Ringworm of the scalp

Ringworm is a fungus that infects the hairs and causes them to break, and is not caused by a worm.  Over 90% of cases are due to Trichophyton tonsurans, which is transmitted from other children who are infected.  Combs, brushes, hats, barrettes, pillows and towels can transmit the fungus.  Less than10% of cases are caused by infected animals.  Ringworm is not dangerous, but without treatment, hairloss may spread.  Some children develop kerion, which is a boggy, tender swelling of the scalp, and can drain pus.  Kerions are allergic reactions to the fungus and may require additional treatment with an oral steroid.  Hair regrowth is normal, but may take 6 to 12 months.

The symptoms of ringworm include:

  • Round patches of hair loss that slowly increase in size
  • A black-dot, stubbled appearance of the scalp from hair shafts that are broken off at the surface
  • The scalp may have scaling or itching
  • This diagnosis must be confirmed by positive microscope test or fungus culture

Home Treatment 

Oral Antifungal Medicine. The main treatment for ringworm of the scalp is griseofulvin taken orally for 8 weeks.  It is best absorbed if taken with fatty foods such as milk or ice cream.  Antifungal creams or ointments are not effective in killing the fungus that causes ringworm.

Antifungal Shampoo. The use of antifungal shampoo makes your child less contagious and allows him to return to day care or school.  Purchase a nonprescription shampoo containing selenium sulfide.  Lather up and leave it on for 10 minutes before rinsing.  Use the antifungal shampoo twice a week for the next 8 weeks.  On other days use a regular shampoo.

Contagiousness. Ringworm is mildly contagious.  Once your child has been started on griseofulvin and had one washing with the special shampoo, he can return to school.  Caution your child not to share combs or hats with others.  Check the scalps of your child’s siblings

Ringworm of the Scalp and close friends. If you see any scaling or patches of hair loss, refer that child to their doctor’s office.

Common Mistakes. It is psychologically harmful and unnecessary to shave the hair, give a close haircut, or to force your child to wear a protective skull cap.

Follow-up Appointments. In 4 weeks, return for lab tests of your child’s hair to be certain we have achieved a cure.  If not, the griseofulvin will need to be given for longer than 8 weeks.

Call our office during regular hours if . . . 

  • The ringworm looks infected with pus or a yellow crust.
  • The scalp is swollen or boggy.
  • The ringworm continues to spread after 2 weeks of treatment.
  • You have other questions or concerns.