In a child with hair loss and scale on the scalp, fungal infection may be the cause. In tinea capitis (fungal infection of the scalp), there can be thick scaling. In tinea capitis, there can be many areas of hair loss, as displayed in this image. In a fungal infection of the scalp, there can be scaling without hair loss, as displayed in this image. Tinea capitis (a fungal scalp infection) typically has round areas of hair loss with scaling and redness of the scalp. Areas of scaling, redness, and possible hair loss are typical of tinea capitis. Multiple areas of hair loss and scaly patches of skin on the scalp is known as tinea capitis.   Tinea capitis (ringworm) can cause thick, white, scaly areas within the scalp. In addition to a thick scale in this patient, there is usually temporary hair loss due to tinea capitis (ringworm).
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Ringworm, Scalp (Tinea Capitis)  A parent's guide to condition and treatment information

Picture of Ringworm, Scalp (Tinea Capitis): In a child with hair loss and scale on the scalp, fungal infection may be the cause. Divider line
In a child with hair loss and scale on the scalp, fungal infection may be the cause.
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Treatments Your Provider May Prescribe
To confirm the diagnosis of scalp ringworm, the physician might scrape some surface skin scales onto a slide and examine them under a microscope. This procedure, called a KOH (potassium hydroxide) preparation, allows the doctor to look for tell-tale signs of fungal infection.

Sometimes the doctor will also perform a culture in order to document the presence of fungus or to discover the particular fungus that is causing the scalp ringworm. The procedure involves:
  1. Plucking a few hairs from involved areas of the scalp
  2. Rubbing a sterile cotton-tipped applicator across the skin to collect scale and any pus
  3. Sending the specimen away to a laboratory
Typically, the laboratory will have results within 2–3 weeks. Sometimes, the laboratory is able to identify the type of dermatophyte that is causing the scalp ringworm.

Occasionally, a Wood's lamp is used to look for the fungus. In this procedure, the doctor shines a black light at the scalp, and certain strains of dermatophyte may appear as yellow-green fluorescent spots.

Scalp ringworm is treated with oral antifungal medicines because the fungus invades deep into the hair follicle, where topical creams and lotions cannot penetrate. Scalp ringworm usually requires at least 6–8 weeks of treatment with oral antifungal pills or syrup, including:
  • Griseofulvin
  • Terbinafine
  • Itraconazole
  • Fluconazole
  • Ketoconazole
Often, the doctor will also prescribe a medicated shampoo to reduce the risk of spreading the scalp ringworm to someone else:
  • Selenium sulfide shampoo
  • Ketoconazole shampoo
Occasionally, untreated scalp ringworm seems to heal on its own when a child reaches puberty.


Last Modified: 22 Dec 2008