Ringworm: There's a Fungus Among Us

From the WebMD Archives

April 17, 2001 -- Does your child seem to have dandruff? That's not a common condition in kids -- but ringworm of the scalp is, and it can look just like dandruff. This fungal infection is on the rise in the U.S. and requires treatment, so if your child has a flaking, scaling scalp, it's time for a visit to the doctor to prevent potential long-term problems.

"Tinea capitis, also known as ringworm of the scalp, is a common childhood infection ... caused by [a fungus] called T. tonsurans," expert Boni E. Elewski, MD, tells WebMD.

"In [big cities in] the northern U.S. and Canada ... I'm guessing that 15% of children between 5 and 10 have this infection," says Elewski, professor of dermatology at the University of Alabama in Birmingham (UAB). "I'm betting that in the Southern U.S., based on data, it's even more common. I wouldn't be surprised if in Alabama, Georgia, and Florida, we may go to 25% of children in that young age group."

Black children, especially boys, are especially prone to contract ringworm of the scalp. However, the condition does occur in adults and in children of all races, and identifying it can be tricky.

"We see a ton of it in our office," says David Fleece, MD, a pediatrician working in a clinic at Temple University School of Medicine in Philadelphia. "It is not always easy to diagnose based on the way it looks because it has many various appearances. Sometimes it's obvious and you have a circular patch of inflamed scalp and hair loss. But it can present as pimples or just a little flakiness [on the scalp]."

Patches of baldness and a scaly scalp are also common signs.

Even doctors have trouble identifying the disease and often confuse it for a bacterial infection of the hair follicles and treat it with antibiotics, Fleece says. This doesn't help because antibiotics only attack bacteria, not fungi.

To further complicate matters, Elewski says, a child may carry the disease for years before developing symptoms. It's always contagious, however, so during that time the child may pass it on to dozens of other kids.

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The condition can be spread not only by direct contact between two children but also by indirect contact through inanimate objects. So a child can pick up the fungus by sharing a hat or hairbrush of an infected pal, or even by sitting in a seat recently used by a child carrying the fungus.

Also, some suspect the disease is spread through barbershops, so parents should make sure that the barbers who cut their children's hair sterilize combs, scissors, clippers, and other equipment.

Ringworm of the scalp is increasing quickly enough in the U.S. to warrant a conference on the matter. Sponsored by the UAB department of dermatology, the conference took place in Savannah, Ga., this past weekend and brought together experts from all over the country. Elewski helped moderate the meeting.

"This is just a little fungus that we don't think much about," she says, "but if it affects you or your family members, it can be a nightmare."

For instance, Elewski says, untreated ringworm of the scalp can lead to permanent patches of baldness. Also, children with severe infections may go through periods of feeling unwell, which can affect school performance.

The primary treatment for ringworm of the scalp is an antifungal drug called griseofulvin (brand names include Fulvicin, Grifulvin, and Grisactin). It must be taken orally for at least eight weeks and until all symptoms disappear.

Although hair may take some time to grow back, don't stop giving your child the medication until all flaking, scaling, and pimples are all gone. There are other antifungals available to try if griseofulvin doesn't work, but they are not yet officially approved for this condition or for use in children.

If your child must be treated for ringworm of the scalp, consider getting the whole family treated. It's very possible that your child has passed it on to siblings or parents. In fact, experts recommend that when two or more children in a classroom are diagnosed with this disease, the parents of all the other children should be informed, so they can have their own children checked out.

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