Scalp Ringworm (Tinea Capitis): What You Need to Know

Although Tenia capitatis is treatable and very easy to diagnose, but can cause some serious issue to a person. Here is a case of 10 years old boy, suffering from Scalp ringworm,

The patient had an erythematous, boggy patch of alopecia involving more than 50% of the scalp and clinically consistent with a kerion (Figure 1), an inflammatory subtype characterized by tender, erythematous, boggy plaques with thick crusting, often with pustules and purulent drainage.1,2 The patient had no cervical lymphadenopathy. A potassium hydroxide scraping test and Wood lamp examination were negative. A punch biopsy found hyphae and spores within the hair shaft. The fungal culture grew Trichophyton tonsurans. The patient was treated with griseofulvin, 20 to 25 mg per kg per day, and ketoconazole 2% shampoo applied to the scalp for five minutes, rinsed daily for two weeks, and then rinsed twice a week for six weeks. The kerion resolved after eight weeks, leaving patchy alopecia with permanent scarring. Tinea capitis can mimic seborrheic dermatitis, atopic dermatitis, contact dermatitis, scalp psoriasis, sebopsoriasis, and discoid lupus. It can develop into a kerion.1,2 It is caused by advanced disease and an exaggerated immune response, predominantly found in children five to 10 years of age.3 More than 20 misdiagnosed cases have been reported, usually as bacterial abscesses or dissecting cellulitis.4 Delayed treatment increases risk of permanent hair loss.

Scalp ringworm, medically known as tinea capitis, is a common fungal infection that affects the scalp and hair shafts. Despite its name, scalp ringworm isn’t caused by worms but by a group of fungi called dermatophytes. This infection primarily affects children, though adults can also be affected. In this blog post, we'll explore the causes, symptoms, treatment options, and prevention strategies for scalp ringworm, providing you with a comprehensive understanding of this condition.

 What is Scalp Ringworm (Tinea Capitis)?

Scalp ringworm is a fungal infection that leads to itchy, scaly patches on the scalp. These patches may cause hair loss and can spread to other parts of the body or even other individuals if not treated promptly. The condition is contagious and can be passed through direct contact with an infected person, animal, or object.

Causes of Scalp Ringworm

Tinea capitis is caused by dermatophytes, a group of fungi that thrive in warm, moist environments. The most common fungi responsible for this infection belong to the genera Trichophyton and Microsporum. The infection can spread in several ways:

• Person-to-Person Contact: The most common mode of transmission is direct contact with an infected individual. This can occur through skin-to-skin contact or sharing personal items like combs, towels, or hats.

  

• Animal-to-Person Contact: Pets, particularly cats and dogs, can carry the fungus and transmit it to humans. Farm animals like cows and horses can also be carriers.

• Object-to-Person Contact: The fungus can survive on surfaces like hairbrushes, clothing, or bedding, leading to infection when someone comes into contact with these contaminated items.

• Environment-to-Person Contact: Fungi can live in soil, and although it’s less common, infection can occur after contact with contaminated soil.

Symptoms of Scalp Ringworm

The symptoms of scalp ringworm can vary depending on the severity of the infection and the type of fungus involved. Some common symptoms include:

• 1. Scaly, Itchy Patches: The most characteristic sign of scalp ringworm is the presence of scaly, red, or grayish patches on the scalp. These patches are often circular, hence the name "ringworm."

• 2. Hair Loss: Infected areas may experience hair loss, either in small patches or across larger areas of the scalp. The hair may break off near the scalp, leaving short stubs that resemble black dots.

• 3. Kerion: In more severe cases, a kerion may form. A kerion is an inflamed, swollen area on the scalp that may ooze pus and be tender to the touch. It is usually accompanied by significant hair loss.

• 4. Brittle Hair: Hair affected by tinea capitis often becomes brittle and may break easily, leading to noticeable hair thinning or bald spots.

• 5. Swollen Lymph Nodes: Some individuals may experience swollen lymph nodes in the neck as the body responds to the fungal infection.

• 6. Fever: Although rare, some individuals may develop a low-grade fever in response to the infection.

Diagnosis of Scalp Ringworm

If you suspect that you or your child has scalp ringworm, it’s important to seek medical attention promptly. A healthcare provider will typically diagnose tinea capitis through:

• 1. Physical Examination: A visual examination of the scalp is often enough to suspect ringworm, especially if there are characteristic circular patches and hair loss.

• 2. Wood’s Lamp Examination: A Wood’s lamp is a special type of ultraviolet light that can be used to detect certain types of fungi on the scalp. Under the light, affected areas may fluoresce, appearing bright green or blue.

