Ringworm of the scalp (tinea capitis) is a fungal infection of the scalp and hair shafts. The signs and symptoms of ringworm of the scalp may vary, but it usually appears as itchy, scaly, bald patches on the head.

Ringworm of the scalp, a highly contagious infection, is most common in toddlers and school-age children.

Treatment for ringworm of the scalp includes medications taken by mouth to kill the fungi, as well as medicated shampoos that may lessen the spread of infection.

Some cases of ringworm of the scalp result in severe inflammation at the site of infection that may cause scarring or permanent hair loss.

The signs and symptoms of ringworm of the scalp include:

• One or more round patches of scaly skin where the hair has broken off at or just above the scalp
• Patches that slowly expand or enlarge
• Scaly, gray or reddened areas
• Patches that have small black dots where the hair has broken off at the scalp
• Brittle or fragile hair that easily pulls out
• Tender or painful areas on the scalp<

When to see a doctor

Several conditions affecting the scalp may have a similar appearance. See your child's doctor if your child has any hair loss, scaling or itchiness of the scalp, or other unusual appearance of the scalp. It's important to get an accurate diagnosis and prompt, appropriate treatment.

Ringworm of the scalp is caused by one of several varieties of mold-like fungi called dermatophytes. The fungi attack the outer layer of skin on the scalp and the hair shaft.

Ringworm isn't caused by a worm. The common name for the disorder refers to the ring-like or circular appearance of the infection on the skin.

Methods of transmission

Ringworm is contagious and can spread in the following ways:

• Human to human. Ringworm often spreads through direct skin-to-skin contact with an infected person.
• Object to human. Ringworm can spread through contact with objects or surfaces that an infected person or animal has touched, such as clothing, towels, bed linens, combs or brushes.
• Animal to human. Dogs and cats, especially puppies and kittens, are often carriers of ringworm. Other animals that are often carriers of the fungi include cows, goats, pigs and horses. Your child can contract ringworm by grooming or petting an animal with ringworm.

Other types of ringworm

The fungi that cause ringworm of the scalp can cause other infections on the body. These infections are generally classified by the part of the body affected. They include:

• Ringworm of the body (tinea corporis). This form causes a red, scaly ring or circle of rash on the top layer of your skin.
• Athlete's foot (tinea pedis). This form of ringworm affects the moist areas between your toes and sometimes on the foot itself.
• Jock itch (tinea cruris). This form affects your genitals, inner upper thighs and buttocks.

Risk factors for ringworm of the scalp include:

• Age. Ringworm of the scalp is most common in toddlers and school-age children.
• Exposure to other children. Outbreaks of ringworm are common in schools and child care centers where the infection easily spreads through close physical contact.
• Exposure to pets. A pet, such as a cat or dog, can have the infection without showing any signs. Children can get the infection by touching or petting the animal.

In some cases, ringworm of the scalp causes kerion — a severe, painful inflammation of the scalp. Kerion appears as soft, raised swellings that drain pus and cause thick, yellow crusting on the scalp.

Instead of breaking, the hair falls out or can be easily pulled out. Kerion may be caused by an overly vigorous reaction to the fungus and can lead to permanent scars and hair loss.

Ringworm is difficult to prevent because the fungi that cause it are common and highly contagious. You can help reduce the risk of ringworm by taking these steps:

• Educate yourself and others. Be aware of the risk of ringworm from infected persons or pets. Tell your children about ringworm, what to watch for and how to avoid the infection.
• Shampoo regularly. Be sure to wash your child's scalp regularly, especially after haircuts.
• Keep clean. Be sure your child washes his or her hands often to avoid the spread of infection. Keep common or shared areas clean, especially in schools, child care centers, gyms and locker rooms.
• Avoid infected animals. The infection often looks like a patch of skin where fur is missing. In some cases, though, you may not notice any signs of the disease. Ask your veterinarian to check your pets and domesticated animals for ringworm.
• Don't share personal items. Teach your children not to let others use their clothing, towels, hairbrushes or other personal items, or to borrow such items from other children.

Your doctor can often make a diagnosis of ringworm or another condition affecting the scalp based on a visual examination of the scalp and your answers to questions.

He or she may take a sample or hair or skin for examination under a microscope. This test may reveal the presence of fungi and help confirm a diagnosis.

Antifungal medications that can be taken by mouth are used to treat ringworm of the scalp. The medications most commonly prescribed include griseofulvin (Gris-Peg) and terbinafine (Lamisil). Your child might need to take one of these medications for six weeks or more.

Your doctor might recommend that you also wash your child's hair with a prescription-strength medicated shampoo. This may help remove fungus spores and prevent the spread of the infection to other people or to other areas of your child's scalp or body.

If your child has a condition affecting his or her scalp, you'll likely start by seeing your family doctor or child's pediatrician. You may be referred to a skin specialist (dermatologist).

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you first notice symptoms?
• What did the scalp look like when symptoms first appeared?
• Is the rash painful or itchy?
• What, if anything, makes the condition better or worse?
• Do you have any pets at home, or has your child been around farm animals?
• Does another family member or a pet already have ringworm?
• Do you know of any cases of ringworm in your child's school?

Questions for your doctor

Questions you might be prepared to ask your doctor include:

• If this is ringworm, what can we do to prevent the infection from spreading?
• What hair care routines do you recommend while the condition heals?
• When can my child return to school?
• Should I schedule a follow-up appointment for my child?
• Should I make appointments for my other children even if they aren't showing signs or symptoms right now?