Ringworm (Scalp)

Ringworm of the scalp (tinea captis) usually infects the scalp and hair shafts. Signs and symptoms of ringworm of the scalp may vary depending on the person and severity.

Ringworm of the scalp is a highly contagious disease commonly seen in toddlers and school children.

Young children and older adults can be a carrier of this infection and could easily pass it on to others. This condition largely occurs in areas where people live in poor conditions or in overcrowded houses with low levels of hygiene.

The ringworm infection of the scalp is not the same as that found on other parts of the body. It is caused by other set of fungal organisms and hence requires a different line of treatment.

The disease is largely known to affect people who have compromised immunity levels either due to age or other conditions like diabetes, AIDS, and so on.

Treatment of ringworm of the scalp includes oral medications (anti-fungal) to kill the fungi.

There are also special shampoos available which can decrease the spread of infection.

In some cases, the inflammatory response evoked by the pathogen is so severe that scarring and permanent hair loss may occur.

Facts about ringworm

• Ringworm is a very commonly seen infection caused by fungi, and not worms as the name would suggest. These infections normally affect the external part of the body or the skin.
• Ringworm is known as tinea. It gets its name based on the part of the body that is affected by the ringworm.
• There are various forms of ringworm infections that are caused by tinea, but they attack various parts of the body like the genitals, foot, and so on. These different forms of the infection also cause different types of symptoms.
• Ringworm often causes an infection that has a scaly appearance with a crusty top. It appears as red bumps, causing a scaly, crusted rash that may appear as round, red patches on the skin. Other symptoms and signs of ringworm include patches of hair loss or scaling on the scalp, itching, and blister-like lesions.
• Ringworm of the scalp is an infection that is extremely common among schoolchildren as the infection becomes easy to spread among them.
• In case of children, ringworm of the scalp is very common in the age group of 4 to 9.
• The infection easily spreads through the sharing of personal belongings such as combs, brushes, hats, and so on.
• The treatment of the infection largely involves certain pills and medicated shampoos which can help in killing the fungi and preventing it from spreading further.
• Once treated, there is always a risk of relapse of the infection.
• Ringworm is contagious and can be passed from person to person.

Symptoms depend on each unique case and the intensity with which the fungi attacks the person. However there are some common sings that help in early identification of the disease.

These signs include redness of the affected area, crusting, dandruff, and scaling. People could also face unusual itching in the infected area of the scalp. Scalp ringworm is often an underlying cause that results in hair loss. The infection could also cause an enlargement of the lymph nodes in the neck region, also resulting in high or low grade fever in some children. The signs and symptoms depends on how their immune systems are functioning and responding to the infection.

Black dot ringworm: Caused by the organism Trichophyton, this is one of the most commonly found fungi resulting in the black dot ringworm infection. This organism affects the inner scalp around the hair shaft. The hair could become highly susceptible to breaking as it becomes brittle due to the infection. The hair that is brittle breaks off easily. There is a part of the hair which is left behind within the hair follicle that looks like a black dot. One of the most common symptoms from this infection is hair loss.

Grey patch ringworm: This occurs when the infection is caused by the organism Microsporum. This was one of the most commonly found fungi in the US in 1940s and 1950s. However, this is now a rare form of scalp ringworm. The infection caused by microsporum fungi results in grey patches. This infection is still prevalent in Southern and Eastern Europe. When this infection occurs, the lesions slowly develop from small bumps that are red in color and found around the shaft of the hair. The lesions slowly progress and grow outwards resulting in red, scaly rings. These lesion patches are dry but without any inflammation. Along with hair loss, the hair in the patches affected by the infection looks grey in color and can appear dull and lifeless. The hairs are highly susceptible to breakage. People also face severe itching due to the infection.

Inflammatory ringworm: Fungi that is normally found in animals or in the soil commonly triggers the inflammatory form of the ringworm scalp infection. The areas affected by the infection start developing small formations that contain small pustules or kerion formations. Kerions are slightly raised masses of skin that contain pus and have broken hair on top. This form of the infection could result in high or low grade fevers, pain around the scalp, and severe itching and tenderness along with enlargement of the lymph nodes. Inflammatory ringworm also triggers permanent scarring along with severe hair loss. Often oral or topical steroids are prescribed for treating this form of scalp infection depending upon how severe the infection looks. There is no evidence of permanent hair loss resulting from this infection.

