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Scalp Ringworm (Tinea Capitis)

By

Denise M. Aaron

, MD, Dartmouth-Hitchcock Medical Center

Last full review/revision Feb 2020| Content last modified Feb 2020
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Topic Resources

Scalp ringworm is a dermatophyte (fungal) infection of the scalp.

  • Symptoms of tinea capitis include a dry patch of scale, a patch of hair loss, or both on the scalp.

  • Doctors base the diagnosis on an examination of the scalp and samples taken from the scalp.

  • Treatment includes antifungal drugs taken by mouth for all people and, for children, antifungal cream.

Tinea capitis is a type of dermatophytosis. In the United States, tinea capitis is primarily caused by Trichophyton.

Tinea capitis is highly contagious and is common among children.

Symptoms

Tinea capitis may cause a dry scaly rash that may be somewhat itchy, a patch of hair loss (alopecia), or both. One type of fungus causes "black dot" ringworm, in which hair shafts break at the scalp surface. Another type of fungus causes "gray patch" ringworm, in which hair shafts break above the surface, leaving short stubs. Tinea capitis may sometimes cause flaking that resembles dandruff.

Kerion

A dermatophyte infection occasionally causes a kerion, which is a large, painful, inflamed, swollen patch on the scalp that sometimes oozes pus. A kerion may have blisters and crusting and can look like an abscess (a pocket of pus). A kerion is caused by an immune system reaction to the fungus and may result in scarring hair loss.

Diagnosis

  • A doctor's examination of the skin

  • Examination of plucked hairs or scale from the scalp

  • Sometimes a Wood light examination and sometimes culture

Tinea capitis is diagnosed by its appearance and the results of an examination of a sample of plucked hairs or of hairs and scale from the scalp. Doctors examine the samples under a microscope.

Sometimes a type of ultraviolet light (called a Wood light) is shined on the scalp to distinguish the type of fungus.

Doctors may also do a culture (the process of growing an organism in a laboratory for identification) of the samples or of material taken from a kerion.

Treatment

  • In children and adults, antifungal drugs taken by mouth

  • In children, antifungal cream and selenium sulfide shampoo

  • In adults, sometimes selenium sulfide shampoo

  • Sometimes prednisone

In children, treatment of tinea capitis involves an antifungal drug called terbinafine taken by mouth for 4 weeks. Griseofulvin is an alternative drug for children.

An antifungal cream can be applied to the scalp to prevent spread, especially to other children, until the tinea capitis is cured. Prescription-strength selenium sulfide shampoo should also be used at least twice a week. Children may attend school during treatment. (See also table Some Antifungal Drugs Applied to the Skin (Topical Drugs).)

In adults, tinea capitis treatment is with the antifungal drug terbinafine or itraconazole taken by mouth. How long treatment is needed depends on the drug used. Selenium sulfide shampoo is also sometimes used in adults.

For severely inflamed areas and for a kerion, doctors may prescribe a short course of a corticosteroid such as prednisone taken by mouth to lessen symptoms and perhaps reduce the chance of scarring.

Drugs Mentioned In This Article

Generic Name Select Brand Names
GRIFULVIN V
SPORANOX
LAMISIL
RAYOS
Selenium
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