share hats, helmets, hairbrushes, combs, hair ties, pillows, or towels with others.

• Keep the scalp clean and dry. Wash your child's hair regularly.

• Clean household items. Wash pillows, sheets, towels, and bedding in hot water frequently. Clean, disinfect, or replace shared combs, brushes, and hair accessories.

• Check the whole family. If one person in the household has tinea capitis, everyone else should be checked — even if they have no symptoms. Some people can carry the fungus without showing signs and can spread it to others. Your provider may recommend that family members use a medicated shampoo 2 to 3 times per week for a few weeks as a precaution.

• Check your pets. If a pet has a skin rash, hair loss, or sores, take them to a veterinarian. Pets can carry and spread the fungus.

• Wash hands after touching animals. Always wash hands after petting, playing with, or caring for animals.

• Avoid contact with infected areas. Try to keep your child from scratching the affected patches, as this can spread the fungus.

When to Contact Your Child's Healthcare Team

Call your child's healthcare provider if:

• The scalp does not look better after 2 months of treatment

• Hair has not started growing back within 6 months after finishing treatment

• The infection seems to be getting worse or spreading

• Your child develops new symptoms such as increased pain, swelling, or pus on the scalp

• Your child has a fever or swollen glands in the neck

• You are having trouble getting your child to take the medicine

• Other family members develop signs of scalp ringworm