Tinea Capitis
A contagious fungal infection of the scalp and hair
Quick Facts
- Type: Fungal skin infection
- Location: Scalp and hair
- Most affected: Children
- Treatment: Oral antifungal medication
Overview
Tinea capitis, commonly called scalp ringworm, is a fungal infection of the scalp and the hair shafts. Despite the name, it is not caused by a worm but by fungi called dermatophytes, the same group that causes ringworm elsewhere on the body and athlete's foot. It mainly affects children and is one of the most common fungal infections in this age group.
The infection causes scaly, itchy patches on the scalp and often patchy hair loss. Because the fungus gets inside the hair shafts, tinea capitis cannot be cleared with creams alone and needs antifungal medication taken by mouth. It is contagious and spreads through direct contact and shared items such as combs and hats.
Because the fungus lives within the hair shaft, scalp ringworm behaves differently from ringworm on smooth skin and will not clear with creams alone. Recognizing it early and starting the right oral treatment helps relieve symptoms, limit spread to other children, and reduce the small risk of permanent scarring or hair loss.
Symptoms
Tinea capitis can look different from person to person but commonly causes:
- Round or patchy areas of scaling and redness on the scalp
- Hair loss in the affected patches, sometimes with hairs broken off near the skin leaving black dots
- Itching of the scalp
- Flaking that can resemble dandruff
- Swollen, tender lymph nodes in the neck
In some cases a severe, inflamed, boggy swelling called a kerion develops, which is tender and may ooze and can lead to scarring and permanent hair loss if not treated promptly. Any markedly inflamed or pus-filled scalp lesion should be seen by a doctor.
Causes
Tinea capitis is caused by dermatophyte fungi that infect the skin of the scalp and the hair. These fungi thrive in warm, moist conditions and feed on keratin, the protein in skin and hair.
The infection spreads through:
- Direct skin-to-skin contact with an infected person
- Sharing combs, brushes, hats, pillows, or towels
- Contact with infected pets, such as cats and dogs, in some cases
It spreads easily among children in households and schools.
Risk Factors
- Being a young child, especially of school age
- Close contact with an infected person or sharing personal items
- Contact with infected pets or animals
- Crowded living conditions
- Warm, humid climates
Diagnosis
Doctors diagnose tinea capitis by examining the scalp and confirming the fungus:
- Scalp examination: Recognizing scaling, hair loss, broken hairs, or a kerion.
- Microscopy and fungal culture: Taking scrapings or plucked hairs to look at under a microscope and to grow the fungus, which confirms the diagnosis and the type of fungus.
- Wood's lamp: A special light that makes some, though not all, types of the fungus glow.
Treatment
Because the fungus invades the hair shaft, treatment requires oral antifungal medication; creams alone are not enough.
- Oral antifungal medication: Such as griseofulvin or terbinafine, taken for several weeks as prescribed, which is the main treatment.
- Antifungal shampoo: Used alongside the oral medicine to reduce shedding of fungal spores and limit spread to others.
- Treating contacts: Household members may be checked and, in some cases, treated to prevent reinfection.
- Care of a kerion: A severely inflamed area may need additional treatment to reduce inflammation and prevent scarring.
Completing the full course of medication is important, as stopping early can let the infection return. Itching and scaling usually improve within the first couple of weeks, but the medicine must be continued for the full prescribed period to fully clear the fungus.
Prevention
- Avoid sharing combs, brushes, hats, towels, and pillows
- Wash and disinfect items that may be contaminated
- Have pets checked and treated if they may be the source
- Treat affected children promptly and follow guidance on when they can return to school
- Encourage good general hygiene and avoid close contact with active infections
When to See a Doctor
See a doctor if a child or adult develops scaly, itchy patches on the scalp, especially with hair loss or broken hairs, as scalp ringworm needs prescription oral antifungal treatment and will not clear with over-the-counter creams.
Seek prompt care for a markedly swollen, tender, or pus-filled area on the scalp (a kerion), spreading redness, fever, or signs of a bacterial infection, as early treatment helps prevent scarring and permanent hair loss.
Frequently Asked Questions
Why can't scalp ringworm be treated with cream alone?
The fungus infects the hair shafts as well as the surface of the scalp, and creams cannot reach inside the hair. Effective treatment requires an oral antifungal medication, often combined with an antifungal shampoo to reduce spreading the fungus to others.
Is tinea capitis contagious?
Yes. It spreads through direct contact and by sharing combs, brushes, hats, towels, and bedding, and sometimes from infected pets. Avoiding shared items and treating the infection promptly help prevent it from spreading, especially among children.
Will the hair grow back?
In most cases hair grows back after the infection is treated. However, a severely inflamed area called a kerion can cause scarring and permanent hair loss if not treated promptly, which is why early medical care is important.
How long does treatment take?
Oral antifungal medication is usually taken for several weeks, and it is important to complete the full course even if the scalp looks better, because stopping early can allow the infection to return. Your doctor will advise on the exact length of treatment.
Can adults get scalp ringworm?
Although tinea capitis is most common in children, adults can get it too, particularly through close contact with an infected child or pet. The diagnosis and oral antifungal treatment are similar in adults.
References
- Centers for Disease Control and Prevention (CDC). Ringworm.
- American Academy of Dermatology. Ringworm of the scalp.
- Mayo Clinic. Ringworm (scalp).
- MedlinePlus, U.S. National Library of Medicine. Tinea capitis.