Tinea Capitis
Tinea Capitis | Causes, Symptoms, and Treatment Options
Commonly known as scalp ringworm, tinea capitis is a fungal infection that affects the scalp and hair. Dermatophyte fungi cause this highly contagious condition, which spreads through direct contact with infected individuals, objects, or animals. While it primarily affects children, people of all ages can develop the infection. Tinea capitis often leads to discomfort and visible hair loss, making it both physically irritating and cosmetically concerning.
What is Tinea Capitis
Tinea capitis, or scalp ringworm, is a fungal infection that affects the scalp and hair follicles. While most common in children, it can occur at any age. Dermatophyte fungi, primarily Trichophyton or Microsporum species, cause this condition. Infected individuals may experience itching, redness, scaling, and circular bald patches on the scalp. The infection spreads through direct contact with infected individuals, contaminated objects like combs or hats, or pets carrying the fungi. Prompt diagnosis and treatment are essential to controlling the infection and preventing further transmission. Doctors typically prescribe oral antifungal medications along with medicated shampoos to eliminate the fungus and promote hair regrowth.
Causes of Tinea Capitis
Tinea capitis is a fungal infection that damages the scalp and hair follicles, causing hair loss, itching, and scaly patches. Dermatophyte fungi, which thrive on keratin in hair, skin, and nails, trigger this condition. Although fungi are the primary cause, other factors can increase the risk of developing tinea capitis.
Dermatophyte Fungi
The primary cause is infection by dermatophytes, a type of fungus that feeds on keratin found in the skin, hair, and nails. The most common dermatophytes responsible for tinea capitis are Trichophyton species, such as Trichophyton tonsurans and Trichophyton violaceum, as well as Microsporum canis. These fungi thrive in warm, moist environments and can spread easily through direct contact. The fungi infect the outer layers of the hair and scalp, leading to hair loss, scaly patches, and itching.
Close Contact with Infected Individuals
Tinea capitis is highly contagious and commonly spread through close contact. The infection can be passed along through sharing personal items like a comb as well as direct skin-to-skin contact. Since the fungi responsible are present on the skin and hair, sharing a bed or engaging in activities like sports can increase the risk of transmission. Infections are particularly common in crowded settings like schools or daycares where children are in close contact.
Poor Hygiene and Environmental Factors
Poor hygiene can increase the likelihood of developing tinea capitis. Fungal infections thrive in environments that are moist, warm, and poorly ventilated. Those who do not wash their hair or scalp regularly, or those who frequently wear hats, create an ideal environment for fungal growth. Environmental factors such as hot, humid climates can contribute to the spread of the infection. Maintaining a clean scalp and hair, as well as avoiding excessive moisture, can help reduce the risk of fungal infections like tinea capitis.
Sharing Personal Items
It can be spread when individuals share personal items that have come into contact with the scalp and hair. Commonly shared items include combs, brushes, hats, scarves, and towels. Since the dermatophyte fungi are present in hair and skin flakes, they can easily be transferred onto these objects. Once on these objects, the fungi can subsequently spread to others who use them. This can be a particular problem in settings where items are frequently shared, like a sports team, schools, and households. Proper hygiene and avoiding sharing personal grooming items is essential to reduce the risk of spreading.
Weakened Immune System
A weakened immune system can increase susceptibility to fungal infections. Conditions like diabetes, HIV/AIDS, and immunosuppressive therapy can impair the body’s ability to fight off fungal infections. Those with compromised immune systems may find it more difficult to prevent or control the growth of dermatophytes. This can increase their vulnerability to infections, like tinea capitis. For these cases, medical intervention is often necessary to help manage the infection and prevent additional complications.
Pre-existing Skin Conditions
Certain pre-existing skin conditions can increase the risk of developing tinea capitis. Conditions like eczema, seborrheic dermatitis, or psoriasis can compromise the skin’s natural barrier. This makes it easier for the fungi to invade the scalp. These conditions often cause the skin to become dry, flaky, or inflamed, which creates an environment where dermatophytes can thrive. Those with these skin conditions may need additional care to prevent fungal infections, including treating any underlying skin issues.
Animal Contact
Animals, particularly cats and dogs, can be carriers of the fungi that cause tinea capitis. Microsporum canis, a type of dermatophyte, is commonly transmitted from infected animals to humans through direct contact. Pets with bald spots, scaly patches, or signs of hair loss may be infected with tinea capitis. The spores can then be transferred to humans who come into contact with them. Ensuring pets receive proper veterinary care and maintaining good hygiene can help reduce the risk of transmission.
