Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Scalp ringwormbald, scaly patches on the head, mainly in children
Scalp ringworm (tinea capitis) is a fungal infection of the scalp that mainly occurs in children. Often not only the skin but also the hair roots are affected. One or more bald patches appear, sometimes with grey scaling and redness. Because the fungus reaches the hair roots, treatment with tablets is needed.
What is scalp ringworm?
Tinea capitis is the medical term for a fungal infection of the scalp. Often not only the skin but also the hair roots are affected. Fungi that affect the top layer of the skin are called dermatophytes. Scalp fungal infection mainly occurs in children. Fungi can also infect elsewhere: the trunk (ringworm), the feet (athlete's foot) and the nails (nail fungus).
How does your child get scalp ringworm?
Fungal spores are everywhere, for example in gyms, swimming pools, schools and other public spaces. Children are at greater risk of scalp fungus because of a different composition and lower production of sebum. Adults probably have a higher fatty-acid concentration in their sebum and stronger defences, so they normally no longer get scalp ringworm. The fungus is very contagious and spreads easily via combs, brushes, clothing, bedding, towels, headwear and seats. Animals such as cats, dogs and guinea pigs can also carry fungi and pass them to children.
What symptoms does scalp ringworm cause?
Scalp ringworm can cause symptoms in several ways. One or more bald patches can appear, with or without grey scaling and sometimes redness. In a more extensive form the bald patch can grow several centimetres. There can also be patches with redness, swelling, hair loss, pain and pustules.
Is scalp ringworm contagious?
Yes. Scalp ringworm is very contagious to other children. In adults it often causes no symptoms, though adults with weaker defences are at higher risk.
How is the diagnosis made?
Because scalp ringworm is common in children, the doctor usually recognises it without further tests. For more certainty, flakes or hairs from the scalp are taken for direct microscopic examination, which detects fungi quickly. A second method is culturing flakes or hairs; how long the result takes varies by method.
What treatments are there?
The fungi are usually in the hair roots too, and a local treatment with cream or shampoo does not penetrate deep enough. Treatment with tablets, capsules or a syrup is therefore needed, often for a long time, six to twelve weeks, to kill all the fungi. Tell the doctor if your child takes other medicines, because these antifungals do not combine with everything, and with liver problems they cannot always be given. The course is usually combined with an antifungal shampoo to limit spread.
Can scalp ringworm be cured?
Scalp ringworm can be treated well, but the infection can return, so it is important to follow the treatment. The bald patch often fills in again on its own if treatment succeeds. In rare cases a bald patch remains, but this is uncommon.
What can you do yourself?
Carry out the treatment properly and finish the course, even if the symptoms seem gone; fungi deep in the hair roots can otherwise return. Take hygiene measures to prevent spread to family members and classmates: do not share brushes, combs, towels, clothing or bedding, and wash textiles at at least 60 degrees. Have pets with bald or scaly patches treated by the vet, and have family members with similar symptoms treated too. Inform the school; children with scalp ringworm do not need to stay home.
Frequently asked questions about scalp ringworm
Is scalp ringworm contagious?
Yes, very, especially between children. It spreads via combs, brushes, towels, bedding and sometimes pets.
Why is a cream or shampoo not enough?
Because the fungus is in the hair roots, where a local product does not penetrate deep enough. Tablets are needed, often for six to twelve weeks.
Will the hair grow back?
Usually yes; the bald patch often fills in on its own if treatment succeeds. In rare cases a bald patch remains.
Can my child go to school?
Yes. Children with scalp ringworm do not need to stay home, but do inform the school and take good hygiene measures.
Could it come from our pet?
Yes. Cats, dogs and guinea pigs can carry the fungus. Have a pet with bald or scaly patches treated by the vet.