Definition

• A fungus infection of the scalp
• The medical name is Tinea capitis

Health Information

Symptoms

• Round patches of hair loss that slowly increase in size.
• The scalp in the patches does not look normal. It has scaling, crusts and/or redness.
• The bald spots may have a black-dot appearance. These are hair shafts that are broken off at the surface. Note: the dots are blond in blond-haired children.
• It is often itchy.
• The main complication of untreated ringworm is a kerion. A kerion is tender swelling of the scalp that can drain pus. Kerions are an allergic reaction to the fungus, not a bacterial infection. They get better when you use the antifungal medicine.
• Peak age group is 2 to 10 years.

Cause

• Ringworm of the scalp is caused by a fungus infection. It is not caused by a worm.
• Over 90% of the time, it is spread from other children who are infected.
• Less than 10% are caused by pets that are infected. Examples are kittens, puppies and guinea pigs.
• The pet type cannot be spread from your child to other children.

Diagnosis

• Ringworm of the scalp often can be diagnosed by how it looks.
• Sometimes, some scales will need to be cultured for fungus.

Prevention of Spread to Others

• Ringworm can be spread to other people.
• Scales, broken hairs and any drainage is contagious.
• Do not share combs, brushes or hats with other people.
• Try to avoid scratching the patches of ringworm.
• Contacts: Check other family members for signs of ringworm.
• Pets with a skin rash or sores should be checked by a vet.

Care Advice

1. Overview:
   • Ringworm of the scalp won’t go away on its own.
   • It will keep spreading to more of the scalp.
   • It can be cured with prescription medicines.
   • It can be treated at home.
   • Here is some care advice that should help.
2. Anti-Fungal Drug:
   • Scalp ringworm needs a prescription for an anti-fungal drug.
   • The anti-fungal drug will kill the fungus that is causing the ringworm.
   • Give the drug as directed. (once or twice a day)
   • Try not to forget any of the doses.
   • Take the medicine with whole milk, ice cream or other fatty food. This will help absorb the medicine. Take the medicine for as long as directed. It is usually given until 2 weeks after the scalp starts to look normal. Often this is for 8 to 12 weeks.
   • Caution: Stopping the medicine too soon will cause the ringworm to come back.
3. Dandruff Shampoos:
   • Fungal spores in the hair can spread the disease.
   • Special dandruff shampoos can help prevent the spread of spores.
   • They don’t kill the spores but they get rid of them.
   • They are over the counter shampoos. Examples are Selsun Blue or Head and Shoulders.
   • Lather up and leave it on the scalp for 10 minutes before rinsing.
   • Use the shampoo 3 times a week for 2 weeks.
4. Treating Siblings:
   • About 25% of sibs or other close contacts get ringworm.
   • Many doctors treat all sibs with the special dandruff shampoo.
   • Reason: It may prevent the ringworm infection from happening to them.
   • Also some of the sibs may be "carriers" of the fungus. That means their scalp looks normal, but they still have fungus in it. The shampoo can clear them of any fungus.
   • Use the shampoo 3 times a week for 2 weeks.
5. Mistakes to Avoid:
   • Don’t try to treat ringworm of the scalp with any OTC ointments or creams. These can cure athlete’s foot or ringworm of the body. But, they can’t cure ringworm of the scalp. Reason: The infection is deep in the hair follicles and scalp.
   • Also, never shave off the hair. Reason: It won’t cure ringworm, because it doesn’t treat the scalp. Also, it’s cruel.
6. What to Expect:
   • The scalp will return to normal appearance in 4 to 8 weeks.
   • The hair will grow back in 3 to 6 months after treatment is completed.
7. Return to School:
   • Can return to school 24 hours after starting prescription anti-fungal medicine by mouth.
   • Should not return to wrestling until 2 weeks after starting treatment. Reason: Can easily spread to other wrestlers.

Call Your Doctor If

• With treatment, the scalp does not look normal by 2 months
• Hair does not grow back by 6 months
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

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