It’s important to note that while the fungi responsible are contagious, not everyone exposed will develop an infection. How tinea capitis appears can vary, with some experiencing mild symptoms while others exhibit more sever symptoms. Proper and timely diagnosis and treatment is crucial for both controlling the infection and preventing the spread.
Symptoms of Tinea Capitis
Tinea capitis can lead to hair loss, scalp irritation, and various visible changes to the skin and hair. The symptoms can vary depending on the severity of the infection and the type of dermatophyte causing it.
Hair Loss
One of the most noticeable symptoms of tinea capitis is hair loss, often in small, round patches on the scalp. The fungi infect the hair follicles, causing the hairs to become weak and brittle. In some cases, the hairs may break off at the scalp level, leading small round or oval bald patches. These patches can become more pronounced over time as the infection spreads. The affected areas may have stubbly or uneven regrowth. Hair loss is often permanent if the infection is not treated quickly.
Scaly, Red, or Inflamed Scalp
The affected areas of the scalp may become red, scaly, and inflamed. The skin may feel tender or sore, and there may be noticeable swelling around the infected areas. This inflammation occurs as a result of the body’s immune response to the fungal infection. In mild cases, the scalp may have a dry and flaky appearance. For situations with more severe inflammation, the scalp may have scaling and crusting. The presence of redness and irritation on the scalp is a key symptom that differentiates tinea capitits from other forms of hair loss.
Itching and Discomfort
Itching is a common symptom that is caused by the inflammation and irritation of the scalp due to the infection. The intensity of the itching can vary from mild to severe and can be especially troublesome in children. Scratching can exacerbate the symptoms and may cause secondary infections if the skin is broken. The discomfort from itching is often accompanied by a sense of tightness or tenderness in the affected area.
Pustules and Crusting
In some cases, particularly those caused by Trichophyton or Microsporum species, pustules (small, pus-filled blisters) may form on the scalp. These pustules can rupture, leading to the formation of crusts or scabs on the affected skin. The presence of pustules and crusting is a sign that the infection has progressed. The crusting can make the scalp look scaly or flaky and may cause further discomfort as the lesions heal.
Black Dots
A distinctive symptom caused by Trichophyton tonsurans is the appearance of “black dots” on the scalp. These are small, dark spots that occur where the hair has broken off at the scalp level. The dark color comes from the fungus remaining within the hair follicle, which can be seen when looking closely at the scalp. The presence of black dots is a characteristic feature of the infection and is often seen in more chronic or long-standing cases.
Swollen Lymph Nodes
In some cases, tinea capitis may cause swelling of the lymph nodes in the neck or behind the ears. This occurs as the body’s immune system reacts to the infection and attempts to fight off the fungal pathogens. Lymph node swelling is not always present but may be an indication that the infection is more widespread or severe. Enlarged lymph nodes may be tender to the touch and can cause discomfort, especially in children.
Ring-Like Lesions
Ring-like lesions on the scalp, resembling a rash may be observed. These lesions are usually circular or oval, with a raised border and a clearer center. The lesion can appear scaly or have a red, inflamed edge, and is more noticeable when the infection is active. The ring-like appearance is characteristic of tinea capitis and can help differentiate it from other scalp conditions.
Thickened or Brittle Nails
In rare cases, it may also affect the nails, leading to changes in their texture and appearance. This can result in thickening, discoloration, or brittleness of the nails. While this symptom is more commonly associated with tinea infections of the nails (onychomycosis), it can occur alongside scalp infections. Nail involvement can complicate the condition and may require additional treatment to address both the scalp and nail infections.
Treatment Options for Tinea Capitis
Tinea capitis is a fungal infection that requires quick and effective treatment to prevent hair loss and spreading of the infection. Treatment usually involves antifungal medications, both topical and oral, and sometimes additional treatments to manage the infection.
Oral Antifungal Medications
The primary treatment is oral antifungal medications. This is due to topical treatments generally not being able to effective penetrate the scalp and hair follicles. Commonly prescribed oral antifungals include griseofulvin, terbinafine, and itraconazole. Griseofulvin can been used treat tinea capitis, but terbinafine is considered more effective and may have a shorter treatment duration. These medications work by interfering with the fungal cell membrane, preventing the growth and spread of the fungus. Treatment typically lasts 4–8 weeks, depending on the severity of the infection and the specific antifungal prescribed. Oral antifungals are considered the gold standard for treating this condition, especially in cases that are moderate to severe.
