Tinea Capitis Treatment | Scalp Fungus (Ringworm on Scalp) | Causes, Symptoms & Prevention

A fungal infection of the scalp and hair shafts is known as tinea capitis or ringworm on the scalp. Ringworm on the scalp can have a variety of signs and symptoms, but it commonly presents as itchy, scaly, hairless patches on the scalp.

The fungus causes annular or circular patches on the skin, often with flat centers and elevated edges, giving it the term ringworm. Tinea capitis is most common in children aged 3 to 14, however, it can affect people of any age group. Adults with weak immune systems may be more vulnerable to the infection.

Ringworm on the scalp is a highly contagious infection which can get transmitted by direct contact between people or by sharing combs, towels, hats, or pillows with someone who already has tinea capitis. Some cases of scalp fungus may result in significant inflammation at the site of infection , which can lead to scarring and permanent hair loss. Tinea Capitis treatment includes oral drugs that destroy the fungus, as well as medicated shampoos that may help prevent  spread, and arrest the growth of fungus.

Ringworm on the scalp is caused by one of several mold-like fungi known as dermatophytes. Fungi damage the scalp's outer layer of skin as well as the hair shaft. A worm does not cause a ringworm. The disorder's common name refers to the infection's ring-like or annular shape of patch on the skin. 

Ringworm on the scalp is more common in those with poor hygiene, those who live in congested residences, or those who live in warm, humid conditions. People with compromised immune systems, such as those who have diabetes, AIDS, or cancer, are more susceptible to this condition.

Ringworm on the scalp is contagious and can be transmitted in a variety of ways, including:

• Object to human: Scalp fungus can be transferred by touching goods or surfaces that have been touched by an infected person or animals, such as clothing, towels, bed linens, combs, or brushes.

• One human to another: Direct skin-to-skin contact with an infected person is a common way for ringworm to spread.

• Animals to humans: Ringworm is commonly carried by dogs and cats, particularly pups and kittens. Cows, goats, pigs, and horses are among the species that can also harbor  the fungus. Children can get ringworm on the scalp via grooming or stroking a ringworm-infected animal.

Tinea capitis is characterized by little red bumps and pustules on the scalp, as well as scaling. These bumps may become more numerous with time. The rash if left untreated may further expand to involve a larger area. Following are some of the signs and symptoms of ringworm on the scalp:

• Hair breaks off at or just above the level of scalp, resulting in one or more circular patches of scaly skin with hair loss.

• Patches tend to gradually grow or expand in size.

• Clinically may present as scaly, grey, or reddish colored plaques.

• Patches with little black dots near the scalp where hair has broken off.

• Hair loss (bald patches) can occur as a result of several infections. Usually, the bald areas are dry and scalp. In bald patches, little broken-off hairs may remain scattered.

• Several painful boils (pustules) may appear on the scalp if the causative fungus is of a more pathogenic strain.

• Areas of the scalp may be tender or painful to touch.

• In most cases, the infection appears as severe dandruff on various parts of the scalp. It's possible that this gets misinterpreted for psoriasis.

• In a small percentage of instances, a more serious infection may also develop. This results in a kerion, a big 'boggy' swelling in a portion of the scalp. This can be sticky and develop severe secondary infection, and if not treated promptly, it can leave a permanent scar and result in irreversible hair loss.

• You may acquire a high temperature and the lymph nodes in your neck may enlarge if you have a severe infection, such as a kerion or pustules.

The symptoms can sometimes point to a fungal infection. Scalp ringworm, on the other hand, can be mistaken for other conditions too. For example, some cases may resemble psoriasis, severe dandruff, and bald patches and hair loss can be caused by a variety of factors, like alopecia areata, lichen planus of scalp and also  fungal infection. A dermatologist would usually send a hair sample or a scraping from the affected skin to the laboratory to confirm the diagnosis. The Tinea capitis treatment will be based on how severe the condition is. Here are some of the tests that can help in diagnosing scalp fungus: 

• If Microsporum species are present, the base of the hair shaft will light up a blue-green fluorescent band when inspected with a Wood lamp that transmits UV light. This is owing to the metabolic waste products that this species excretes.

• A visual inspection and observation of the symptoms present is the simplest  way for a doctor to diagnose scalp ringworm. Scrapings examined  in the lab are occasionally required to confirm the diagnosis, and they might be useful if repeated to ensure that the ringworm on the scalp has been treated successfully.

• There are several methods of collecting skin samples for microscopy. The best way to collect scales and hair is to pass a toothbrush over the scalp 10 times. Other procedures include scraping the scalp with a surgical blade and extracting the hair with a needle and forceps, or using cotton swabs, or moistened gauze.

• After collecting the sample, a 10 -15 percent solution of KOH (potassium hydroxide) is added to the sample slide, which is then examined under a microscope for fungal spores or hyphae. Although this procedure is quick, it only works 50% of the time in detecting fungal elements.

• Culture is the most effective method of diagnosis. To see if growth occurs, the specimen is placed in a solution that contains fungal medium. This method naturally takes longer, and the report may take upto seven to ten days.

Risks and Complications of Ringworm on the scalp

If the infection is not treated and becomes severe, there is a chance that permanent scarring and bald areas will remain on the scalp even after therapy. The fungal infection can sometimes penetrate deep into the scalp, resulting in a kerion, a painful, thick, lumpy mass of fungal infection. This can appear as a cluster of pus filled bumps and be misdiagnosed as a bacterial infection when, in fact, it is tinea capitis. The hair falls out or can be easily pulled out instead of breaking. Kerion is caused by an extremely aggressive immune response to the fungus, and it can result in permanent scarring and hair loss.

