What Is Tinea Capitis?

Tinea capitis is a fungal skin infection that affects the scalp and involves both skin and hair. It is also known as ringworm of the scalp. The most common symptoms of tinea capitis are hair loss, dry and scaly areas of skin, inflamed skin, redness, and itch.

Fungi called dermatophytes cause tinea capitis. The condition is highly contagious and is transmitted from person to person. It is most common in children ages 3 to 7 but can also affect older children and adults, especially those with weakened immune systems.

The article covers the signs and symptoms of tinea capitis, its causes, treatment, and more.

Tinea Capitis Symptoms

Tinea capitis is a type of ringworm, a common skin infection caused by a fungus. It is called ringworm because it causes a distinct circular rash. 

The medical terms for ringworm are “tinea” and “dermatophytosis.” Other names for ringworm are specific to the location of the infection, such as tinea capitis (ringworm of the scalp) or tinea barbae (beard ringworm). 

Tinea capitis may affect all or part of the scalp. While rare, it might also affect the eyebrows and eyelashes. The most common symptom is itchy, swollen, red patches on the scalp. 

Additional symptoms of tinea capitis might include:

• Scaly, dry skin
• Flaking on the scalp that looks like dandruff
• Alopecia (hair loss) typically appearing as fine scaling with single or multiple areas of circular alopecia, slight hair loss with dandruff-like scaling, or fine-scale patches with broken-off hairs at the scalp surface
• Low-grade fever
• Swollen lymph nodes
  

Tinea capitis can sometimes cause swollen patches called kerion. The patches may have blisters that ooze pus and crust over. If this occurs, tinea capitis can lead to scarring and permanent hair loss. 

Causes

Tinea capitis is most often caused by Trichophyton tonsurans and Microsporum canis fungi. It can spread very quickly. 

You or your child can acquire tinea capitis from contact with a person or animal with the infection or from contaminated soil. You can also acquire ringworm from objects or surfaces that hide the fungus.

Risk factors for tinea capitis include:

• Living in close quarters with other people 
• Playing contact sports 
• Having a minor scalp injury 
• Excessive sweating 
• Sharing personal care items, hairbrushes, towels, and bedding
• Sharing sports equipment, such as helmets
• Not bathing or washing hair often enough 
• Having a weakened immune system
  

Diagnosis

A healthcare provider can typically diagnose tinea capitis by examining your scalp. They may use a special light test called a Wood’s lamp test to light up the scalp and look for signs of infection.

The healthcare provider may take a skin or hair sample to look for the presence of fungi. That is usually done with a KOH prep test, which involves scraping an affected skin or hair area onto a slide. Potassium hydroxide (KOH) is added to the sample, which causes it to break apart and makes the fungus easier to see under a microscope.

If the KOH test doesn’t confirm a diagnosis, a healthcare provider might order a fungal culture test that allows fungi to grow and be identified in the lab. This test is more accurate than the KOH stain. But it might be weeks before the results are reported.

Conditions That Mimic Tinea Capitis

Tinea capitis is sometimes mistaken for other conditions that cause similar symptoms. This includes scalp psoriasis and seborrheic dermatitis. 

Scalp Psoriasis 

Scalp psoriasis can cause red, flaky patches on the scalp. Like tinea capitis, it might cause temporary hair loss. 

Psoriasis is a problem with the immune system overreacting and causing skin cells to grow quicker than the body can shed them, leading to a buildup on the skin’s surface. Also, psoriasis cannot be spread to others.

Scalp psoriasis is typically diagnosed by examining the scalp, running blood tests, and performing a skin biopsy (examining a sample of tissue microscopically in the lab).

Seborrheic Dermatitis

Seborrheic dermatitis can cause red, flaky rashes on the scalp. It can affect people of all ages and is known as cradle cap in babies.

While it might cause similar symptoms as ringworm, it is not a fungal infection, nor is it contagious. Instead, it is caused by excess oil in the skin or an immune system problem. Seborrheic dermatitis is diagnosed by examining the scalp and with a skin biopsy. 

Treatment

Antifungal medicines are used to treat tinea capitis. Topical treatments (applied to the affected area) are usually a first-line therapy. If these do not work, or if the ringworm is widespread, a healthcare provider will prescribe oral medicines. Treatments must be taken for at least a few weeks before the fungal infection fully clears. 

Topical treatments for tinea capitis include antifungal creams and medicated shampoos. 

Most topical creams for treating scalp ringworm are available over the counter (OTC) and applied directly to the scalp. Examples of OTC antifungal creams include Desenex (miconazole), Lotrimin (clotrimazole), and Tinactin (tolnaftate).

A healthcare provider might prescribe a steroid cream to manage inflammation if the ringworm has led to kerion. The steroid might help to reduce scarring and prevent permanent hair loss.

A medicated shampoo will stop the fungus from spreading and affecting more areas of the scalp. It is typically combined with oral medicine to help eliminate the fungus.

Oral medicines used to treat tinea capitis include Grifulvin V (griseofulvin microsize), Diflucan (fluconazole), and Lamisil (terbinafine). These medicines can be prescribed to children and adults. 

If you suspect a pet has ringworm, they also need a diagnosis and treatment plan. Maintain regular wellness visits for all your pets and ask the veterinarian to check for ringworm. 

Prognosis 

Fungal infections can be hard to clear up. Therefore, using antifungal medicines as prescribed and helping your child use creams or shampoos is essential. 

Antifungal treatments should be taken consistently. You should complete the treatment course even if your skin appears to be cleared up. 

To avoid reinfection or spread, check everyone in the household for infection, including pets. All household members might need treatment to prevent transmitting the infection back and forth. 

Antifungal creams and shampoos are available over the counter, or a healthcare provider can prescribe these if needed. You will also want to wash bedding, pillows, and towels and disinfect shared hair items like combs and hairbrushes. 

Prevention

Fungi that cause ringworm are prevalent and highly contagious. This can make prevention hard, especially in children. Even so, reducing the risk of getting or spreading the infection might be possible. 

Regular shampooing, handwashing, and not sharing personal care items might help to reduce the spread. Teach children how to practice good hygiene and about the risks of sharing hairbrushes and other personal care items. 

Summary 

Tinea capitis (scalp ringworm) is a fungal infection of the scalp and involves both the skin and hair. Common symptoms include hair loss, dry, scaly patches, and inflamed skin. 

Tinea capitis is most commonly caused by Trichophyton tonsurans and Microsporum canis fungi. The infection can be transmitted easily and quickly. You might acquire ringworm after contact with a person or animal (usually a pet) with the infection, contaminated soil, or from contact with contaminated objects or surfaces. 

Ringworm of the scalp is treated with antifungal medicines, including creams, shampoos, and oral medicines. It is crucial to stay on your treatment plan until your healthcare provider tells you the infection has cleared or you can stop treatment. 

Fungal infections can be challenging to prevent, but reducing your risk and not spreading the infection to others is possible. Regular shampooing, handwashing, not sharing personal care items, and pet wellness visits might reduce the spread of ringworm.