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Ringworm Of The Scalp (Tinea Capitis)

Ringworm of the scalp usually occurs in children between 2 and 10 years of age. This fungus infects the roots of the hair shaft. It is not dangerous, but untreated, hair loss and scaling may spread to other areas of the scalp. Hair grows back after treatment, but regrowth takes 6-12 months. It is necessary to treat this infection with an oral medicine for 6-8 weeks to effectively eliminate fungus.

Ringworm may present as one of the following:

• Round patches of hair loss that slowly increase in size.
• A black-dot, stubbled appearance of the scalp from hair shafts that are broken off at the surface.
• Scaling on the scalp which may resemble dandruff.
• Mild itching of the scalp and enlarged lymph nodes behind ears may be present with any of the above.

Cause

Most cases of ringworm of the scalp are caused by Trichophyton tonsurans, a fungus that infects the hair roots and causes them to break. The fungus is usually transmitted by other children who are infected. Combs, brushes, hats, barrettes, seat backs, pillows, and bath towels can carry the fungus.

A few cases are caused by a fungus from infected animals, such as kittens and puppies. This type of fungus is not contagious to other children. Pets with a skin rash or sores should be evaluated by a veterinarian.

Diagnosis

Diagnosis of ringworm of the scalp requires taking a sample of the skin overlying the bald area on your child’s scalp. It is not painful. A Q-tip is rubbed gently over the scalp to obtain the sample. The sample is then sent to a lab to be cultured. The results of this culture can take up to 3 weeks to complete because it is necessary for the lab to grow the ringworm (fungus) in a test tube for proper identification.

Treatment

Oral antifungal medicine - The main treatment for ringworm of the scalp is an oral medicine, Griseofulvin, taken orally for 6-8 weeks. Your child's dosage is: ____teaspoons, given once a day. This medicine is best absorbed if your child takes it with fatty foods such as milk or ice cream.

Antifungal cream - Use of these creams once a day, on the bald spots, will prevent your child from spreading this infection to other children. Lotrimin (OTC), Nizoral, and Spectrazole are examples of these.

Antifungal shampoo - Use a nonprescription shampoo containing selenium sulfide (Selsun). Lather and leave it on your child's scalp for 10 minutes before rinsing. Use the antifungal shampoo twice a week for the next 8 weeks. On other days, use a regular shampoo. This shampoo can be used if it is difficult to apply the antifungal cream directly or there are too many affected areas.

Is my child contagious?

Once your child has begun taking Griseofulvin and applies the antifungal cream to the bald areas, he/she is no longer contagious and can return to school.

Follow-up appointment

It is necessary to continue taking the Griseofulvin until a follow-up scalp culture shows the ringworm is gone. This reculture should be done 3-4 weeks after the medicine is started. It takes 3 weeks until the culture results are complete.

Call our office during office hours if:

• The ringworm becomes infected with pus or a yellow crust.
• The scalp becomes swollen or boggy (soft).
• The ringworm continues to spread after your child has been treated for 2 weeks.
• Your child develops a rash over entire body after taking Griseofulvin.