Tinea Infections

Introduction
Signs and Symptoms
Causes
Risk Factors
Screening and Diagnosis
Treatment
Prevention

Ringworm of the scalp is one of several forms of ringworm, a type of fungal infection that affects the skin, nails and scalp. Ringworm of the scalp is most common in toddlers and school-age children and causes red, itchy, bald-looking patches on the scalp.

Also called tinea capitis, ringworm of the scalp is closely related to other skin conditions with similar names. "Tinea" is a type of fungus, and "capitis" is the Latin word for "head." Other common tinea infections include:

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

Although unsightly, ringworm usually isn't serious, but it can be persistent and difficult to treat. Ringworm treatment includes antifungal medication and medicated shampoo. Ringworm can be passed on to others if not treated.

Ringworm of the scalp usually appears as one or more round patches of scaly skin where the hair has broken off at or just above the scalp. These patches slowly expand and may be tender or painful.

The patches on the scalp may also:

• Appear gray or reddened
• Have small black dots if your child has dark hair
• Have brittle or fragile hair that easily pulls out

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.

The signs and symptoms of ringworm include:

• A circle of rash on your skin that's red and inflamed around the edge and healthy looking in the middle
• Slightly raised expanding rings of red, scaly skin on your trunk or face
• A round, flat patch of itchy skin

More than one patch of ringworm may appear on your skin, and patches or red rings of rash may overlap. You can have tinea infection without having the common red ring of ringworm.

The signs and symptoms of athlete's foot can be numerous, although you probably won't have all of them:

• Itching, stinging and burning between your toes, especially the last two toes
• Itching, stinging and burning on the soles of your feet
• Itchy blisters
• Cracking and peeling skin, especially between your toes and on the soles of your feet
• Excessive dryness of the skin on the bottoms or sides of the feet
• Nails that are thick, crumbly, ragged, discolored or pulling away from the nail bed

Fungal infections, such as ringworm, are caused by microorganisms that become parasites on the body. These mold-like fungi (dermatophytes) attack the outer layer of skin on the scalp and invade the hair shaft, causing it to break.

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, cats, ferrets, rabbits, goats, pigs and horses can spread ringworm to humans. Your child can contract ringworm by grooming or petting an animal with ringworm.
• Soil to human. In rare cases, ringworm can be spread to humans by contact with infected soil. Infection would most likely occur only from prolonged contact with highly infected soil.

Though adults can get ringworm of the scalp, it occurs most often in toddlers and school-age children. Outbreaks of ringworm are common in schools and child care centers where the infection easily spreads through close physical contact or by touching common items, such as door handles.

In addition, children with pets are at increased risk of ringworm. 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.

Others factors that increase the risk of ringworm of the scalp include:

• Small skin or scalp injuries
• Ongoing wetness of the scalp, such as from sweating
• Poor hygiene
• Overcrowded living conditions

The organisms that cause ringworm thrive in damp, close environments. Warm, humid settings that promote heavy sweating also favor its spread. Excessive perspiration washes away fungus-killing oils in your skin, making it more prone to infection. Athletes are at higher risk of ringworm.

Ringworm often occurs in young children. Outbreaks of ringworm are common in schools, child care centers and infant nurseries. Children with pets are at increased risk of ringworm.

Others at increased risk of ringworm include people with weakened immune systems, such as people with diabetes or HIV/AIDS. If you have atopic dermatitis — a chronic, skin disease characterized by itchy, inflamed skin — you may be more susceptible to ringworm. The barrier in your skin that normally protects you from viral, bacterial and fungal infections is often weakened or compromised. Some people may be genetically prone to this type of infection.

The organisms that cause athlete's foot thrive in damp, close environments created by thick, tight shoes that can pinch the toes together and create warm, moist areas between them. Damp socks and shoes increase the risk. Warm, humid conditions that promote heavy sweating favor its spread.

