Introduction
Ringworm of the scalp, also known as tinea capitis, is a common fungal infection, caused by dermatophytes.
Mainly affecting children, this disease manifests itself as scaly patches, areas of hair loss and sometimes inflammation.
Ringworm is highly contagious and can be spread through direct contact, contaminated objects or pets.
Diagnosis is based on clinical and mycological examination, and treatment includes oral antifungals and strict hygiene measures. Prompt treatment can prevent complications such as permanent baldness.
Clinical examination
The symptoms of ringworm of the scalp (tinea capitis) can vary depending on the severity of the infection and the patient’s individual response. Here are the most common manifestations:
1. Scaly patches
- Appearance of rounded or oval areas on the scalp, often red and scaly. These patches may be lighter or darker than the surrounding skin.
2. Hair loss
- Hair can break on the scalp, leading to areas of baldness. Hair loss can be localized, with patches without hair, or more diffuse.
3. Itching
- The lesions may be accompanied by mild to moderate itching, causing discomfort and irritation.
4. Inflammation
- In some cases, the infection can lead to significant inflammation, with swelling and redness around the lesions.
5. Kerion
- In more severe cases, ringworm can progress to kerion, an inflammatory form of the infection. This condition is characterized by swollen, painful, pus-filled patches accompanied by fever or swollen lymph nodes.
6. Pustules
- Formation of small pustules or crusts on plaques, indicating secondary infection or irritation.
7. Temporary or permanent hair loss
- In some cases, especially if the infection is not treated quickly, it can lead to permanent hair loss in the affected areas.
These symptoms require medical attention for proper diagnosis and effective treatment to prevent complications and spread of infection.
Diagnosis of ringworm of the scalp
The diagnosis of ringworm of the scalp is based on several complementary methods:
- Clinical examination
- Observation of skin lesions and alopecia patches to identify typical features of infection, such as scaly patches, inflammation, and hair loss.
- Wood’s Lamp
- Some species of fungi glow under ultraviolet light. Wood’s light examination may reveal a yellow-green fluorescence, which points to a fungal infection.
- Mycological examination
- Scraping dander or removing hair from affected areas. The samples are then analyzed under a microscope to look for the presence of fungi.
- A fungal culture is also carried out, allowing the identification of the dermatophyte responsible. The results of this culture can take anywhere from 3 to 6 weeks.
The diagnosis is therefore systematic, combining clinical observation, Wood’s light examination and mycological analyses to confirm the presence of dermatophytis.
Treatment of ringworm of the scalp
The treatment of ringworm of the scalp is based on a combined approach, including oral and topical antifungals, as well as hygiene measures.
- Oral antifungals
- Drugs like griseofulvin (although no longer marketed) and terbinafine are commonly used. Oral treatment usually lasts 4 to 6 weeks.
- Antifungal shampoos
- Used as a supplement, shampoos based on ketoconazole or selenium sulfide help reduce transmission and eliminate fungal spores.
- Local treatment
- In the case of direct examination or positive cultivation, it is imperative to combine a local (fungicide) and general (fungistatic) treatment. Local treatment can be started while waiting for results.
- Options for local treatment include:
- Econazole 1% cream, applied 2 times a day.
- Bifonazole 1% cream, applied once daily.
- Ketoconazole 2%, used as a shampoo, 2 times a week.
- Aftercare
- The child is usually seen again after four weeks to take new samples. Treatment may be stopped if the results of the samples are negative.
- Hygiene precautions
- It is essential to avoid sharing personal items such as combs and towels, and to treat infected pets to prevent the spread of infection.
This combined approach ensures effective treatment of ringworm of the scalp while minimizing the risk of reinfection.