Antibiotics are ineffective against kerion; instead, antifungal tablets such as terbinafine or griseofulvin are required. A 'secondary' bacterial skin infection might result over the scaly patches caused by the fungal infection on rare occasions. If this happens, you may require antibiotic treatment. The following are risk factors for the fungal infection of scalp:

• Age factor: Ringworm on the scalp is more prevalent among the toddlers and school-aged youngsters.

• Contact with other children: Ringworm outbreaks are widespread in schools and child care facilities, where the infection spreads easily through close physical contact.

• Exposure to animals: It is possible for a pet, such as a cat or a dog, to be infected without showing any symptoms. Children can contract the disease by stroking or touching the animal.

Most other types of ringworm can be treated with topical antifungal drugs prescribed by a doctor. Tinea capitis, on the other hand, frequently necessitates the use of prescription-strength oral antifungal drugs for 1–3 months.

Disclaimer: For personalized medical advice, please see your dermatologist. With any inquiries about a medical condition, always seek the opinion of a certified healthcare expert. Consult a dermatologist for a comprehensive evaluation before using any medicines or over-the-counter treatments. 

Tinea capitis treatment: OTC

Antifungal creams and shampoos: Antifungal lotions and shampoos are ineffective in completely removing the infection. Fungi enter into the hair shafts where lotions and shampoos can't. As a result, they are incapable of providing sustained relief or complete cure.. Fungi and fungal spores are, nevertheless, removed from the hairs and scalp surface. 

In addition to oral antifungal medicine, an antifungal shampoo or cream, such as selenium sulfide shampoo, ketoconazole shampoo, or terbinafine cream, maybe recommended twice-weekly for a few weeks. This is to swiftly eliminate any surface fungi and reduce the risk of the fungus spreading to other youngsters.

Tinea capitis treatment: Prescription: 

To get rid of ringworm on the scalp, you'll need to take an oral antifungal drug. They show great improvement in the majority of the patients..

• Griseofulvin (Fulvicin, Grisactin): For many years, Griseofulvin (Fulvicin, Grisactin) has been the medicine of choice due to its safety. This drug is also available in a liquid version, making it easier for youngsters to take. For six to eight weeks, the normal dose is to take the drug every day with a fatty meal to improve absorption. The treatment should be continued until the ringworm is gone and your dermatologist tells you to stop. A scalp culture may be performed on occasion to ensure that no fungi are present. Headaches and gastrointestinal disturbances are some of the  side effects of griseofulvin. For healthy children with ringworm on the scalp, routine liver and other blood tests are not required.

• Itraconazole (Sporanox), Fluconazole (Diflucan), or Terbinafine (Lamisil) are alternatives to Griseofulvin for those who are allergic or intolerant to it. 

• For inflammatory ringworm on the scalp: Prednisone can be used for symptom alleviation during the first 10-15 days of treatment, but no data has demonstrated that it increases the cure rate.

Ringworm is caused by dermatophytes, which are prevalent and contagious. This makes prevention challenging. Tell your children about the dangers of sharing hairbrushes and other personal objects because they are especially vulnerable. People may be able to avoid reinfection by doing the following:

• Make sure to cleanse your child's scalp on a regular basis, especially after haircuts. 

• To prevent the transmission of infection, make sure your youngster washes his or her hands frequently. Maintain cleanliness in common or shared places, particularly in schools, child care facilities, gyms, and locker rooms.

• Be cautious of the possibility of contracting ringworm from sick people or pets. Inform your children about ringworm, including symptoms to look out for and how to avoid becoming infected.

• Educate your child not to share their clothes, towels, hairbrushes, or other personal items, or to borrow them from other kids.

• Stay away from infected animals. The infection generally appears as a patch of skin with no fur. However, you may not detect any symptoms of the condition in other circumstances. Request a ringworm examination for your pets and domesticated animals from your veterinarian.

• Keep an eye on the heads of the kid(s) in the house. Seek medical help if you see any signs of scaling or localized patchy hair loss.

Tinea Capitis treatment: Recovery

Ringworm takes a long time to heal. It can take up to a month to notice any changes. Be patient and take all medications as prescribed.

In 4 to 6 weeks, your doctor may want to check on you or your child to see if the infection has cleared up. Ringworm is tough to get rid of, and it is possible to contract it more than once. Recurrences, on the other hand, frequently end after puberty. Long-term consequences could include bald patches or scars.

To conclude, a variety of scalp disorders can have a similar appearance. Some people may have fungi in their hair even if they have no symptoms. These individuals are known as 'carriers.' As a result, members of the affected person's home and other close acquaintances may be urged to take a simple test.

Frequent shampooing, hand cleaning, and other basic hygiene routines can all assist to prevent scalp fungus. Having said that, if your child experiences hair loss, scaling or itching on the scalp, or any other unusual aspect of the scalp, consult a dermatologist. It's advised to have a proper diagnosis and treatment as soon as possible. 

Our dermatologists at SkyMD are highly qualified and can be reached without any hassle. For a consultation, download our app, fill out the required information, and you'll be ready to schedule your appointment by video call or chat, whatever suits you.

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