Scalp ringworm (tinea capitis): signs and treatment

Despite its name, ringworm has nothing to do with worms. It is a common fungal infection ¹. When it affects the scalp it is called tinea capitis, and it involves both the skin and the hair, causing scaly patches, itch and hair loss ². Unlike ringworm on the body, scalp ringworm usually needs prescription treatment.

Who gets it?

Tinea capitis mainly affects children before puberty, with cases peaking between the ages of 3 and 7 ². Adults can get it too, especially those with a weakened immune system ². A 2024 review estimated that 3% to 11% of cases worldwide occur in adults, and that adults living in crowded conditions, close to animals, or in a household with an affected child are at greatest risk ³.

DermNet lists these risk factors ²:

• Contact with animals, especially cats and kittens
• Crowded households
• Warm, humid environments
• Contact sports

Malaysia's climate and the many stray and pet cats make it worth knowing about. DermNet notes that in Asia the most common cause is *Microsporum canis*, a fungus that comes from cats ².

How it spreads

Scalp ringworm is contagious ². It can be passed on through close contact with ¹:

• An infected person or animal
• Infected objects such as combs, towels and bedsheets
• Less commonly, infected soil

Fungal spores can survive on hairbrushes, hats, towels, bedding, sofas and toys for months ². Some people carry the fungus without symptoms and can still spread it ².

Signs to look for

• A rash that may be red, or darker than the surrounding skin on brown and black skin. It may be scaly, dry, swollen or itchy ¹
• Patchy hair loss ¹
• Patches where hairs have broken off at the surface, leaving black dots ²
• Grey, scaly patches with hair loss ²
• Sometimes diffuse scale that looks like ordinary dandruff, with little or no hair loss ²

On the scalp, the rash may not look like the classic ring seen on the body ¹.

Kerion: the severe form

Some people develop a kerion, a strong inflammatory reaction to the fungus. It forms a painful, red, boggy swelling with hair loss and pus spots, and is usually caused by a species caught from animals ². A kerion can be mistaken for a bacterial abscess. It can leave scarring hair loss ², so it needs prompt medical attention.

Why creams are not enough

For ringworm on the body, a pharmacist can often recommend an antifungal cream, gel or spray ¹. The scalp is different. The NHS advises seeing a doctor if you have ringworm on your scalp, because you will usually need prescription antifungal tablets and shampoo ¹.

DermNet explains why: the fungus grows down into the hair follicle and hair shaft, where creams cannot reach. Tinea capitis always needs at least 4 weeks of medicine taken by mouth ². The 2024 review also states that oral antifungal therapy is the mainstay and that topical treatment alone is not recommended ³.

Treatment

A doctor may confirm the diagnosis by examining hairs or scale under a microscope or sending them for fungal culture ³. Treatment usually includes:

• Oral antifungal medicine for several weeks. Options include terbinafine, griseofulvin, itraconazole and fluconazole; the choice depends on the fungus and the patient ^{2 3}
• Antifungal shampoo, such as ketoconazole or selenium sulfide, to reduce the spread of spores ²

Complete the full course, even if the scalp looks better. The NHS stresses using antifungal medicine for the right amount of time, even after the rash has gone ¹.

Stopping it from spreading

• Start treatment as soon as possible ¹
• Check the whole household. Everyone should be screened and treated at the same time if affected ²
• Do not share combs, towels, hats, pillows or bedsheets ^{1 2}
• Clean brushes, hats and pillows, and wash towels and bedsheets regularly ^{1 2}
• Take pets to the vet if they have patches of missing fur ¹
• Do not scratch, which can spread it to other parts of the body ¹

Children can go back to school or nursery once they have started treatment. Let their teachers know ¹.

Will the hair grow back?

For the common, non-inflammatory types, the outlook is excellent with early, appropriate treatment ². The 2024 review also describes an excellent prognosis in adults with prompt treatment, but warns that delayed diagnosis or inadequate treatment can lead to scarring hair loss ³. This is why early treatment matters.

Ringworm or something else?

Scalp ringworm can look like dandruff, seborrhoeic dermatitis, psoriasis or alopecia areata. If a child has scaly patches with hair loss, do not assume it is dandruff. See dandruff treatment, alopecia areata and itchy scalp.

When to see a doctor

• Any scaly patch with hair loss, especially in a child
• A painful, swollen or pus-filled patch on the scalp
• Ringworm in someone with a weakened immune system, such as from chemotherapy, steroids or diabetes ¹

The bottom line

Scalp ringworm is a contagious fungal infection, most common in young children. It needs prescription antifungal tablets for several weeks, plus a medicated shampoo. Treat early, check the household and pets, and do not share combs or towels.

Frequently asked questions

Is scalp ringworm caused by worms?

No. Ringworm is a fungal infection, not a worm ¹.

Can I treat scalp ringworm with cream?

Usually not. Scalp ringworm needs prescription antifungal tablets and shampoo ^{1 2}.

Can my child go to school?

Yes, once treatment has started. Let the teachers know ¹.

Will the hair grow back?

In most cases yes, with early treatment. Severe or untreated infection can cause scarring hair loss ^{2 3}.

Educational content. Not medical advice.