Diseases & Conditions

Ringworm (scalp)

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 if your child has dark hair
• Brittle or fragile hair that easily pulls out
• Tender or painful areas on the scalp

Ringworm of the scalp is persistent and contagious if not treated. It spreads easily through person-to-person contact or through contact with pets and shared objects.

When to see a doctor
If you suspect your child has ringworm of the scalp, see your doctor. A prescription medication is needed to cure the infection.

Your doctor will determine if your child has ringworm or another skin disorder, such as seborrheic dermatitis or psoriasis. He or she will ask about possible exposure to contaminated areas or contact with people or animals with ringworm.

Your doctor may take skin scrapings or samples of a few hairs plucked from the infected area and examine them under a microscope. If a sample shows fungi, treatment includes an antifungal medication. If the test is negative but your doctor still suspects ringworm, a sample may be sent to a lab for further testing. Your doctor may also order tests if your child's condition doesn't respond to treatment.

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.

Medications approved for treating ringworm of the scalp include:

• Griseofulvin (Grifulvin V, Gris-Peg), which is taken by mouth as a liquid or tablet
• Terbinafine hydrochloride (Lamisil), an oral granule medication that can be sprinkled on food

Your child may take one of these medications for up to six weeks or more. Medications you apply directly to the head aren't as effective because they're less able to penetrate the scalp and hair.

After starting the medication, you may not notice any changes in your child's condition right away. Your child still needs to continue taking the medication as directed by your doctor, however.

Your doctor may recommend that you wash your child's hair with a medicated shampoo that contains selenium sulfide (Selsun, others). This may kill the ringworm spores and prevent the spread of the infection to other people or to other areas of your child's scalp or body.

For best use:

• Lather your child's hair with the medicated shampoo. Let the shampoo sit on your child's scalp for five minutes before rinsing.
• Use the medicated shampoo two to three times a week for about a month, or as otherwise directed by your doctor. Use a milder, nonmedicated shampoo on the other days.

Have your child wear a hat or scarf if he or she is self-conscious about the bald patches. You don't need to shave the scalp.