Tinea Capitis

Tinea capitis is a superficial fungal infection of the scalp. It is also called ringworm, but it is not caused by a worm. It can be caused by many types of fungus but is usually due to Trichophyton or Microsporum species. Most of the fungi are transmitted from other infected people but can also be transmitted from the environment or infected animals. Combs, brushes, hats, barrettes, pillows, towels, and seat backs can all transmit the fungus. This disease is most common in children and slightly more frequent in boys than girls.

Tinea capitis causes round patches of hair loss that slowly progress without treatment. There can also be itching, crusting, and scaling in these patches. Sometimes black dots are seen. This is due to hair broken off near the scalp. Some patients develop a kerion, which is a boggy, tender swelling of the scalp that can drain pus. Other symptoms associated with severe tinea capitis are fever and large, tender lymph nodes in the neck.

Sometimes, the scalp is scraped superficially to look under the microscope for fungus. This uses a special preparation with potassium hydroxide solution. The doctor may also take hair samples for culture or examine the scalp with a Wood’s lamp. A biopsy is rarely required to make this diagnosis.

The first line of treatment is with an oral antifungal medication such as Griseofulvin, for at least six to eight weeks. The dose is dependent on how much the patient weighs. Griseofulvin is best absorbed if taken with fatty foods like milk or ice cream. Be careful to follow your doctor’s specific instructions. Alternative antifungals such as itraconazole and terbinafine are sometimes used.
Antifungal shampoo such as ketoconazole shampoo is an important adjunct to oral medication. This will make the scalp less contagious so that the patient can return to school or child care. The shampoo can be purchased without a prescription. Lather up the shampoo and leave it on for ten minutes before rinsing. Use this twice a week for eight weeks. Regular shampoo can be used on other days.
Antibiotics or oral steroids may be necessary if the patient develops a kerion.

It is important for family members and close contacts to be examined for tinea capitis because it is mildly contagious.
Once the patient has started Griseofulvin and antifungal shampoo, he or she can return to school or other activities.
Large areas of hair loss may be covered by a scarf or hat. It is never necessary to shave the head or give a close haircut.
Do not use creams or other medications on the scalp without your doctor’s permission.
Please contact the office if the scalp becomes swollen, drains pus, or the infection continues to spread after two weeks of treatment.