Topical Antifungal Treatments
While oral antifungals are the most common treatment, topical antifungal creams or shampoos can be used supplementary. Antifungal shampoos containing ketoconazole can help reduce the fungal load on the scalp and minimize the infection spread. These shampoos are typically used to wash the scalp and hair several times a week, alongside oral antifungal medications. Topical treatments alone are not sufficient to treat the infection but can be helpful in reducing symptoms and preventing the spread of the infection. They can also be prescribed to cleanse the scalp after oral treatment to help speed up recovery and prevent relapse.
Antihistamines and Corticosteroids
In some cases, antihistamines or corticosteroids may be prescribed to manage symptoms like severe itching or inflammation. Antihistamines, such as diphenhydramine (Benadryl), can help alleviate itching and discomfort caused by the infection. In more severe cases, corticosteroids (either topical or oral) may be prescribed to reduce inflammation and prevent scarring. Especially if the infection is accompanied by a significant inflammatory response. Corticosteroids should be used with caution, as they may suppress the immune response and potentially worsen the fungal infection. It’s important to use corticosteroids in conjunction with antifungal treatment.
Hair Removal or Shaving
In cases where there are large patches of hair loss or inflammation, it may be recommended to shave the hair around the affected area. This can help reduce the spread of the infection and make it easier to apply antifungal treatments. Shaving can also help with scalp hygiene and prevent the buildup of fungal spores in the hair. Shaving is not always necessary and is typically only recommended for cases where the infection is extensive or unresponsive to oral antifungal treatment.
Hygiene and Cleaning of Personal Items
To prevent the spread of tinea capitis to others, it is important to maintain good hygiene and clean personal items. Personal items that contact the scalp should be washed thoroughly with hot water and disinfected to kill any fungal spores. Regular cleaning of the scalp with antifungal shampoo and avoiding sharing personal items can help reduce the risk of reinfection and transmission.
Treatment of Secondary Bacterial Infections
Tinea capitis may lead to a secondary bacterial infection due to scratching or open sores on the scalp. Bacterial infections may be pus-filled blisters or increased redness and swelling. If there is evidence of bacterial infection, a doctor may prescribe antibiotics to treat the secondary infection. These are typically administered alongside antifungal medications. Treating both the fungal infection and any secondary bacterial infections is critical for full recovery and to prevent complications.
FAQ
What is tinea capitis?
Commonly known as scalp ringworm, it is a fungal infection that affects the scalp and hair shafts. It causes scaly patches, hair loss, and sometimes redness or swelling on the scalp. Despite its name, it is not caused by a worm but by dermatophyte fungi.
What are the symptoms of tinea capitis?
The symptoms include:
- Scaly, round patches of hair loss on the scalp
- Broken hairs that appear as black dots
- Itchy or flaky scalp
- Swollen lymph nodes near the neck
- In severe cases, inflamed, pus-filled lesions (kerion)
How is tinea capitis transmitted?
It is highly contagious and spreads through direct contact with an infected person, animal, or contaminated objects such as brushes, combs, hats, or bedding. Fungal spores can survive on surfaces for a long time, increasing the risk of transmission.
How is tinea capitis treated?
It is treated with oral antifungal medications such as griseofulvin or terbinafine, as topical treatments alone are not sufficient. Medicated shampoos containing ketoconazole or selenium sulfide may also be used to reduce fungal spread and speed up recovery.
Can tinea capitis cause permanent hair loss?
In most cases, hair regrows after successful treatment of tinea capitis. However, if the infection is severe or left untreated, it can lead to scarring of the scalp, which may cause permanent hair loss in the affected areas. Early diagnosis and treatment are crucial to prevent long-term damage.
Conclusion
Tinea Capitis, or scalp ringworm, is a fungal infection that affects the scalp and hair. While it can be uncomfortable and distressing, it is a treatable condition with antifungal medications. Quick diagnosis and proper treatment are essential for managing tinea capitis effectively. Consulting with a dermatologist for a proper diagnosis and tailored treatment plan can help ensure a fast recovery.
Want to Learn More?
View the latest scientific paper on Tinea Capitis from the National Library of Medicine.
