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Tinea Capitis

Medically reviewed by C. Fookes, BPharm Last updated on Apr 22, 2019.

Tinea capitis is a superficial fungal infection of the skin of the scalp, eyebrows, and eyelashes that is more commonly known as ringworm. However, it is not caused by a worm, but a dermatophyte fungus that is easily spread through person-to-person contact or by sharing combs, towels, hats, or pillows. The fungus may also be spread by house pets, such as cats and dogs, and farm animals. This means household pets should be treated for ringworm even if they do not show any signs of infection.

Colloquially, the condition is called ringworm because the fungus causes circular marks on the skin, often with a raised border and flat center. The fungus attacks hair shafts and follicles, making the hair in the area affected fragile and broken, leaving small areas of baldness (alopecia). There may also be small black dots on the scalp.

Tinea capitis is most common in people who are immunocompromised and children, particularly those under the age of 10, but it can infect any age. The prevalence in the U.S. is increasing.

What Causes Tinea Capitis?

Dermatophyte fungi thrive on dead tissue especially that which is warm and moist. A minor injury of the scalp will increase your risk of infection.

There at least eight different types of dermatophytes that can cause tinea capitis but the two main species are Trichophyton fungi and Microsporum fungi. Trichophyton infections are more common in Central America, United States, and parts of Western Europe whereas  Microsporum infections predominate in South America, Asia-Pacific, Southern and Central Europe, Africa and the Middle East.

What are the Symptoms of Tinea Capitis?

Symptoms can vary depending on the type of infecting dermatophyte, the type of hair invasion, and the individual’s immune system response. In some people, infection may only be realized after careful inspection reveals a few, broken-off hairs with minimal scaling.

Others may develop a severe, painful, inflammatory mass called a kerion. This is generally confined to a specific area, although occasionally a large part of the scalp may be infected. There is substantial hair loss in the area and any hairs that remain are easily pulled out. Follicles discharge pus and swollen lymph nodes may also be present. The pus is usually an inflammatory response to the fungus itself rather than a secondary bacterial infection, although occasionally bacteria may be present.

Itching may or may not be present but in all cases the characteristic symptom is partial hair loss with some degree of inflammation and flaking which may resemble dandruff. There may be several or many patches of infection. Symptoms in most people fall into one of three main categories: grey patch (scaling with patchy hair loss from hair shafts breaking off above the surface, leaving short stubs), black dot (characterized by hair shafts breaking off at the scalp leaving black dots), or diffuse alopecia.

How is Tinea Capitis Diagnosed?

The diagnosis is suspected primarily based on the appearance of the scalp. A skin lesion biopsy with microscopic examination or culture may show dermatophytes. This test is often not necessary to diagnose tinea capitis. A Wood's lamp test may be performed to confirm the presence of a fungal scalp infection.

Newer diagnostic tests involve molecular techniques using different forms of polymerase chain reaction (PCR) screening which results in faster and more accurate diagnosis. Examples include multiplex ligation-dependent probe amplification (MLPA) and rolling circle amplification (RCA).

Call your doctor if:

Call for an appointment with your health care provider if you have symptoms of tinea capitis. Home care remedies do not effectively treat tinea capitis. Longer-term , prescription oral medications are usually needed.

Treatment Options

Oral antifungals are needed to effectively treat tinea capitis. Terbinafine, itraconazole, and fluconazole are the preferred agents for tinea capitis.

Griseofulvin is also effective and may be used in resource-poor settings where other antifungals are not available.

Although topical antifungals may improve the appearance of tinea capitis and reduce itching, this is usually only temporary and relapse rates of infection are high. They are not recommended.

Oral Antifungal Treatments for Tinea Capitis

Drug Oral Formulations* Patient Information
Terbinafine (Lamisil)

 

  • Generics available

  • Off-label use

  • Lamisil: 250 mg tablet; 125 mg and 187.5 mg granule packet (for pediatric dosing)

     

  • Generics: 250 mg tablet
  • Avoid exposure to sunlight or tanning beds.; use sunscreen.

     

  • May cause stomach upset, diarrhea; take capsules with a full meal.
  • Report rash, dark urine, stomach pain, or yellowing of eyes or skin to doctor immediately.
  • Report changes in smell or taste to doctor.
  • Granules can be sprinkled on soft, non-acidic food like pudding or mashed potatoes; swallow without chewing.
Itraconazole (Onmel, Sporanox)

 

    • Generics available
    • Off-label use
  • 100 mg capsule; 200 mg tablet

     

  • 10 mg/mL oral solution
  • Subject to multiple, possibly serious drug interactions; consult with pharmacist if new prescription, over-the-counter, or herbal meds.

     

  • Use reliable contraception during and for two months after therapy.
  • Discuss breastfeeding with doctor.
  • May cause stomach upset, diarrhea, fatigue.
  • Report rash, dark urine, stomach pain, or yellowing of eyes or skin to doctor immediately.
  • Take capsules, tablets with full meal.
Fluconazole (Diflucan)

 

    • Generics available
    • Off-label use
  • 50, 100, 150, 200 mg tablet

     

  • 10, 40, 50, 200 mg/mL oral powder for suspension
  • May cause stomach upset or headache.

     

  • Report skin rash to doctor immediately.

*See Dosage (https://www.drugs.com/dosage/) for additional information.

Prevention of tinea capitis

Good general hygiene can help prevent all types of tinea infections. Regular scalp shampooing, along with cleaning of combs and hairbrushes is important. Headgear, combs, brushes, and similar items should not be shared and contact should be avoided with infected pets or farm animals. There have been reports of children sharing sleeping mats at daycare contracting tinea capitis, so these should be disinfected regularly.

Other family members and pets should be examined and treated, if necessary.

See Also

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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