Clinical Reference Systems: Pediatric Advisor 10.0
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Ringworm of the Scalp (Tinea Capitis)
Description
- round patches of hair loss that slowly increase in size
- a black-dot, stubbled appearance within the bald spots of
the scalp from hair shafts that are broken off at the
surface (Note: The dots are blond in blond-haired
children.)
- sometimes scaling on the scalp
- mild itching of the scalp
- sometimes ringworm on the face (a ring-shaped, pink rash
with a raised border and a clear center).
Children who get ringworm of the scalp are usually 2 to
10 years old. A positive microscope test (KOH prep) or
fungus culture is needed to confirm the diagnosis.
Cause
Over 90% of the cases of ringworm of the scalp are caused by
Trichophyton tonsurans, a fungus that infects the hairs and
causes them to break. A worm does not cause ringworm.
Ringworm is usually transmitted by other children who are
infected. Combs, brushes, hats, barrettes, seat backs,
pillows, and bath towels can transmit the fungus.
Less than 10% of cases are caused by a fungus from infected
animals, such as kittens and puppies. The animal-type of
fungus causes more scalp irritation, redness, and scaling.
If your child has the animal-type of fungus, he is not
contagious to other children.
Expected Course
Ringworm of the scalp is not dangerous. Without treatment,
however, hair loss and scaling may spread to other parts of
the scalp.
Some children develop a kerion, which is a boggy (soft),
tender swelling of the scalp that can drain pus. Kerions
are an allergic reaction to the fungus. They get better when
you use antifungal medicine.
Hair normally grows back 6 to 12 months after treatment. In
the meantime, your child can wear a hat or scarf to hide the
bald areas.
RELATED TOPICS
Hair Loss
Treatment
- Oral antifungal medicine
The main treatment for ringworm of the scalp is
griseofulvin taken orally for 8 weeks. Give the dosage
prescribed by your physician. Griseofulvin comes in a
125-mg-per-5-ml suspension and 250-mg capsules. This
medicine is best absorbed by the stomach if your child
takes it with fatty foods such as milk or ice cream.
Shake the bottle well each time before you use it.
Antifungal creams or ointments are not an effective
treatment because they can't reach the fungus deep in
the hair roots.
- Antifungal shampoo
If you wash your child's hair with an antifungal
shampoo, he will be less contagious and able to return
sooner to child care or school. The shampoo kills
ringworm spores. Your child's shampoo is
_______________________. Lather and leave it on your
child's scalp for 10 minutes before rinsing. Use the
antifungal shampoo twice a week for 1 month. On other
days, use a regular shampoo. Avoid putting any oil or
ointment on the scalp because it increases contagiousness
of the ringworm.
- Contagiousness
Ringworm is mildly contagious. In the days before
antifungal medications, about 5% of children in contact
with an infected child at school became infected.
However, 25% of siblings (close contacts) acquired
ringworm. After your child has started taking
griseofulvin and washed his hair once with antifungal
shampoo, he is not contagious and can return to school.
Warn your child not to share combs, brushes, hats, etc.
Siblings with an itchy scalp or scalp rash should be
examined. Pets with a skin rash or sores should be
examined by a vet.
- Common mistakes
It is not necessary and it can be psychologically
harmful to shave your child's hair, give him a close
haircut, or force him to wear a protective skull cap.
- Follow-up appointment
In 6 weeks return to your physician's office to be
certain the ringworm has been cured. If the ringworm is
not yet cured, your child will need to take the
griseofulvin for longer than 8 weeks.
Call Your Child's Physician During Office Hours if:
- The area with ringworm looks infected with pus or a
yellow crust.
- The ringworm continues to spread after 2 weeks of
treatment.
- You have other questions or concerns.
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