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Tinea Capitis: Causes, Symptoms, Diagnosis, and Treatment
Introduction
Tinea capitis, also known as scalp ringworm, is a common superficial fungal infection that affects the scalp and hair shafts. Despite its name, it is not caused by a worm but by dermatophyte fungi. It occurs most frequently in children but can also affect adults, especially in overcrowded or unhygienic conditions. Tinea capitis is contagious and spreads through direct contact with infected individuals, animals, or contaminated objects such as combs, hats, and pillows.
Causes
Tinea capitis is caused by dermatophyte fungi that invade the keratinized tissues of the scalp and hair. The most common fungal species include:
- Trichophyton species (e.g., Trichophyton tonsurans, Trichophyton violaceum)
- Microsporum species (e.g., Microsporum canis, Microsporum audouinii)
The mode of transmission may be:
- Human-to-human contact
- Animal-to-human contact (especially cats and dogs)
- Contact with contaminated objects (fomites)
Risk Factors
Certain factors increase the risk of developing tinea capitis:
- Children, especially between ages 3–10 years
- Overcrowded living conditions
- Poor personal hygiene
- Sharing hairbrushes, combs, hats, or bedding
- Close contact with infected pets or livestock
- Weakened immune system
Signs and Symptoms
The clinical presentation of tinea capitis may vary, depending on the causative fungus and immune response of the host. Common symptoms include:
- Scaly patches on the scalp – round or irregular, with broken hair shafts
- Itching – mild to intense, causing discomfort
- Hair loss – patchy alopecia due to fungal invasion of hair shafts
- Black dots – hairs broken at scalp level, leaving small dark spots
- Kerion formation – severe inflammatory reaction leading to boggy, pus-filled swelling
- Swollen lymph nodes – especially in the neck region, due to secondary infection
Types of Tinea Capitis
- Gray Patch Type – hair becomes dull, brittle, and breaks above the scalp surface.
- Black Dot Type – hair breaks at scalp level, leaving tiny black dots.
- Kerion Type – severe inflammatory form with painful swelling, pustules, and risk of scarring.
- Favus – rare chronic type with yellow crusts (scutula) and foul odor, leading to permanent hair loss.
Complications
If untreated, tinea capitis can lead to:
- Permanent hair loss and scarring alopecia
- Secondary bacterial infections
- Emotional distress due to cosmetic appearance
Diagnosis
Diagnosis is based on clinical examination and confirmed through laboratory tests:
- Wood’s lamp examination – some fungi fluoresce under ultraviolet light
- Microscopic examination (KOH test) – reveals fungal hyphae in hair or scalp scales
- Fungal culture – to identify the exact dermatophyte species
Treatment
Treatment involves antifungal medications and proper scalp hygiene. Unlike superficial fungal infections of the skin, topical treatment alone is not effective because fungi invade hair shafts.
Medications:
-
Oral antifungals (first-line treatment):
- Griseofulvin – commonly used, especially in children
- Terbinafine – effective against Trichophyton species
- Itraconazole or Fluconazole – alternatives in resistant cases
-
Topical antifungals (adjunct therapy):
- Antifungal shampoos (ketoconazole, selenium sulfide) help reduce transmission
Supportive Measures:
- Avoid sharing combs, brushes, towels, or hats
- Treat infected pets if they are the source
- Regular scalp washing with antifungal shampoo
- Educating family members about hygiene and prevention
Prevention
Prevention strategies focus on reducing transmission and reinfection:
- Maintain good scalp hygiene
- Avoid sharing personal hair care items
- Wash bedding and hats regularly
- Examine and treat household pets if infected
- Early diagnosis and treatment to prevent spread in schools and families
Prognosis
With timely diagnosis and appropriate antifungal therapy, tinea capitis usually resolves without complications. However, severe cases such as kerion or favus may lead to permanent scarring and irreversible hair loss.
Conclusion
Tinea capitis is a contagious fungal infection of the scalp, mainly affecting children. It is caused by dermatophyte fungi and spreads through human, animal, or fomite contact. Clinical features range from mild scaling and hair loss to severe inflammatory lesions like kerion. Oral antifungal therapy is the cornerstone of treatment, while preventive measures play a crucial role in controlling transmission. Awareness, early detection, and proper management can ensure complete recovery and prevent long-term complications.
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