Ringworm (scalp)

Overview

Ringworm of the scalp (tinea capitis) is a rash caused by a fungal infection. It usually causes itchy, scaly, bald patches on the head. Ringworm gets its name because of its circular appearance. No worm is involved.

Ringworm of the scalp is a contagious infection. It's most common in toddlers and school-age children. Tinea capitis is related to athlete's foot (tinea pedis), jock itch (tinea cruris) and ringworm of the body (tinea corporis).

Medication taken by mouth can kill the fungus that causes ringworm of the scalp. Medicated shampoos may help keep a person from spreading the infection to others.

Symptoms

Signs and symptoms of ringworm of the scalp may include:

One or more round, scaly or inflamed patches where the hair has broken off at or near the scalp
Patches that slowly get bigger and have small, black dots where the hair has broken off
Brittle or fragile hair that can be easily broken or pulled out
Tender or painful areas on the scalp

When to see a doctor

Several conditions affecting the scalp may have a similar appearance. See your child's doctor if your child has any hair loss, scaling or itchiness of the scalp, or other unusual appearance of the scalp. It's important to get an accurate diagnosis and prompt treatment with prescription medicine. Nonprescription creams, lotions and powders won't get rid of ringworm of the scalp.

Causes

Ringworm of the scalp is caused by a common fungus. The fungus attacks the outer layer of skin on the scalp and the hair. This causes those hairs to break. The condition can be spread in the following ways:

Human to human. Ringworm often spreads through direct skin-to-skin contact with an infected person.
Animal to human. You can contract ringworm by touching an animal with ringworm. Ringworm can spread while petting or grooming dogs or cats with ringworm. Ringworm is fairly common in kittens, puppies, cows, goats, pigs and horses.
Object to human. It's possible for ringworm to spread by contact with objects or surfaces that an infected person or animal has recently touched. This includes items such as clothing, towels, bedding, combs and brushes.

Risk factors

Risk factors for ringworm of the scalp include:

Age. Ringworm of the scalp is most common in toddlers and school-age children.
Exposure to other children. Outbreaks of ringworm are common in schools and child care centers where the infection easily spreads with close contact.
Exposure to pets. A pet, such as a cat or a dog, can have the infection without showing any signs. Children can get the infection by touching the animal.

Complications

Some people with ringworm of the scalp may develop a severe inflammation called kerion. Kerion appears as soft, raised swellings that drain pus and cause thick, yellow crusting on the scalp.

With kerion, the hair falls out or can be easily pulled out. The condition may be caused by an overly vigorous reaction to the fungus and can lead to scarring and permanent hair loss.

Prevention

Ringworm of the scalp is difficult to prevent. The fungus that causes it is common, and the condition is contagious even before symptoms appear. Take these steps to reduce the risk of ringworm:

Educate yourself and others. Be aware of the risk of ringworm from infected people or pets. Tell children about ringworm, what to watch for and how to avoid the infection.
Shampoo regularly. Be sure to wash your child's scalp regularly, especially after haircuts. Some scalp conditioning products, such as coconut oil and pomades with selenium, might help prevent ringworm of the scalp.
Keep skin clean and dry. Be sure children wash their hands, including after playing with pets. Keep shared areas clean, especially in schools, child care centers, gyms and locker rooms.
Avoid infected animals. The infection often looks like a patch of skin where fur is missing. If you have pets or other animals that commonly carry ringworm, ask your veterinarian to check them for the infection.
Avoid sharing personal items. Teach children not to let others use their clothing, towels, hairbrushes, sports gear or other personal items.

Diagnosis

Your doctor will likely be able to diagnose ringworm of the scalp by looking at the affected skin and asking certain questions. To confirm the diagnosis, your doctor may take a sample of hair or skin to be tested in a lab. Testing a sample of hair or skin can show if a fungus is present.

Treatment

Treatment for ringworm of the scalp requires a prescription-strength antifungal medication taken by mouth. The first-choice medication is usually griseofulvin (Gris-Peg). Alternatives might be used if griseofulvin isn't working or your child is allergic to it. These include terbinafine, itraconazole (Spoanox, Tolsura) and fluconazole (Diflucan). Your child might need to take one of these medications for six weeks or more — until hair regrows. Typically, with successful treatment, the bald spots will grow hair again and the skin will heal without scarring.

Your doctor might recommend that you also wash your child's hair with a prescription-strength medicated shampoo. The shampoo removes fungus spores and helps prevent spreading the infection to others or to other areas of the body.

There is no need to shave the head or cut the hair as part of the treatment.

Preparing for your appointment

If your child has a condition affecting the scalp, you'll likely start by seeing your family doctor or child's pediatrician. You may be referred to a skin specialist (dermatologist).

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

When did you first notice symptoms?
What did the scalp look like when symptoms first appeared?
Is the rash painful or itchy?
What, if anything, makes the condition better or worse?
Do you have any pets at home, or has your child been around farm animals?
Does another family member or a pet already have ringworm?
Do you know of any cases of ringworm in your child's school?

Questions for your doctor

Questions you might be prepared to ask your doctor include:

If this is ringworm, what can we do to prevent the infection from spreading?
What hair care routines do you recommend while the condition heals?
When can my child return to school?
Should I schedule a follow-up appointment for my child?
Should I make appointments for my other children even if they aren't showing signs or symptoms right now?