Conditions & Diseases: Skin Diseases

Ringworm of the Scalp

Introduction: Ringworm of the scalp is an infection of the scalp by mold-like fungi called dermatophytes. Also called Tinea Capitis, ringworm is not a worm at all. It get's it's name from the appearance it leaves on the skin. Tinea is the medical name for a group of fungus caused skin infections which include athlete's foot (tinea pedis), jock itch (tinea cruris), nail infections (tinea unguium) and ringworm of the body (tinea corporis).

Ringworm of the scalp is a common skin disorder in children and affects them almost exclusively, but it can appear occasionally in adults. Tinea capitis is contagious and can be spread to other children. Tinea capitis is a leading cause of hair loss in children with 50 percent of cases occuring as a direct result of scalp ringworm.

Other symptoms, which are more rare but do occur, include:

• "Black dot" ringworm is a type of ringworm caused by the organism Trichophyton. This organism attacks the hair follicle and causes it break off at the surface of the scalp, leaving the "base" behind which resembles a black dot. This remaining hair follicle may scab or become pus filled and resemble a pimple.

• The lymph nodes on the back of the neck may become inflammed.

• In rare cases, scalp ringworms can result in kerion which is characterized by large, tender, swollen red, bald areas that ooze fluid.

Causes: Dermatophytes (the fungi behind most tinea infections) live naturally on the skin and can be found in humans, household pets, farm animals and soil. When the fungi multiply and spread, this can cause an infection called dermatophytosis. Dermatophytosis of the scalp is tinea capitis or scalp ringworm.

According to HairLossLibrary.com, "The fungi that cause tinea capitis infections thrive in warm, moist areas. Children with poor hygiene, minor skin and scalp injuries are more susceptible to tinea infection."

Excessive sweating of the scalp coupled with poor hygiene or infrequent hair washing create the right environment for dermatophytes to live. The spores of these mold-like fungi may then enter the scalp through scratches or other minor skin traumas. Once inside the skin, dermatophytes can "...invade and digest the tissue’s keratin (a type of protein) as the organisms grow." (3)

Tinea capitis fungal spores can be transmitted from person to person, or person to objects such as: hats, combs, unwashed clothing and bedding, and other items to include barber or hairstylist tools. In some cases, pets like dogs and cats can spread the spores to humans as well as farm animals.

Medical Tests & Diagnosis: Doctors usually make a diagnosis of ringworm of the scalp based on a visual inspection of the symptoms and microscopic examination of hair and scalp scrapings. The most iron clad diagnosis is made with a culture, where extracted fungi are allowed to feed and grow in a process that takes 7 to 10 days.

Treatment: Treatment for ringworm of the scalp is based on both topical and oral medicines. Topical antifungal creams or anti-dandruff shampoo are prescribed to clean the surface of the scalp from spores and fungi which can reduce the chance of spreading the infection to others. However, topical treatments cannot get inside the skin or into the hair follicles where the fungi lives. Therefore, oral antifungal medication must be prescribed and used for as long as the symptoms are present.

The most common antifungal oral medication prescribed for ringworm of the scalp is Griseofulvin, a fungicidal antibiotic, which comes in liquid or pill form and is taken twice a day. Griseofulvin (brand names Fulvicin, Grifulvin) has to be taken with fatty foods (such as milk, ice cream, etc.,) which aid it's absorption from the digestive tract.

Griseofulvin is not indicated for women who are or may become pregnant or for men who may father a child. Since adults rarely get ringworm of the scalp, this is usually not a problem. Allergic reactions to this medication are rare, but do happen.

When a patient is not able to take griseofulvin or is non-responsive, other fungicidal antibiotics may be prescribed to include: Sporanox, Diflucan or Lamisil.

Oral fungicidal antibiotics will have to be taken regularly for 4 to 10 weeks until the condition is completely eliminated as proven by a culture sample. In stubborn cases of tinea capitis, this treatment could last months. Special care should be taken to avoid spreading the fungal spores to others.

Article by Jason Morrow,
OmniMedicalSearch.com

Sources:
(1). MedlinePlus Medical Encyclopedia, Ringworm, June 2005
(2). HairLossLibrary.com, Hair Loss Diseases in Children & Adults, 2006
(3) eMedicineHealth.com, Ringworm on the Scalp, Tuan Dang Nguyen, MD et al, October 2005
(4) Patient.co.uk, Scalp Ringworm, January 2006
(5) University of Utah Health Sciences Center, Scalp Fungus Infection, Ilona Frieden, MD, 1998