Signs of ringworm scalp (tinea capitis) infection is a condition that can result in hair loss and irritated-looking, scaly patches. It’s highly contagious, affecting both adults as well as children.  

Untreated, it can cause severe inflammation leading to permanent hair loss and scarring. The good news is that it can be treatable – if caught early.

Symptoms of Ringworm Scalp Infections

Symptoms of scalp ringworm (tinea capitis) may include:

• Scaly bald spots or patches on the scalp.
• Tender or painful areas on the scalp.
• Fragile or brittle hair that comes out easily.
• Scaly grey or reddened areas (these may vary depending on your skin tone and are likely to be less obvious for those with darker skintones).
• One or more round scaly patches of skin where hair has broken off at the scalp.
• Patches that slowly enlarge or expand.
• Patches of small black dots indicating hair that has broken off at the scalp.
• Swollen lymph nodes.
• Low grade fever.

What are the Risks of Untreated Scalp Ringworm?

If left untreated, ringworm of the scalp can result in kerion – a severe painful inflammation that manifests as soft, raised and pus-filled swollen areas causing a thick, yellow crust on the scalp. This can be the result of a strong reaction to the fungus and may result in scarring and hair loss. 

Diagnosing Scalp Ringworm

A number of other scalp conditions can look similar to a ringworm scalp infection. Book an appointment with your doctor to be sure of an accurate diagnosis, discuss appropriate treatment and to rule out any other potential causes.

When consulting with your doctor about scalp ringworm, you may wish to ask them:

• What can be done to help prevent the spread of infection.
• Recommended hair and skin care as the condition heals.
• Potential side effects and drug interactions with medicines you are already taking if you are prescribed medication for ringworm.
• Advice if you are immunocompromised – for example if you are undergoing chemotherapy, or if you have a medical condition affecting your immune system such as rheumatoid arthritis.

If you have children, it may also be a good idea to ask:

• When it’s safe for your child to return to school.
• Whether to make appointments for any of your other children (even if they are not showing signs of infection).
• Whether to schedule a follow-up appointment.

Other Types of Ringworm

Ringworm can also occur elsewhere in the body:

• Feet – this form of ringworm is known as athlete foot (tinea pedis). It affects the moist areas between the toes and occasionally the foot itself.
• The body – Ringworm of the body (tinea corporis) causes a circular rash, or a scaly, reddened ring on the top layer of skin.
• Genitals, upper thighs and buttocks – This form of ringworm is commonly known as “jock itch” (tinea cruris). 

What causes Ringworm Scalp Infection?

Despite the name, ringworm scalp infection is not caused by an actual worm – rather the “ring” refers to the circular appearance of infection that appears on the scalp. 

The main cause of scalp ringworm is one of several varieties of a mould-like fungus known as dermatophytes which thrive on warmth, dead tissue (such as nails and dead skin-cells) and moisture and which attack both the outerlayer of the scalp and the hair shaft. 

How Is It Transmitted?

Ringworm of the scalp is highly contagious and can be transmitted through:

• Direct skin-to-skin contact with an infected person – ringworm can be common in overcrowded areas).
• Contact with surfaces or objects that have also been in contact with an infected person (or animal), including soft surfaces such as bed linens or towels.
• Contact with animals, particularly kittens and puppies (frequent carriers of ringworm). Other species of animals who often carry this infection include farm or petting zoo animals such as cows, goats, horses and/or pigs.
• Less commonly, it can be transmitted via infected soil.

Who is Most at Risk from Infection?

• Toddlers and school-age children.
• Animals and those exposed to household pets: animals such as cats and dogs can carry the infection without showing symptoms.

How to Prevent Ringworm of the Scalp

• Avoid sharing personal items such as clothing, towels or brushes. Discourage children from sharing these items.
• Keep clean: wash hands regularly and keep the home and any other items which might carry the infection clean, especially in shared spaces. 
• Shampoo regularly, especially after haircuts as infections can be transmitted from salons or barber shops.
• Avoid contact with animals who look as though they may be infected. Although animals can be asymptomatic, bald patches can sometimes appear in those infected with ringworm – if in doubt, seek advice from a trained veterinarian and ask them to check.

How to Treat a Ringworm Scalp Infection

Treatment for ringworm of the scalp involves taking an oral medication to kill the fungi found on the scalp (the most common include  terbinafine (Lamisil) and griseofulvin (Gris-Peg). These may need to be taken in excess of six weeks. 

Oral medication may also be taken alongside a medicated shampoo to help relieve soreness, remove fungal spores and to help prevent the spread of infection. 

Other medicines might include antifungal topical treatments in the form of cream, sprays or gels depending where on the body the infection is. 

Avoid scratching a ringworm rash, as this can spread it to other parts of the body.

If you are unsure about how best to treat scalp ringworm, consult a pharmacist.