The treatment of ringworm scalp infection often requires anti-fungal and other severe medications to be administered to completely remove the infection causing fungi from the body.  These medications could also have some other side effects particularly when consumed by small children. Some of the common reactions resulting from the anti fungal medications include widespread "id" reaction. This term is used to describe symptoms like itching, and raised bumps that start on the face and slowly move towards the backside. This side effect is essentially an autoimmune response that is triggered by the immune system of the body and not really an allergic reaction to the medication.

Even with these side effects, the medicine must be completed to its full course and should not be altered or discontinued suddenly. Speak to your doctor if you notice these symptoms in your child or yourself.

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What Does Ringworm Look Like?

Warning

Potentially graphic imagery ahead

Causes of ringworm of the scalp can be mold-like fungi called dermatophytes.

The fungi attack the outer layer of scalp and shafts of hair causing a scaly scalp and loss of hair in specific regions.

Ringworm is not caused by worms but by fungi. It is referred to as ringworm due to its ring-like appearance on the skin.

Ringworm of the scalp is highly contagious and can spread in the following ways of contact:

• Human to human: Ringworm is contagious from person to person by skin-to-skin contact.
• Object to human: Ringworm can spread from objects which were touched or previously used by an infected person such as clothes, towels and combs.
• Animal to human: One can get infected by touching animals including dogs, cats, horses, and cows. You or your child might get infected with ringworm while grooming or petting an animal with ring worm.

Your doctor may make a diagnosis of ringworm of the scalp or other infections based on:

• Physical examination
• Lab diagnosis
• Chemical tests
• Microscopic examination (if needed)

During physical examination the doctor might examine the infected area visually and may check skin dryness.

A scrape of the scaly part of the scalp will be taken, and then it will be sent to the lab for identification of the specimen.

Potassium hydroxide, a chemical which removes all the skin cells from the sample and leaves fungi untouched, is used during microscopic examination for accurate results.

In addition, your doctor may ask you some questions to decide if additional testing is required.

The final diagnosis will be established only after receiving test results.

Oral anti-fungal drugs can be administered to treat ringworm of the scalp.

Some of the common anti-fungal drugs are griseofulvin and terbinafine. Depending on the severity of the disease, the course of the treatment can be six weeks or more.

Your doctor may also advise you to use anti-fungal shampoo that may help to reduce fungal spores and prevent spreading of infection from scalp to other parts of the body.

Ringworm of the scalp is difficult to prevent because the fungi that causes ringworm is highly contagious and spreads easily from person to person.

The following steps can be taken to prevent the spreading of ringworm:

• Educate yourself and others. Spreading awareness about ringworm is a major step towards preventing the disease. It is particularly important to teach children about ringworm infections and how it spreads since it is extremely easy for them to get it from school.
• Shampoo regularly. Infections like ringworm of the scalp can be caused due to improper care of hair. As dust and dirt can easily accumulate, it is essential to keep hair neat and clean to stay away from such infections. It is very important to shampoo hair well at least twice a week to maintain proper hygiene.
• Keep clean. Make sure that you wash hands regularly after working outside and before eating food. Taking regular baths can also decrease the risk of being infected with fungi. Avoid animals that have a patch of fur missing because it is usually a sign of ringworm.
• Avoid sharing personal items. Children must be taught not to use other's things such as clothes, towels, hair brushes, and other personal items. Every child must have their own things.  

Alternative remedies for ringworm of the scalp are:

• Garlic extract (ajoene is a natural compound extracted from garlic)
• Vinegar 
• Tea tree oil, whose germicidal and fungicidal properties are of great importance
• Aloe Vera has bactericidal and fungicidal effects 

Other remedies include coconut oil, salt and vinegar, vegetable juice, and papaya juice.

Lifestyle changes are directed towards preventing relapse.

Fungal infections are usually chronic (long-term) infections, so it is essential to complete the course of medication prescribed by the doctor.

Shampoo with fungicidal activity must also be used in order to prevent spreading of disease from the scalp to other parts of body and proper hygienic measures must be taken to prevent complications. 

Risk factors of ringworm of the scalp are:

• Age: Ringworm of the scalp is most common in toddlers and children.
• Educate children: Outbreaks of ringworm among children are common because of lack of awareness. Low immunity also plays an important role in contracting the infection.
• Exposure to pets: As pets can be a potential carrier of ringworm, it is of great importance to keep track of your pets' health.

Complications:

• Ringworms of the scalp sometimes in severe cases causes kerion - a severe painful inflammation of the scalp. Kerion appears as soft, raised swelling filled with pus and when the pus escapes, it covers the scalp with a yellow crust. Kerion may cause reaction with fungi and cause scars with permanent hair loss.