This topic is about
ringworm of the scalp or beard. For information about other
fungal infections, see the topics:
is an infection on your skin, hair, or nails. It is caused by a
fungus. Ringworm of the scalp occurs in children and
adults all over the world. It is most common in young children. Ringworm of the
beard is not common.
Ringworm is not caused by a worm. Ringworm
infections are caused by a fungus. The kinds of fungi (plural of fungus) that
cause ringworm live and spread on the top layer of the skin and on the hair.
Ringworm is contagious. It spreads when you come into close
contact with a person or animal that has it. It can also spread when you share
hats, combs, brushes, towels, clothing, and other items. Children get ringworm
more often than adults.
If an adult gets ringworm, he or she will
most likely become a carrier of the ringworm fungus. Carriers can pass ringworm
on to others but do not have symptoms of the disease.
You can also
get ringworm by touching an infected dog or cat, although this form of ringworm
Ringworm of the
beard often looks like round, bald patches. Most
often, the infection spreads outward while the inside of the circle clears up.
This makes the infection look like a ring. The name "ringworm" comes from this
But ringworm of the scalp or beard doesn't always make a
ring pattern. Sometimes it just looks like dandruff. In some cases the hair
breaks off, leaving stubble that looks like black dots. Sometimes people get
ringworm but do not have any symptoms
In the most severe cases,
the infected area is swollen, red, crusty, and painful, with small bumps that
look like blisters.
Ringworm is contagious, meaning it can spread
from one person to another easily. If you or someone in your family has the
symptoms listed above, see your doctor.
If you have a ring-shaped rash, you very likely have ringworm. Your
doctor will be able to tell for sure. He or she will probably look at a hair or
skin sample under a microscope to check for the ringworm fungus. You may have
other tests. But most of the time, none are needed.
Your doctor will prescribe pills that will kill the fungus.
And you can use special shampoo to keep ringworm from spreading to
Ringworm can come back, so be sure to throw away your
combs and brushes and buy new ones that won't spread the infection. Try to keep
your skin clean and dry. Don't share hats, combs, or brushes. If you treat
ringworm early, the hair in the bald spots will probably grow back. If you
don't treat it, the bald spots could be permanent.
A child who has
ringworm can still go to school, as long as he or she is taking pills to kill
the fungus. You do not need to shave your child's head.
Learning about ringworm of the scalp or beard:
Ringworm infection is caused by a
fungus. Fungi that cause
ringworm live and multiply on the upper layer of the
skin and on the hair. Ringworm is not caused by a worm
or other parasite.
The medical term for fungal infections is
tinea, followed by a word that describes the location of infection. For
example, tinea capitis is ringworm of the scalp, and tinea barbae is ringworm
of the beard.
Ringworm of the scalp is most commonly caused by
the fungus Trichophyton tonsurans, which is spread from
one person to another. This fungus causes more than 90 out of 100 cases of
ringworm of the scalp in North and Central America.1
In the past, the fungus Microsporum canis was the most
common cause, but it is a less frequent cause now. Microsporum canis is spread by cats and dogs.
Ringworm of the beard is
caused by Trichophyton verrucosum and is spread by
cattle, horses, or dogs.
You can catch ringworm by sharing
contaminated hats, combs, brushes, towels, telephones, clothing, sports
equipment, or even theatre seats, and by direct contact with an infected
Children are more susceptible to the fungus and more
likely to get an infection than adults. Adults often do not get an
infection even after exposure to ringworm-causing fungi. Adults, and less
commonly children, can be carriers for ringworm. Carriers do not have symptoms of ringworm but can pass the infection on
Ringworm-causing fungi can live on people, objects (such as hats or
brushes), or animals for several months.
ringworm appears as one or more round or oval patches
of baldness or scaly skin on the scalp or beard. Typically, the circular
patches spread along their outer borders while clearing at the centre, which
gives them a ringed appearance and the name "ringworm." But you don't always
see this pattern.
Other patterns include:
Sometimes swollen lymph nodes and fever occur with ringworm
When fungal infections occur, other areas of skin may
have a delayed allergic reaction in the form of a rash that looks like
blisters, known as an "id" reaction. Id reactions from ringworm of the scalp
usually appear on the face.
Early diagnosis and treatment of
ringworm of the scalp or beard may stop the infection from becoming
uncomfortable and prevent scarring and permanent hair loss.
Ringworm can be confused with
other conditions with similar symptoms.
ringworm of the scalp or beard may look like dandruff
with flakes of dead skin on the hair or beard. There may be round or oval
patches of baldness. The skin under the hair or beard may be itchy, red, and
peeling. The infection can spread gradually and cover a large area.
As fungi invade the hair, the hair becomes infected, brittle, and breaks
off near the root, resulting in patches of baldness. If you treat ringworm
early, hair loss is usually temporary.
The scalp or the skin under
the beard may become very tender if swollen areas and bumps that look like
blisters or nodules with pus (kerions) develop. Skin blisters can become
Ringworm of the scalp or beard can cause scarring and
permanent hair loss.
