Detailed information on tinea capitis or ringworm of the scalp

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Ringworm of the scalp
Ringworm of the scalp is a fungal infection - it has nothing to do with worms at all. Ringworm is an infectious skin condition which can occur anywhere on the body skin, but if it develops on the scalp it can cause patches of hair loss. When it occurs on the scalp the professional term for scalp ringworm is “Tinea Capitis”. It is directly caused by the fungus and is quite similar to the fungus that causes 'athletes foot'.

In United States and other regions of the world, the incidence of ringworm of the scalp is gradually increasing and tinea capitis is becoming a more and more common diagnosis in dermatology clinics.

The patches of tinea capitis are usually redder around the outside with a more normal skin tone in the center. This makes the appearance of a ring, and so the disease is called ringworm of the scalp.

Although this infectious ringworm of the scalp is common in children, it is also frequently seen in adults. Most often, children pick up the infection first and then it spreads to related adults who are in contact with the children.

Ringworm of the scalp usually begins as a small pimple that progressively expands in size, leaving scaly patches of temporary baldness. The fungus gets into the hair fibers of the affected area and these hairs become brittle and break off easily leaving a bald patch of skin. The affected areas are often itchy, red, inflamed, scaly patches that may blister and ooze.

Ring worm: The dermatophyte fungus
Ringworm of the scalp is caused by several types of fungus. The most common among them are:
  • Microsporum audouini
  • Trichophyton tonsurans
Microsporum audouini is a very common cause of ringworm of the scalp all over the world. But Trichophyton tonsurans is also increasingly found as a major cause, especially in Latin America.

Other fungi that may cause tinea capitis may include Trichophyton schoenleinii, Trichophyton megninii in Southern Europe and Africa, and Trichophyton violaceum in the Middle East. Also Microsporum gypseum can sometimes cause tinea capitis. This fungi is common in soil and may be transferred to humans by contact with infected animals. Microsporum gypseum induced ringworm is most often seen in people who work with animals such as farmers or veterinarians.

The fungal infectious agents that cause ringworm of the scalp are opportunists. The fungi are likely to enter the scalp skin through a cut or scrape. Once they get underneath the outer skin barrier they multiply and spread out in a circle.

They particularly like to locate themselves in and around growing hair follicles. This weakens the hair fiber and infected fibers can be very brittle and liable to break off.

The effects of the ringworm of the scalp can vary depending on the type of agent involved, the individual's immune response, and the type of hair they have. Some forms of ringworm of the scalp may involve significant inflammation and even scarring of the skin can occur in extreme cases. Some infections may expand very rapidly to affect the entire scalp whereas others may progress very slowly and the individual may experience scaly skin and mild hair loss for several months or even years before the diagnosis is made.

Typically, a tinea capitis infection spreads to cover a patch of scalp of up to four centimeters in diameter, but for some people ringworm of the scalp can be more extensive. In a superficial tinea capitis infection, the patchy hair loss may typically resolve in about 7 months, but again some people can have ringworm of the scalp for much longer.

The best treatments for ringworm of the scalp involve the use of antibiotics. Most commonly an antibiotic called Griseofulvin is used. Griseofulvin is very effective against fungi in hair and skin but it is not very good at treating yeast or bacterial infections. More recently, some agents like ketoconazole have been used to treat scalp ringworm. In terms of reducing skin scaling and inflammation associated with tinea capitis, medicated shampoos can be helpful. The active agents of medicated shampoos like ketaconazole, zinc pyrithione, and selenium sulfide are beneficial to help reduce scaling. However, the medicated shampoos are not strong enough to cure the ringworm so oral medications are also required.

Scalp infections and infestations like tinea capitis are still very common, even in the developed Western world. The diseases are due to fungus which are microscopic, and can easily be transmitted from one individual to another so it is very necessary to avoid the sharing of toiletries like hair brushes or towels in order to prevent scalp contamination.

Shannon Harrison and Rodney Sinclair, ”Optimal Management of Hair Loss (Alopecia) in Children”, 2003, Am J Clin Dermatol, 4 (11)

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