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Scalp Ringworm (Tinea Capitis)

By

Denise M. Aaron

, MD, Dartmouth Geisel School of Medicine

Last full review/revision Feb 2020| Content last modified Feb 2020
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Scalp ringworm is a dermatophyte (fungal) infection of the scalp.

  • Symptoms of tinea capitis include a dry patch of scale, a patch of hair loss, or both on the scalp.

  • Doctors base the diagnosis on an examination of the scalp and samples taken from the scalp.

  • Treatment includes antifungal drugs taken by mouth for all people and, for children, antifungal cream.

Tinea capitis is highly contagious and is common among children.

Symptoms of Scalp Ringworm

Tinea capitis may cause a dry scaly rash that may be somewhat itchy, a patch of hair loss (alopecia Alopecia (Hair Loss) Hair loss, also called alopecia, can occur on any part of the body. Hair loss that occurs on the scalp is generally called baldness. Hair loss is often of great concern to people for cosmetic... read more Alopecia (Hair Loss) ), or both. One type of fungus causes "black dot" ringworm, in which hair shafts break at the scalp surface. Another type of fungus causes "gray patch" ringworm, in which hair shafts break above the surface, leaving short stubs. Tinea capitis may sometimes cause flaking that resembles dandruff.

Kerion

A dermatophyte infection occasionally causes a kerion, which is a large, painful, inflamed, swollen patch on the scalp that sometimes oozes pus. A kerion may have blisters and crusting and can look like an abscess (a pocket of pus). A kerion is caused by an immune system reaction to the fungus and may result in scarring hair loss.

Diagnosis of Scalp Ringworm

  • A doctor's examination of the skin

  • Examination of plucked hairs or scale from the scalp

  • Sometimes a Wood light examination and sometimes culture

Treatment of Scalp Ringworm

  • In children and adults, antifungal drugs taken by mouth

  • In children, antifungal cream and selenium sulfide shampoo

  • In adults, sometimes selenium sulfide shampoo

  • Sometimes prednisone

In children, treatment of tinea capitis involves an antifungal drug called terbinafine taken by mouth for 4 weeks. Griseofulvin is an alternative drug for children.

An antifungal cream can be applied to the scalp to prevent spread, especially to other children, until the tinea capitis is cured. Prescription-strength selenium sulfide shampoo should also be used at least twice a week. Children may attend school during treatment. (See also table Some Antifungal Drugs Applied to the Skin (Topical Drugs) Some Antifungal Drugs Applied to the Skin (Topical Drugs) Fungi usually make their homes in moist areas of the body where skin surfaces meet: between the toes, in the genital area, and under the breasts. Common fungal skin infections are caused by... read more .)

In adults, tinea capitis treatment is with the antifungal drug terbinafine or itraconazole taken by mouth. How long treatment is needed depends on the drug used. Selenium sulfide shampoo is also sometimes used in adults.

For severely inflamed areas and for a kerion, doctors may prescribe a short course of a corticosteroid such as prednisone taken by mouth to lessen symptoms and perhaps reduce the chance of scarring.

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