Things that increase a person's risk for
Call your doctor if you suspect
ringworm of the scalp or beard, and:
Symptoms such as flakes of dead skin on the
scalp can be due to dandruff, which should go away in about 2 weeks if treated
with dandruff shampoos. But if the symptoms are due to ringworm of the scalp or
beard, you need to be treated with antifungal pills to completely destroy the
Your family doctor or general practitioner can diagnose
and treat ringworm of the scalp or beard. You may be referred to a specialist,
such as a dermatologist.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Doctors can often easily recognize
ringworm when there is a distinct ringworm-patterned
rash. Your doctor will probably also look at a hair or skin sample (KOH
preparation) under a microscope to find out whether a fungus is
Tests used for ringworm of the scalp or beard
If someone in your family has ringworm of the
scalp or beard, talk to your doctor about whether other family members should
be examined. It is quite common for one family member to spread the fungus to
other family members.
Ringworm of the
scalp or beard is treated with antifungal pills in combination with antifungal
shampoo or lotion.
Topical antifungal medicines, such as shampoos
or lotions that you apply directly to the infected area, do not work when used
alone. They cannot get deep enough into the infected hair shaft to kill
fungi there. But antifungal shampoo helps prevent spreading the fungus to other
people, because it decreases fungal shedding from the scalp or beard area.
Doctors also recommend occasional use of antifungal shampoos for
ringworm carriers, people who can spread the fungus but do not have ringworm
symptoms. Often an adult becomes a carrier after exposure to an infected
A veterinarian can treat pets or farm animals for ringworm.
Ringworm of the scalp or beard
can come back after treatment has cleared the infection.
of the scalp or beard can cause scarring and permanent hair loss.
ringworm of the scalp or beard:
You usually treat
ringworm of the scalp or beard with antifungal pills
prescribed by a doctor. Shampoos available without a prescription are helpful
if you use them along with prescription pills. But when they are used alone,
they cannot completely destroy all of the fungi causing the infection.
If you have ringworm of the scalp or beard:
You do not need to keep your child out of school if he or
she is taking pills to treat ringworm of the scalp. Although parents sometimes
use a special shampoo to help prevent the spread to other children, it is not
needed. And you do not need to shave your child's head.1
Antifungal medicine (pills or liquid) and
shampoo used together are most effective in curing
ringworm of the scalp and beard.
Depending on the medicine, antifungal pills are taken for as few as 4
weeks or as long as 12 weeks.
Antifungal shampoo is not effective
when used alone to treat ringworm of the scalp or beard, because it cannot
penetrate into infected hairs and destroy the fungi present there.
Sometimes other infections occur when a person has ringworm, usually
because bacteria have entered the body through the ringworm sores or rash. If
needed, you can use other medicines, such as
antibiotics, along with antifungals to treat these
secondary bacterial infections.
Swollen areas and bumps that look
like blisters and have pus (kerions) are caused by an allergic reaction to
fungus. You can treat kerions with a combination of oral antifungal medicine
corticosteroid (usually oral), such as
To help prevent ringworm from developing after
exposure to the fungus, you can use antifungal shampoo every 2 days for about a
The most common antifungals you can use to treat ringworm
of the scalp or beard include:
Antifungal shampoos are available by prescription and as over-the-counter products. Both kinds may contain active ingredients like ketoconazole or selenium sulfide. Prescription shampoos often contain a larger amount of these medicines.
People who are taking antifungal pills should have a doctor monitor their blood counts and liver and kidney function
during treatment to watch for any adverse side effects.
The Canadian Dermatology Association promotes research and
education for dermatologists, provides information and support for dermatology
patients, and offers public education materials on sun awareness and skin
The Canadian Paediatric Society (CPS) promotes quality health care
for Canadian children and establishes guidelines for paediatric care. The
organization offers educational materials on a variety of topics, including
information on immunizations, pregnancy, safety issues, and teen health.
The Caring for Kids website was developed by the Canadian Paediatric
Society and provides parents with information about child health and well-being.
This website is sponsored by the Nemours Foundation. It
has a wide range of information about children's health—from allergies and
diseases to normal growth and development (birth to adolescence). This website
offers separate areas for kids, teens, and parents, each providing
age-appropriate information that the child or parent can understand. You can
sign up to get weekly emails about your area of interest.
American Academy of Pediatrics (2009). Tinea capitis (ringworm of the scalp). In LK Pickering, ed., Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed., pp. 661–662. Elk Grove Village, IL: American Academy of Pediatrics.
American Public Health Association (2008). Tinea barbae and tinea capitis. In DL Heymann, ed., Control of Communicable Diseases Manual, 19th ed., pp. 172–174. Washington, DC: American Public Health Association.
Other Works Consulted
Elewski BE, et al. (2008). Terbinafine hydrochloride oral granules versus oral griseofulvin suspension in children with tinea capitis: Results of two randomized, investigator-blinded, multicenter, international, controlled trials. Journal of the American Academy of Dermatology, 59(1): 41–54.
Grossberg R (2011). Fungal diseases of the skin. In ET Bope et al., eds., Conn's Current Therapy 2011, pp. 869–871. Philadelphia: Saunders.
Habif TP, et al. (2011). Tinea of the beard (tinea barbae). In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 288–289. Edinburgh: Saunders.
Habif TP, et al. (2011). Tinea of the scalp (tinea capitis). In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 284–287. Edinburgh: Saunders.
Higgins EM (2010). Tinea capitis. In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 3rd ed., pp. 736–739. Edinburgh: Saunders Elsevier.
February 20, 2013
Kathleen Romito, MD - Family Medicine
& John Pope, MD - Pediatrics
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