Tinea Capitis (Scalp Ringworm) - Symptoms, Causes & Treatment
By ScanSkinAI Editorial Team✓ Reviewed for medical safetyLast updated June 2026
A fungal infection of the scalp causing scaly patches and hair loss. It's most common in children and is contagious.
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Quick Answer
Tinea capitis, commonly known as scalp ringworm, is a highly contagious fungal infection that mainly affects children between the ages of 3 and 14. It attacks the scalp and hair follicles, causing scaly, itchy patches and areas of temporary hair loss. You might also notice characteristic 'black dots' where hair has broken off at the surface. Unlike mild skin ringworm, this condition always requires prescription oral antifungal medication because topical creams cannot penetrate deep enough into the hair follicle to cure the infection.
Clinical Context
Tinea capitis is a dermatophyte infection of the scalp and hair follicles, primarily affecting children ages 3-14. It's the most common fungal infection in children worldwide. Trichophyton tonsurans is the predominant cause in the US and UK; Microsporum canis (from cats/dogs) is common in other regions. The infection invades the hair shaft, causing breakage and characteristic 'black dots' (broken hair stubs). A kerion is an inflammatory, boggy, pustular mass that can cause permanent scarring alopecia if not treated promptly. Topical antifungals alone are ineffective - oral therapy is required.
Symptoms
- Scaly patches on scalp
- Hair loss in patches
- Black dots (broken hairs)
- Itching
- Kerion (inflamed, boggy mass)
- Swollen lymph nodes
Severity & Progression
Causes & Risk Factors
- Dermatophyte fungi
- Direct contact with infected person or animal
- Shared combs, hats, pillows
- More common in children
Treatment & Management
Oral antifungal therapy is required - topical treatments cannot penetrate the hair follicle. Griseofulvin (microsize 20-25 mg/kg/day) for 6-8 weeks is the traditional treatment. Terbinafine is now preferred for Trichophyton species (shorter course, fewer interactions). Antifungal shampoo (ketoconazole 2% or selenium sulfide) used twice weekly reduces contagion but doesn't treat the infection. Children can attend school during treatment. Kerion may require short-course oral steroids to reduce inflammation and prevent scarring. Household members should be screened; asymptomatic carriers can perpetuate infection.
- Oral antifungals (griseofulvin, terbinafine)
- Antifungal shampoo (reduces spread)
- Treat family members if needed
- Continue treatment for 6-8 weeks
Red Flags & Complications
Seek medical attention if you experience any of the following:
- Permanent scarring alopecia (especially with kerion)
- Id reaction (widespread hypersensitivity rash)
- Secondary bacterial infection
- Spread to other family members
- Psychological impact of hair loss
- Recurrence if treatment incomplete
Self-Care Tips
- Complete the full course of prescribed medication
- Use antifungal shampoo as directed
- Don't share combs, brushes, hats, or pillows
- Wash bedding and hair items in hot water
- Check other family members for symptoms
- Take pets to vet if animal source suspected
- Child can attend school during treatment
When to See a Doctor
If your child has scaly scalp patches or hair loss
Frequently Asked Questions
What does scalp ringworm look like when it first starts?
It usually begins as a small, scaly, itchy patch on the scalp that gradually expands. You may notice thinning or patchy hair loss in the affected area. A classic warning sign is the appearance of tiny "black dots," which occur when infected hairs become weak and break off flat at the scalp surface. Swollen lymph nodes at the back of the neck are also common.
How do children usually catch this infection?
Scalp ringworm is highly contagious and spreads easily through direct skin-to-skin contact with an infected person or occasionally a pet, like a dog or cat. It can also spread indirectly when children share personal items like hats, combs, hairbrushes, towels, or bed pillows. Fungi thrive in crowded living conditions, making it easily passed among young children at home or school.
Why isn't a standard antifungal cream enough to cure it?
Fungi that cause tinea capitis invade deep into the hair shafts and follicles where standard topical creams and lotions simply cannot reach. To permanently clear the infection, doctors must prescribe oral antifungal medication, such as terbinafine or griseofulvin, for several weeks. Using a special medicated shampoo twice a week is usually added to help reduce spreading, but it cannot cure it alone.
Will the hair grow back once the infection is gone?
In most standard cases, the hair will fully regrow once the infection is successfully treated. However, if the infection develops into a "kerion"—a severe, painful, swollen, and pus-filled mass—it can cause permanent scarring and permanent hair loss if not treated promptly. This is why starting oral treatment early is so important to protect your child's hair follicles.
Do I need to keep my child home from school?
Generally, children can return to school once they have officially started their prescribed oral antifungal medication and medicated shampoo. There is usually no need to keep them home for the entire 6 to 8 weeks of treatment. To protect others, discourage them from sharing any headgear or hair tools, and make sure their bedding and towels at home are washed regularly.
Can adults in the house carry it without showing patches?
Yes, they can. Family members of an infected child occasionally act as asymptomatic carriers. This means they harbor the fungus on their scalp but show no scaly patches, hair loss, or itching. Doctors may recommend screening siblings and parents, or having the whole household use a medicated antifungal shampoo temporarily, to prevent the infection from bouncing back and forth.
When should I take my child to the doctor for an itchy scalp?
You should see a doctor if your child develops scaly patches, unexpected hair loss, or broken hairs on their scalp. Seek immediate medical attention if you notice a painful, inflamed, or pus-filled lump with swollen lymph nodes. This indicates a severe inflammatory reaction called a kerion, which requires urgent treatment, sometimes involving short-term oral steroids, to prevent permanent scarring and baldness.
How can ScanSkinAI help spot tinea capitis?
ScanSkinAI can analyze photos of scaly patches, black dots, or hair loss on the scalp to help you identify common signs of a fungal infection. However, please remember that our AI is a screening tool, not a substitute for a medical diagnosis. Because scalp ringworm requires prescription oral medication to heal, you must consult a doctor or dermatologist for formal testing and treatment.
Medical References
Information on this page is sourced from and verified against reputable medical resources:
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.