If you would like to learn about scalp ringworm symptoms, and treatment of the condition, you will find the following information of help.
Ringworm is a skin infection caused by a fungus. Ringworm on the scalp mainly affects children. Treatment is with antifungal medication which you need to take for several weeks. An antifungal shampoo is not effective alone, but may be advised in addition to medication.
What is ringworm?
Ringworm is a fungal skin infection. (It is not due to a worm as its name implies!) There are many types of fungus germs (fungi) and some can infect the skin, nails and hair. This page just deals with scalp ringworm which is sometimes called tinea capitis. Other pages deal with fungal infections of the skin, foot (athlete's foot), groin (tinea cruris), and nails.
How can you catch scalp ringworm?
- Most cases of scalp ringworm are caught from person to person via touching, sharing towels, etc.
- Fungi and their spores can remain alive on combs, brushes, unwashed towels, furniture, and sheets for long periods.
- Some people are carriers of the fungi. That is, they have fungi on their skin and hair but it does not invade into the skin to cause infection or symptoms. However, they may pass the fungi on to others who then do develop symptoms.
- Sometimes an outbreak of scalp ringworm occurs in families or schools.
- From animals. Some dogs, cats and other pets have fungal infections on their skin. They can pass on the infection, especially to children. (Animals can be treated too if you suspect a pet is the cause. See your vet.) Farm animals can also be a source. Touching a farm gate where infected animals pass through may be enough to infect your skin.
- No apparent reason. Fungi are common and an infection can occur 'out of the blue'.
Scalp ringworm mainly affects children. It is rare in adults. This is thought to be because the normal skin oil (sebum) that increases on the scalp after puberty (in the teenage years) has properties that make it resistant to fungi.
What are the symptoms of scalp ringworm?
- Commonly, the infection just looks like severe dandruff on various places on the scalp. This may be mistaken for psoriasis.
- Some infections cause patches of hair loss (bald patches) to develop. The bald patches are usually inflamed and very scaly. Small broken-off hairs may remain scattered in the bald patches.
- In some cases several painful pustules (boils) develop on the scalp.
- A more severe infection develops in a small number of cases. This causes a large 'boggy' swelling in a section of the scalp called a kerion. This can be oozing and tender, and if not treated early can cause permanent scarring and hair loss.
- If you have a severe infection such as a kerion or pustules you may develop a fever and the glands in the neck may swell.
As a general rule:
- Fungi that cause infections that spread easily from person to person tend to cause the less severe infections (those that look like severe dandruff).
- Fungi that you may catch from animals tend to cause the more severe infections causing bald patches, boils or a kerion.
How is a scalp ringworm diagnosed?
Sometimes the symptoms strongly suggest a fungal infection. However, scalp ringworm may be confused with other problems at first. For example, some cases can look like psoriasis or bad dandruff, and fungal infection is only one cause of bald patches to appear. To confirm the diagnosis a doctor will usually send a hair sample or a scraping of affected skin to the laboratory. This is looked at under the microscope and cultured to confirm that a fungal infection is the cause of the problem.
What is the treatment for scalp ringworm?
Antifungal medicines
An antifungal medicine taken by mouth is needed to clear scalp ringworm.
- Terbinafine is an antifungal medicine that is commonly used to treat scalp ringworm. (Strictly speaking, it is not licensed for this purpose. However, it is a widely used antifungal and considered by many experts to be the best for scalp ringworm.) A 2-4 week course is usually needed. It is important to finish the course to clear the fungus completely from the scalp. You should not take terbinafine if you are pregnant.
- Griseofulvin an alternative option. An 8-12 week course of griseofulvin is usually needed. You should not take griseofulvin if you are pregnant. Men should not father a child within six months of taking griseofulvin treatment.
Antifungal creams and shampoos
Antifungal creams or shampoos do not clear the infection fully. This is because fungi get into the hair shafts where creams and shampoos cannot reach. Therefore, they cannot cure the condition. However, they do clear fungi and fungal spores from the hairs and surface of the scalp.
An antifungal shampoo may be advised in addition to antifungal medication. For example, selenium shampoo or povidone-iodine shampoo or ketoconazole shampoo. This is to quickly clear any surface fungi and make it much less likely for the fungus to spread to other children.
Note: children with scalp ringworm do not need to stay off school.
©EMIS and PIP 2006
