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Tinea Capitis

Ringworm on the Scalp

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Updated February 18, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Tinea capitis is the scientific name for ringworm on the scalp. Tinea capitis is common in children, especially ages 3 to 7. The majority of these fungal infections are caused by two different fungi:
  • Trichophyton tonsurans
  • Microsporum canis

Tinea Capitis Transmission

The fungi that cause tinea capitis produce spores that are shed into the infected child's clothing, brushes or combs, and even into the air around the child. These spores can survive for months on objects. Children get tinea capitis after they come in contact with an infected person or animal, or after they come in contact with spores in other ways. For example, one common source of spores is classmates or adults who carry the spores on their skin or scalp without being infected.

The following factors increase a child's chance of getting a tinea capitis infection:

  • Having a large family
  • Crowded conditions
  • Low socioeconomic status

Tinea Capitis Appearance

The most common symptom of tinea capitis is hair loss. There is also a rash, which can look different depending on whether the fungus gets inside the hair shaft or stays on the outside of the hair shaft. Common appearances include:
  • Black dot: A patch of hair loss with black dots on the scalp caused by hairs that are broken off just below the surface of the skin

  • Gray patch: Areas of hair loss with dry, scaly patches on the scalp

  • Kerion: Areas of hair loss with boggy, thickened scalp and pustules caused by the immune system's exaggerated response to the fungal infection

Tinea Capitis Diagnosis

Tinea capitis is diagnosed by several methods. A Wood's lamp examination may show hairs that turn blue-green. A KOH test on the hair or scalp may show fungi under the microscope. Finally, a fungal culture of the hair or scalp may show what type of fungus is causing the infection.

Tinea Capitis Treatment

It is important to note that tinea capitis cannot be treated with topical antifungal creams. It has to be treated with oral antifungal medications, sometimes for several months. Common antifungal medications used include:
  • Griseofulvin
  • Lamisil (terbinafine)
  • Sporanox (itraconazole)
  • Diflucan (fluconazole)

Tinea Capitis Prevention

The best way to prevent a tinea capitis infection is to use common sense. Don't share combs, brushes, or hats with someone outside your family, and don't touch other children who have a rash on their scalp or animals with a rash anywhere.

Preventing a recurrent infection or preventing an infection in people in close contact with an infected child (like family members) is a little more complicated.

  • Combs, brushes, and hats of the infected person should be disinfected or thrown away.

  • Family members should be examined for similar infections.

  • Family members may want to use an antifungal shampoo like ketoconazole 2% or selenium sulfide 2.5%, which both require a prescription in the U.S. This may help prevent transmission of tinea capitis, although there is no reliable data to confirm this.

Sources:

Mounsey, A. L., & S. W. Reed. Diagnosing and treating hair loss. American Family Physician, 80.4(2009), 356-362.

Sobera, Jenny & Boni Elewski. "Fungal Infections." Dermatology, 2nd Ed. Eds. Jean Bolognia, and et. al. Mosby, 2008. 1141-3.

Habif, Thomas. "Fungal Infections." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 427-33.

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