Ringworm of the Scalp in Children: What Parents Need to Know

What Is Tinea Capitis?

Tinea capitis is a fungal infection of the scalp and hair shafts. Despite being called "ringworm," there is no actual worm involved — the name comes from the ring-shaped patches that sometimes appear. It is caused by a group of fungi called dermatophytes, which grow on the skin and hair.

The infection is most common in children between the ages of 3 and 14. It becomes much rarer after puberty. In North America, the most common cause is a fungus called Trichophyton tonsurans, which is responsible for more than 70% of cases.

Tinea capitis spreads easily among children through direct head-to-head contact or by sharing items like combs, hats, pillows, and hair accessories. In some cases, children catch it from an infected pet, particularly cats.

Signs and Symptoms

The signs of tinea capitis can vary, but the most common include:

• Scaly, flaking patches on the scalp (which may look like bad dandruff)
• Patches of hair loss, often in irregular or round shapes
• Short, broken-off hair stubs that look like small black dots on the scalp
• Redness and mild swelling of the scalp
• Itching (present in about 50–70% of children)
• Swollen lymph nodes at the back or sides of the neck

In more severe cases, a child may develop a kerion (KEER-ee-on) — a boggy, swollen, tender lump on the scalp that oozes fluid. A kerion is the scalp’s strong immune reaction to the fungus. It can look alarming, but it is not a sign of a bacterial infection on its own. Without proper treatment, a kerion can sometimes cause permanent scarring, though this is rare.

Causes and Risk Factors

Tinea capitis is contagious. Your child may be more likely to get it if they:

• Are between 3 and 14 years old
• Have close contact with an infected child at school or daycare
• Share combs, brushes, hats, or hair ties with others
• Have a family member with the infection (about 50–75% of affected children have an infected family member at home)
• Have a pet cat or kitten that carries the fungus
• Have a weakened immune system

The infection is more common in urban settings and in African American and Hispanic communities, largely because the most common fungus in these areas tends to spread more easily from person to person.

How It’s Diagnosed

Your child’s doctor will examine the scalp and may use a few tests to confirm the diagnosis:

• KOH preparation: A sample of hair or scalp flakes is dissolved in a solution and looked at under a microscope to check for fungal structures. This gives results quickly but may miss some cases.
• Fungal culture: A sample is grown in a lab to identify exactly which fungus is present. This takes 2–4 weeks but is the most reliable test (about 90% accurate).
• Wood’s lamp: A special ultraviolet light that makes some fungi glow blue-green. This is not reliable for the most common North American fungus, so a negative result does not rule out infection.
• Dermoscopy: A lighted magnifying tool a dermatologist may use to look closely at the hair and scalp.

The doctor will also rule out other causes of scalp scaling such as seborrheic dermatitis (dandruff), psoriasis, or alopecia areata (an autoimmune cause of hair loss).

Treatment Options

Tinea capitis cannot be cured with shampoo alone. Because the fungus lives inside the hair shaft and deep in the scalp follicles, it requires a prescription antifungal pill taken by mouth.

Oral antifungal medications include:

• Terbinafine: Now the preferred treatment for most children. The dose is based on your child’s weight, and treatment lasts 4–6 weeks.
• Griseofulvin: The traditional treatment, taken for 6–8 weeks. Still very effective, especially for certain fungi.
• Itraconazole: An effective alternative taken for 4 weeks.

Taking the full course of medication is very important. Stopping early — even if your child looks better — leads to relapse in 20–40% of cases.

Antifungal shampoo (such as selenium sulfide 2.5% or ketoconazole 2%) is used twice a week in addition to the oral medication. It helps reduce the number of fungal spores on the scalp, which lowers the chance of spreading the infection to others. It does not treat the infection on its own.

For severe cases with a kerion, a doctor may also prescribe a short course of oral steroids (such as prednisone) for 5–7 days to reduce inflammation and protect against scarring. If there is a secondary bacterial infection, oral antibiotics may be needed.

What to Expect During Treatment

Most children begin to improve within 4–6 weeks of starting treatment. Hair will start to regrow as the infection clears, and this process continues for weeks after treatment ends. Complete hair regrowth is expected in almost all cases — permanent hair loss is rare, occurring in less than 1% of properly treated children.

Your child can usually return to school after 24–48 hours of starting their oral antifungal, as long as they continue using the medicated shampoo and avoid sharing personal items.

To help prevent spreading the infection at home:

• Do not share combs, brushes, hats, or pillowcases
• Wash bedding and towels regularly
• Have other household members checked if they develop scalp symptoms
• If a pet is suspected, have it evaluated by a veterinarian

When to See a Dermatologist

Your child’s pediatrician or family doctor can often diagnose and treat tinea capitis. However, you should see or be referred to a dermatologist if:

• The diagnosis is uncertain
• Your child develops a kerion (severe swelling on the scalp)
• Symptoms are not improving after 4–6 weeks of treatment
• Your child has a weakened immune system
• There is a secondary bacterial skin infection that is not responding to antibiotics

Frequently Asked Questions

Q: Can my child go to school while being treated for scalp ringworm?
A: Yes. Most experts agree that children can return to school after starting oral antifungal treatment — typically within 24–48 hours. They should continue using the antifungal shampoo and avoid sharing hair items. Check with your child’s school, as policies may vary.

Q: Can my child catch tinea capitis from our pet?
A: Yes, this is possible. Cats in particular can carry a fungus called Microsporum canis that causes scalp ringworm. If your pet has patchy fur loss or skin irritation, have a veterinarian examine it. Treating the pet may be necessary to prevent reinfection.

Q: Will my child’s hair grow back after the infection clears?
A: In almost all cases, yes. Temporary hair loss during the infection fills back in as treatment works. Permanent hair loss is very rare — it occurs in less than 1% of treated cases, usually only when a severe kerion goes untreated for a long time.

Q: How long does treatment take?
A: Oral antifungal medication is taken for 4–8 weeks, depending on which medicine is used and which fungus is causing the infection. It is important to complete the full course even if your child’s scalp looks better before the end. Stopping early significantly increases the risk of the infection coming back.