Tinea capitis, also known as ringworm, is a fungal infection of the scalp. It is the most common fungal infection in children under 12 years of age. Ringworm is caused by several kinds of fungus, some of which may also infect dogs and cats.

Symptoms

Common signs include:

• Hair loss, scaling, redness and crusting on the scalp
• Itchy scalp
• Lymph nodes in the back of the neck may increase in size

Occasionally, a more widespread, itchy rash with many small bumps appearing on the face, arms, legs and less often the chest, abdomen and back may develop. This is NOT an allergic reaction but is a sign that the immune system is reacting to the infection. It is usually treated with antihistamines and topical corticosteroid medications.

Sometimes, children with ringworm develop a severe reaction to the infection in their scalp (called a kerion). The child will have swelling, pain and pus in the scalp; fever may also develop. If your child develops these symptoms, they should be seen by a primary care provider right away.

Your doctor may want to take a swab culture from your child’s scalp to confirm the diagnosis.

Treatments

Ringworm must be treated with an oral antibiotic for at least eight weeks. After eight weeks of treatment, a follow-up appointment with your doctor is suggested. At that time, he or she will decide if your child needs to keep taking the medicine.

Griseofulvin is the most common antibiotic used to treat ringworm. For it to work properly, you must give it to your child with whole milk or fatty food, such as ice cream. Your doctor may also decide to use another antibiotic instead, such as Terbinafine (Lamisil). It is very important that you follow the medication instructions exactly as prescribed.

• Your child, as well as all other family members who live at home, will need to shampoo two times a week with a medicated shampoo. You may be asked to continue to use the shampoo on your child even after they finishes taking the prescribed oral antibiotic. This reduces the chance that your child will become re-infected. Sometimes, use of these shampoos can temporarily cause the hair to turn green. Ketoconazole shampoo may also be used by prescription.
• Your child should have their own comb and brush. They should not share hats, pillows or hair accessories with other people. Clean combs, brushes, pillowcases and hats weekly with soap and hot water to decrease the risk of re-infection, which is common.
• If your child develops a kerion, an oral antibiotic may also be prescribed. Scarring is common after the kerion resolves.

Referral to a Specialist

Ringworm can be managed by your primary care provider as long as you follow the treatment plan exactly as prescribed.

Referral to a specialist is needed only if your child:

• Is infected with an unusual fungus
• Fails to respond to appropriate treatment with oral antibiotics and a medicated shampoo for at least two courses of treatment