Scalp Ringworm (Tinea Capitis)

ByDenise M. Aaron, MD, Dartmouth Geisel School of Medicine
Reviewed/Revised Sept 2023
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Scalp ringworm is a dermatophyte (fungal) infection of the scalp.

  • Symptoms of tinea capitis include a dry patch of scale, a patch of hair loss, or both on the scalp.

  • Doctors base the diagnosis on an examination of the scalp and samples taken from the scalp.

  • Treatment includes antifungal medications taken by mouth for all people and, for children, antifungal cream.

(See also Overview of Fungal Skin Infections.)

Tinea capitis is a type of dermatophytosis. In the United States, tinea capitis is primarily caused by the fungus Trichophyton tonsurans.

Tinea capitis is highly contagious and is common among children.

Symptoms of Scalp Ringworm

Tinea capitis may cause a dry scaly rash that may be somewhat itchy, a patch of hair loss (alopecia), or both. One type of fungus causes "black dot" ringworm, in which hair shafts break at the scalp surface. Another type of fungus causes "gray patch" ringworm, in which hair shafts break above the scalp surface, leaving short stubs. Tinea capitis may sometimes cause flaking that resembles dandruff.

Kerion

Kerion
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This photo shows a kerion, which is a large, painful, inflamed, swollen patch on the scalp that sometimes oozes pus and can be crusty. It is caused by a severe reaction to a dermatophyte infection.
Image courtesy of www.doctorfungus.org © 2005.

A dermatophyte infection occasionally causes a kerion, which is a large, painful, inflamed, swollen patch on the scalp that sometimes oozes pus. A kerion may have blisters and crusting and can look like an abscess (a pocket of pus).

A kerion is caused by an immune system reaction to the fungus and may result in scarring hair loss.

Diagnosis of Scalp Ringworm

  • A doctor's examination of the skin

  • Examination of plucked hairs or scale from the scalp

  • Sometimes a Wood light examination and sometimes culture

Tinea capitis is diagnosed by its appearance and the results of an examination of a sample of plucked hairs or of hairs and scale from the scalp. Doctors examine the samples under a microscope.

Sometimes a type of ultraviolet light (called a Wood light) is shined on the scalp to distinguish the type of fungus.

Doctors may also do a culture (the process of growing an organism in a laboratory for identification) of the samples or of material taken from a kerion.

Treatment of Scalp Ringworm

  • In children and adults, antifungal medications taken by mouth

  • In children, antifungal cream and selenium sulfide shampoo

  • In adults, sometimes selenium sulfide shampoo

  • Sometimes prednisone

In children,

Some Antifungal Medications Applied to the Skin (Topical Medications).)

In adults,

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