Tinea capitis

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

Definition
Tinea capitis is an infection of the scalp by mold-like fungi called dermatophytes.

Causes, incidence, and risk factors
The body normally hosts a variety of microorganisms, including bacteria, mold-like fungi (dermatophytes) and yeast-like fungi (such as Candida). Some of these are useful to the body. Others may multiply rapidly and cause symptoms.

Tinea capitis (also called ringworm of the scalp) is a skin disorder that affects children almost exclusively. It can be persistent and contagious, almost to the point of epidemic; however, it often disappears spontaneously at puberty.

The fungi that cause tinea infections thrive in warm, moist areas. Susceptibility to tinea infection is increased by poor hygiene, prolonged wetness of the skin (such as from sweating), and minor skin or scalp injuries.

Tinea infections are contagious and may be passed by direct contact with affected individuals or by contaminated items such as combs, hats, clothing, or similar surfaces. They can be transmitted by contact with pets that carry the fungus, for instance, cats.

Symptoms

     
  • Itching of the scalp, may be slight or absent  
  • Skin (scalp) lesions that are:       o Round, scaly       o Gray or reddened (skin redness or inflammation)       o Bald-appearing patches (hair is broken off, not actually missing)       o Possibly small black dots on the scalp  
  • Occasionally localized area of swelling, raw skin, or pus-filled lesion on the scalp (kerion)

Signs and tests
The diagnosis is suspected primarily based on the appearance of the scalp. A skin lesion biopsy with microscopic examination or culture may show dermatophytes. This test is often not necessary to diagnose tinea capitis. A Wood’s lamp test may be performed to confirm the presence of a fungal scalp infection.

Treatment
The goal of treatment is control of the infection. Oral antifungal medications are required.

Keep the area clean. A medicated shampoo, such as one containing 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, may resolve spontaneously at puberty, and may recur.

Complications

     
  • Kerion: inflammatory, soggy-textured mass filled with pus and broken hairs  
  • Permanent scar formation and hair loss (alopecia) on the scalp

Calling your health care provider
Call for an appointment with your health care provider if symptoms indicate tinea capitis may be present, or if symptoms persist despite treatment.

Prevention
Good general hygiene is important in the prevention and treatment of all tinea infections. The scalp should be shampooed regularly, especially after haircuts.

Avoid contact with infected pets or individuals. Headgear, combs, and similar items should not be exchanged unless they are first thoroughly cleaned and dried.

Johns Hopkins patient information

Last revised: December 8, 2012
by Armen E. Martirosyan, M.D.

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