July 30, 2001 -- When it comes to their children's hair, parents get freaked out over ringworm as much as head lice. Some researchers have suspected that certain hair grooming practices may influence whether or not a child develops the feared fungal infection, known as tinea capitis. But a new study throws cold water on that theory.
"Essentially, tinea capitisis becoming an epidemic in the country," says study co-author Nanette Silverberg, MD. She tells WebMD that there has been close to a 300% increase in the number of cases in black children in the past 10 years. Silverberg, who is the director of pediatric dermatology at St. Luke's-Roosevelt Hospital Center in New York, adds that cases among other minority groups have also increased, but not as much.
Because of this increase, researchers decided to study the hair care practices of minority children. "They clearly have different hair-care practices," says Silverberg.
Silverberg and colleagues sampled 66 children with ringworm who were 12 and younger. They compared the participants to 68 children of the same age without ringworm. The children were recruited from three different cities. Nearly all of the children were black.
The children were all checked for ringworm. Their parents completed a survey on hair care practices, including frequency of shampooing; the use of conditioners, straighteners, oils, curlers, combs, and brushes; their type of hairstyle; and whether or not they shared hair utensils. They were also asked about their family's ringworm history.
The researchers found that children with a known exposure to the fungus, and children with a history of it, were both more likely to develop ringworm.
"Interestingly we didn't find any particular hairstyling technique, frequency of washing, or use of oils or grease affected whether a child got tinea capitisor not," says Silverberg. "The one difference that we found was that the use of conditioners seems to be somewhat protective against the development of tinea capitis."
Why is there such an increase of ringworm?
Silverberg says the organism that causes most cases of ringworm today, called Trichophyton tonsurans, is spread from human to human, as opposed to being passed animal-to-human, like the culprit 20 years ago. There is less swelling and pus, so many people can walk around for months unaware that they have it -- and they are spreading it.
Also, the scaly flakes of the organism can live on surfaces such as the back of a chair, a hat, a comb, or a doll. So children playing together can pass the infection to one another easily.
Kevin Mason, MD, an associate professor of pediatrics at Morehouse School of Medicine, tells WebMD that the organism doesn't live on the scalp's surface but gets into the hair follicle, where medicated creams and lotions can't go. Treatment requires taking medicines by mouth, so getting rid of the fungus takes a long time.
"The medicine grows out into the new follicle and kills the fungus," Mason says. It can take three months or longer for medication to kill the ringworm completely.
Even after medications have been started, children may still be contagious for two weeks. "They need to wear something on their head when they go to school -- baseball cap or scarf -- to keep from passing [it] to other children," says Mason.
So, what's a parent to do?
Selsun shampoos -- both prescription and over-the-counter may help, says Mason.
And he has two more tips.
"You need to also make sure that you clean your comb, your brush, your barrettes, hair bows, and your rubber bands -- fill up your bathroom sink and soak them in the shampoo for an hour once a week," he says. And, "when you take your kids to the barber, immediately go home and wash their heads -- don't go to the mall, or the movies." This will reduce the risk of catching ringworm from clippers at the barber.
Also, both Mason and Silverberg say it is not a good idea to share hair utensils or hats.