Tinea capitis (scalp ringworm): symptoms, causes and treatment

Definition

What is tinea capitis?

Tinea capitis is the name for ringworm that attacks the scalp. Ringworm itself is a disease caused by a fungal infection. This condition not only affects the skin but can also affect the hair shaft.

Tinea capitis is characterized by the appearance of circular bald patches that look dry and scaly on the head. The size of the spots can vary, both large and small.

This disease is a type of infectious skin disease. If you live with someone who is exposed to tinea capitis, your chances of contracting the same disease are higher.

How common is this condition?

Tinea capitis can occur in people of any age group. However, this condition is more common in children than adults, especially in those aged 5 - 10 years. The infection rate is also usually higher in men.

Unfortunately, the prevalence of tinea capitis throughout Indonesia has not been well recorded. However, as reported by MedScape, the rate of infection and disease in Southeast Asia has reportedly decreased from 14% to 1.2% in the last 50 years.

It is likely that this is influenced by the improvement of public sanitation conditions and personal hygiene.

Signs & Symptoms

What are the signs and symptoms of tinea capitis?

As already mentioned, the characteristic that indicates this disease is the appearance of itchy patches on the head. This infection causes part of the hair around the affected area to fall out, leaving areas that are scaly, bald, and reddish.

Some of the other symptoms include:

• The patches have tiny black dots left over from the hair that is cut off from the scalp,
• the patches enlarge slowly,
• the patches feel tender but are painful to the touch, as well
• hair becomes brittle and easy to pull out.

In more serious cases, tinea capitis can cause kerions, large, painful, inflamed, swollen patches on the scalp.

Sometimes this swelling also contains pus. Later, kerion can blister and harden.

The appearance of kerions can lead to the formation of scar tissue (a layer of replacement for the injured skin) in the areas where the hair falls out.

When to see a doctor

You or your child should immediately see a doctor if you feel the symptoms listed above in order to get a faster diagnosis and treatment.

Everyone's body can react differently to infection. Therefore, if you also feel other symptoms or are worried about certain signs, please consult your doctor.

Causes & Risk Factors

What causes tinea capitis?

Ringworm of the scalp is caused by a dermatophyte fungal infection. This group of fungi requires a layer of keratin as a food source to survive. Keratin is the layer that protects the skin, hair and nails to keep them healthy.

When growth is out of control, this fungus will damage the keratin layer and cause various symptoms of tinea capitis.

Based on their host (where they live and develop), dermatophyte fungi are divided into three types, namely anthropophilic species that inhabit human skin, zoophilic species that live on animals, and geophilic species that live in the soil.

Several types of anthropophilic fungi that can cause this condition are T. tonsurans, T. schoenleinii, T. rubrum, and M. audouinii. Whereas fungi of the zoophilic species include M. nanum, M. canis, T. equinium, and T. verrucosum.

In geophilic species, the cause of head ringworm is M. gypseum. However, the emergence of disease due to this type of fungus is rare.

These various fungi have different ways of penetrating and infecting the scalp.

An example is mushrooms M. canis. After penetrating the scalp layer, this fungus will enter the hair roots and then grow to cover the surface of the hair and destroy the cuticles (hair's protective layer). This infection is known as an ectotric infection.

Another with endotric infection, this fungus will attack the hair shaft and grow in it without destroying the cuticle. T. tonsurans fall into this category.

Tinea capitis caused by fungi of anthropophilic species can be transmitted through contact with an infected person or it can be through the use of shared goods.

Meanwhile, conditions caused by zoophilic species of fungi can be transmitted through contact with infected animals, for example from pets such as cats or dogs. Zoophilic fungi can also spread from person to person.

What are the factors that increase the risk of getting tinea capitis?

A person is more at risk of developing this disease if:

• still at the age of toddler or elementary school,
• have pets,
• working in a school or child care center, where outbreaks are frequent and infections are more common,
• living in a humid and warm environment, because excess moisture can be an ideal place for mold growth, or
• have a condition that makes the body's immunity weak.

Diagnosis

How do doctors diagnose this condition?

Often times, tinea capitis can be diagnosed by a dermatologist just by looking at the condition of the patient's infected scalp. During the examination, the doctor will also ask about your symptoms and your contact history with other people or pets.

If necessary, the doctor can perform further examinations by taking skin and hair samples which will be observed using a microscope. This is done to determine whether or not the fungus inhabits the skin.

Sometimes doctors also use wood lamp, an instrument similar to an ultraviolet light that will be illuminated on the scalp to see the type of fungus that infects the skin.

There is also an examination of the culture of the samples that have been taken. In this examination, the doctor will observe how the fungus grows and develops. However, because it can take up to weeks to produce results, this method is rarely used.

Treatment

What are the treatments that can be done?

Unlike other types of ringworm, this disease cannot be treated with ringworm drugs such as creams or ointments. Because, these drugs can not penetrate the hair roots properly.

To treat tinea capitis, patients need drugs with a systemic effect, which means the drug works by circulating throughout the body through the bloodstream.

Systemic drugs can be in the form of oral drugs (drinking) or injection drugs (injected). Generally, the drugs used for this condition are oral medications. The types most commonly prescribed include the antifungal drugs griseofulvin and terbinafine.

Griseofulvin works to stop the fungi from dividing, but does not kill the mushrooms directly. So, this drug must be taken for several weeks or months. Usually the medicine is taken after eating.

Meanwhile, terbinafine works by stopping the cells that make ergosterol, the main component that forms fungal cell walls. This drug is often prescribed to pediatric patients because the duration of treatment is not too long, only ranging from 2 - 4 weeks.

However, terbinafine should not be given to pregnant women because it can pose a risk of birth defects.

Apart from taking medication, you can also wash your hair with a special shampoo that contains ingredients such as povidone-iodine, ketoconazole, and selenium sulfide to reduce mold development.

Prevention

What are the steps that can be taken to prevent tinea capitis?

Ringworm is difficult to prevent because the fungus is contagious even before symptoms begin. But that doesn't mean you can't prevent it from happening. Here are steps to reduce your risk of getting ringworm.

• Maintain cleanliness of the scalp by shampooing regularly, especially after cutting hair.
• Maintain cleanliness by bathing and washing hands after every activity that is prone to dirt and sweat.
• Do not share personal items such as clothes, towels, or hairbrushes. Because it is easier for children, teach your little one not to share personal equipment.
• If you have a pet, take it to the doctor for regular health checks.

If you still have questions about tinea capitis, please discuss it with your doctor.