• 3. Microscopic Examination and Culture: To confirm the diagnosis, a healthcare provider may take a sample of the affected hair or skin and examine it under a microscope. A culture may also be performed to identify the specific type of fungus causing the infection.

 Treatment of Scalp Ringworm

Treating scalp ringworm requires a combination of antifungal medications, good hygiene practices, and patience, as it can take several weeks for the infection to fully resolve.

• 1. Oral Antifungal Medications: The primary treatment for tinea capitis is oral antifungal medications. Commonly prescribed medications include griseofulvin and terbinafine. These medications are typically taken for 4-8 weeks, depending on the severity of the infection. It’s important to complete the entire course of treatment, even if symptoms improve before the medication is finished, to prevent recurrence.

• 2. Topical Antifungal Shampoos: While oral medications are the mainstay of treatment, antifungal shampoos can be used as an adjunct therapy. Shampoos containing ketoconazole or selenium sulfide can help reduce the spread of the infection and decrease the risk of transmission to others. These shampoos are usually used 2-3 times per week.

• 3. Treatment of Kerion: If a kerion is present, additional treatment may be required. This may include the use of corticosteroids to reduce inflammation and prevent scarring. In some cases, incision and drainage of the kerion may be necessary.

• 4. Managing Itching and Discomfort: Over-the-counter antihistamines or corticosteroid creams may be recommended to manage itching and discomfort associated with the infection.

Prevention of Scalp Ringworm

Preventing scalp ringworm involves a combination of good hygiene practices and awareness. Here are some tips to reduce the risk of infection:

• 1. Personal Hygiene: Regular hair washing with antifungal or medicated shampoos can help prevent fungal infections, especially in children who are more susceptible. Teach children the importance of not sharing personal items like hats, combs, or hairbrushes.

• 2. Avoid Sharing Personal Items: Encourage everyone in the household to use their own combs, brushes, towels, and hats. Wash these items regularly to prevent contamination.

• 3. Pet Care: Keep a close eye on pets, especially if they have patches of missing fur or seem to be scratching more than usual. Take them to the veterinarian for regular check-ups, and ensure they are treated promptly if they show signs of a fungal infection.

• 4. Clean Environment: Regularly clean and disinfect surfaces that may harbor fungi, especially in communal areas like bathrooms and locker rooms. Wash bedding, towels, and clothing in hot water and dry them thoroughly.

• 5. Avoid Contact with Infected Individuals: If someone in your household has scalp ringworm, avoid direct contact with their scalp and discourage them from sharing personal items until the infection has cleared.

• 6. Early Detection and Treatment: Early diagnosis and treatment are crucial in preventing the spread of scalp ringworm. If you notice symptoms, seek medical attention promptly to minimize the risk of transmission.

 Complications of Scalp Ringworm

While scalp ringworm is generally treatable, complications can arise if the infection is not addressed promptly. Some potential complications include:

• 1. Scarring and Permanent Hair Loss: In severe cases, especially when a kerion is present, scarring of the scalp can occur, leading to permanent hair loss in the affected areas.

• 2. Secondary Bacterial Infections: Scratching the itchy patches can introduce bacteria into the skin, leading to secondary infections that may require additional treatment with antibiotics.

• 3. Spread to Other Areas: The fungus can spread to other parts of the body, leading to additional infections such as tinea corporis (ringworm of the body), tinea barbae (ringworm of the beard area), or onychomycosis (fungal infection of the nails).

• 4. Social and Emotional Impact: Visible hair loss and scaly patches can be distressing, particularly for children and teenagers. This may lead to social stigma, low self-esteem, and emotional distress. Support from family, friends, and healthcare providers is important to help individuals cope with the psychological impact of the infection.

When to See a Doctor

If you or your child develops symptoms of scalp ringworm, it’s important to see a healthcare provider for diagnosis and treatment. Early intervention can prevent the spread of the infection and reduce the risk of complications. Additionally, if the infection does not improve after several weeks of treatment or if symptoms worsen, follow-up care may be necessary.

 Conclusion

Scalp ringworm, or tinea capitis, is a common and contagious fungal infection that can cause significant discomfort and distress. However, with prompt diagnosis and appropriate treatment, most cases can be effectively managed, and the infection can be cleared within a few weeks. Preventive measures, such as good personal hygiene, avoiding the sharing of personal items, and monitoring pets for signs of infection, can help reduce the risk of contracting or spreading scalp ringworm. If you suspect you or your child has scalp ringworm, don’t hesitate to seek medical advice to ensure a quick and complete recovery.

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Be healthy.Thank you