Tinea capitis

Answer 1

Definition

Tinea capitis is a fungal infection of the scalp.

Alternative Names

Fungal infection - scalp; Infection - fungal - scalp; Tinea of the scalp; Ringworm - scalp

Causes, incidence, and risk factors

Tinea capitis (also called ringworm of the scalp) is caused by by mold-like fungi called dermatophytes. It usually affects children and disappears at puberty. However, it can occur at any age.

The fungi that cause tinea infections thrive in warm, moist areas. You have an increased risk for tinea infection if you have:

• Minor skin or scalp injuries
• Poor hygiene
• Wet skin for a long time (such as from sweating)

Tinea infections are contagious. You can catch tinea capitis if you come into direct contact with someone who has the condition, or if you touch contaminated items such as combs, hats, or clothing. The infection can also be spread by pets, particularly cats.

Symptoms

Symptoms include:

• Areas that appear bald, due to hair that has broken off
• Itching of the scalp
• Pus-filled sores (lesions) on the scalp (kerions)
• Round, scaly lesions on the scalp that may be red or swollen (inflamed)
• Small black dots on the scalp

Signs and tests

The appearance of the scalp will make the health care provider suspect tinea capitis.

Tests may include:

• Skin lesion biopsy with microscopic examination or culture
• Wood's lamptest to confirm a fungal scalp infection

Treatment

Anti-fungal medications, taken by mouth, are used to treat the infection. Griseofulvin, terbinafine, and itraconazole are often used to treat this condition.

Keep the area clean. A medicated shampoo, such as one containing ketoconazole or selenium sulfide, may reduce the spread of infection. Other family members and pets should be examined and treated, if necessary.

Expectations (prognosis)

Tinea capitis may be extremely persistent, and it may return after treatment. In many cases it gets better on its own when the person reaches puberty.

Complications

• Hair loss
• Permanent scars
• Pus-filled sores (kerions)

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of tinea capitis. Home care remedies do not effectively treat tinea capitis.

Prevention

Good general hygiene is important to prevent and treat tinea infections. Shampoo the scalp regularly, especially after haircuts.

Avoid contact with infected pets or people. Do not exchange headgear, combs, and similar items unless they are first thoroughly cleaned and dried.

References

Andrews MD, Burns M. Common tinea infections in children. Am Fam Physician. 2008;77:1415-1420.

Answer 2

Definition

Tinea capitis is a fungal infection of the scalp. It is also called ringworm of the scalp.

Alternative Names

Fungal infection - scalp; Infection - fungal - scalp; Tinea of the scalp; Ringworm - scalp

Causes, incidence, and risk factors

Fungi are a type of germ that can live on the dead tissue of the hair, nails, and outer skin layers. The body normally hosts a variety of fungi. Tinea capitis is caused by by mold-like fungi called dermatophytes.

The fungi that cause tinea infections do well in warm, moist areas. A tinea infection is more likely if you have:

• Minor skin or scalp injuries
• Poor hygiene
• Wet skin for a long time (such as from sweating)

Tinea capitis or ringworm can spread easily to others. It most often affects children and goes away at puberty. However, it can occur at any age.

Tinea infections are contagious. You can catch tinea capitis if you come into direct contact with an area of ringworm on someone else's body, or if you touch items such as combs, hats, or clothing that have been used by someone with ringworm. The infection can also be spread by pets, particularly cats.

Symptoms

Tinea capitis may involve only parts of the scalp, or all of it. Areas that are infected appear bald with small black dots, due to hair that has broken off.

Round, scaly areas of skin that can be red or swollen (inflamed) may be found, as well as pus-filled sores called kerions.

You may have a low-grade fever of around 100 - 101 A°F or swollen lymph nodes in the neck.

There is usually itching of the scalp.

Signs and tests

The appearance of the scalp will make the health care provider suspect tinea capitis. A special lamp called a Wood's lamp test can help diagnose a fungal scalp infection.

The health care provider may swab the area and send it for a culture. However it may take up to 3 weeks to get these results.

Rarely, a skin biopsy of the scalp will be done.

Treatment

The health care provider will prescribe a special medicine you take by mouth to treat ringworm in the scalp.

• Griseofulvin, terbinafine, and itraconazole are used to treat this condition
• You take the medicine for 4 - 8 weeks

Keep the area clean. A medicated shampoo, such as one that contains ketoconazole or selenium sulfide, may slow or stop the spread of infection through the air. However, the shampoo alone cannot get rid of the ringworm.

Other family members and pets should be examined and treated, if necessary.

• Other children in the home may want to use the shampoo 2 - 3 times a week for around 6 weeks.
• Adults only need to wash with the shampoo if they have signs of tinea capitis or ringworm.

Once the shampoo has been started:

• Wash towels in warm, soapy water and dry each time they are used by someone who is infected
• Soak combs and brushes for 1 hour a day in a mixture of one-half bleach and one-half water. Do this for 3 days.

No one in the home should share combs, hairbrushes, hats, towels, pillowcases, or helmets with other people.

Expectations (prognosis)

Tinea capitis may be hard to get rid of, and it may return after treatment. In many cases it gets better on its own when the person reaches puberty.

Complications

• Hair loss
• Permanent scars
• Pus-filled sores (kerions)

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of tinea capitis. Home care remedies do not effectively treat tinea capitis.

References

Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2009:pp 491-523.

Hay RJ. Dermatophytosis and other superficial mycoses. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier;2009:chap 267.

Reviewed By

Review Date: 10/04/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.