The fungus is carried on fragments of skin or other particles that contaminate floors, mats, rugs, bed linens, clothes, shoes and other surfaces. Plastic shoes in particular provide a welcoming environment for fungal growth and infection. Person-to-person contact is another means of transmission. Even household pets can pass along fungal infections. Although transmission can occur within a household, the infection is more commonly passed along in public areas — locker rooms, saunas, swimming pools, communal baths and showers. Not everyone who carries the fungus develops signs and symptoms of athlete's foot.

Although it occurs primarily in adults, athlete's foot can affect children. Men are more likely than women to develop athlete's foot. Vulnerability probably involves a genetic component, but those who are known to be more vulnerable include people with weakened immune systems, for example, people with diabetes or HIV/AIDS.

Your doctor will want to determine if your signs and symptoms are caused by athlete's foot or by another skin disorder, such as dermatitis or psoriasis. You'll probably be asked about exposure to contaminated areas or contact with people who have athlete's foot.

Your doctor may take skin scrapings or fluid samples from your foot to view under a microscope to identify a fungus. If the sample shows a fungus, an antifungal medication is the usual treatment. If the test is negative but your doctor still suspects that you have athlete's foot, a sample may be sent to a laboratory to determine whether it will grow fungus under the right conditions. This test is known as a culture. Your doctor may also order a culture if your condition doesn't respond to treatment.

The main medication for ringworm of the scalp is griseofulvin (Grifulvin V, Gris-Peg), which is taken by mouth as a liquid or tablet. Your child may take this medication for four to six weeks. 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.

If ringworm of the body covers a large area, is severe or doesn't respond to over-the-counter medicine, you may need a prescription-strength topical or oral medication. These include:

Topical

• Econazole (Spectazole)
• Miconazole (Monistat-Derm)

Oral

• Itraconazole (Sporanox)
• Fluconazole (Diflucan)
• Terbinafine (Lamisil)
• Ketoconazole (Nizoral)

Side effects from oral medications include gastrointestinal upset, rash and abnormal liver functioning. Taking other medications, such as antacid therapies for ulcer disease or gastroesophageal reflux disease (GERD), may interfere with the absorption of these drugs. Oral medications for ringworm may alter the effectiveness of warfarin, an anticoagulant drug that decreases the clotting ability of your blood.

For mild conditions, your doctor may advise you to apply a prescription or over-the-counter (nonprescription) antifungal ointment, lotion, powder or spray. Most infections respond well to these topical agents, which include:

• Terbinafine (Lamisil AT)
• Clotrimazole (Lotrimin AF)
• Miconazole (Micatin)

If your fungal infection is severe or doesn't respond to topical medicine, your doctor may give you a prescription oral medication. Oral medications include:

• Itraconazole (Sporanox)
• Fluconazole (Diflucan)
• Terbinafine (Lamisil)

According to the Food and Drug Administration (FDA), oral itraconazole and oral terbinafine may be linked to rare cases of liver failure and death. Oral itraconazole may weaken the heart's contractions and shouldn't be prescribed for people with a history of heart failure.

Your doctor may prescribe an oral antibiotic if you have an accompanying bacterial infection. In addition, your doctor may recommend wet dressings, steroid ointments, compresses or vinegar soaks to help clear up blisters or soggy skin.

Ringworm is difficult to prevent. The fungus that causes ringworm is common and contagious even before signs and symptoms appear. However, 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. Don't let others use your clothing, towels, hairbrushes or other personal items. Refrain from borrowing these items from others as well.
• Keep your feet dry, especially between your toes. Go barefoot to let your feet air out as much as possible when you're home.
• Go with natural materials. Wear socks that are made of natural material, such as cotton or wool, or a synthetic fiber designed to draw moisture away from your feet.
• Change socks and stockings regularly. If your feet sweat a lot, change your socks twice a day.
• Wear light, well-ventilated shoes. Avoid shoes made of synthetic material, such as vinyl or rubber.
• Alternate pairs of shoes. This allows time for your shoes to dry.
• Protect your feet in public places. Wear waterproof sandals or shower shoes in communal showers, pools, fitness centers and other public areas.
• Treat your feet. Use an antifungal powder daily.
• Don't borrow shoes. Borrowing risks spreading a fungal infection.