18 . October . 2019 BY Dr. Sharmishtha Deshpande

Fungal infection. Especially on the scalp. Surely not something any of us would want to endure. And it’s definitely not something that you would want to see your children go through.

A fungal infection that affects the scalp – Tinea Capitis – is perhaps one of the most common hair & scalp problems faced by many, more so in young children, but most have no clue about its root cause and needless to say, how to best tackle it. Well, how do you solve a problem unless you understand it…

We have had some specific queries come our way on this very topic, including some from very concerned parents of young kids. So here we are, again, with the ‘Ask the Hair Expert’ series, to give you some answers and clarity on this scalp irritant.

You asked: ‘Can one catch a fungal infection on my scalp?! How does it occur in children? How is it to be treated?’

Here’s the answer from the Hair Experts.
Yes. Fungal infection CAN affect your scalp and it needs medical attention.
You can get rid of it, and stay clear of it in the future, with the help of a Trichologist!

Tinea Capitis is the medical name given to a particular type of fungal infection that affects the scalp, hair shafts and follicles. This is something that is very common in young children, and in adults as well in some cases.

Let’s first understand what the concern here actually is, what Tinea Capitis is, what the common causes and symptoms are, and then, move on to how it can be tackled. We will look at solutions you can opt for if you are already struggling with the condition and also help with tips to avoid this infection.

What is Tinea Capitis?

Tinea Capitis is a superficial fungal infection that mainly affects the scalp, hair shafts and follicles. It is caused by Dermatophytes a type of fungi that commonly infects the outer layer of skin and keratin-rich parts such as the hair and nails. Usually, fungal infections do not show age disparity. However, Tinea Capitis is seen predominantly in young children especially in the age group of 3 to 7 years and is more common in boys than girls. It is known to cause a ring-shaped mark on the scalp – ringworm that affects the scalp. It is also referred to as tinea tonsurans.

This ringworm can cause scaly, red and in some, bald patches, anywhere on the scalp. It spreads easily across the scalp producing many such separate spots. As mentioned above, this condition on the scalp is more likely to affect children than adults, with more chances of spreading through shared caps, towels, combs and such.

In its milder form, it causes scaling of scalp skin with little hair loss whereas a severe form of Tinea Capitis can cause large plaques with extensive alopecia.

How can one identify it? What are the common symptoms?

Tinea Capitis presents as scaly patches that look similar to flaking caused in seborrheic dermatitis. However, it is specifically characterised by,

  • Ring-shaped rashes
  • Scaly patches on the scalp that are itchy
  • Red patches with scaling and yellow crust on the scalp
  • May cause a foul odour
  • Black dots on the scalp – hair breaks leaving a swollen black dot
  • Inflamed nodules on the scalp that can be painful
  • Hair falls on pulling
  • Itching in the affected area
  • Permanent hair loss in very severe cases

To the untrained eye, many of the early symptoms can overlap and everything may seem like just ‘dandruff’ – what is termed as a differential diagnosis – dandruff, scalp psoriasis, seborrheic dermatitis, alopecia areata, scalp eczema to name some…

Those of you who have been following our pages will know that seborrheic dermatitis is characterised by chronic inflammation and skin shedding that comes and goes. When seborrheic dermatitis becomes chronic and severe, it can lead to Scalp Eczema. Some of these symptoms are also often confused with that of Psoriasis and specifically Scalp Psoriasis.

Tinea Capitis has specific clinical indications and only a Trichologist can diagnose the concern correctly.

Tinea Capitis presents in three forms:

  1. Ectothrix: This invasion affects the outermost part of the hair shaft and the cuticle gets destroyed.
  2. Endothrix: This type of hair invasion occurs within the hair shaft only. The outer cuticle of the hair remains intact.
  3. Favus: This results in scalp crusts and hair XDloss.

In its more severe form, Tinea Capitis occurs as scaly erythematous lesions that affect hair shaft and result in hair loss or alopecia. The lesions slowly progress to inflamed deep abscesses termed kerion, that cause scarring and permanent bald patches on the scalp. These are clearly concerns that need professional intervention.

The fungi causing tinea infection grows from the skin towards the hair in the inner layer of skin and invades the keratin. It then spreads along the hair shaft as it grows. The affected hair becomes brittle and starts to break leaving a black dot on the scalp.

What causes the condition? Who does it affect?

Fungal infection by dermatophytes is the most common cause of Tinea Capitis. Since this infection is highly contagious it is commonly caused by the sharing of hygiene-related items with an infected person. Further, the fungi thrive in warm, humid and moist environments, aggravated by poor hygiene.

Tinea infection in adults is often more subtle because the sebum has protective effects that decrease the risk of infection. However, in post-menopausal women, Tinea Capitis may be caused due to hormonal imbalances that alter the protective effects of sebum.

In young children, who are more prone to this condition, the infection spreads faster due to the constant contact amongst them. Combs, brushes, caps or hats, barrettes, seatbacks, pillows, and bath towels can transmit the fungus. Children who have access to or come in contact with infected animals, like kittens and puppies, also have higher chances of contracting the fungus.

Can Tinea Capitis be cured?

Yes, it can be cured, with timely professional intervention. Tinea Capitis is not dangerous. However, without treatment, hair loss and scaling may spread to other parts of the scalp. The sheer discomfort of inflammation, itchiness etc can be rather painful to deal with, especially when in children.

Treatment options for Tinea Capitis include oral antifungal medication and medicated shampoos. The fungal infections may take around a month or so to cure completely. You may need to visit the trichologist on a weekly/ fortnightly basis for reviews, as suggested.

If there has been hair loss, hair normally grows back in about 6 to 12 months after successful treatment.

Some misconceptions…
The most common misconception about Tinea Capitis is that it can be treated using topical antifungal agents; however, the experts have suggested that Tinea Capitis infection spreads to the hair shaft and inner skin layers and hence need to be treated with oral antifungal agents.

Another commonly held misconceptions about Tinea Capitis is that it can only spread from one person to another. But, the fact is pet or farm animals can also carry the fungus and spread infection.

How can it be prevented?

Here are some basic tips that can help prevent Tinea Capitis infection,

  • Follow good hygiene habits
  • Keep your scalp dry and clean.
  • Give your scalp breathing room. Don’t wear caps, hats, hoods, or scarves other than when really necessary.
  • Avoid close contact with an infected person
  • Do not share items such as combs, towels, bedsheets, cap, etc.
  • Do not self-medicate!
  • Use prescribed medicated shampoos as suggested by your trichologist
  • Take the prescribed medications regularly to prevent relapse of the infection
  • Keep away from pets/farm animals that are infected
How can a Trichologist help?

As mentioned above, to an untrained eye, Tinea Capitis can be often confused with other skin and hair conditions like dandruff, alopecia, dermatitis, eczema or psoriasis of the scalp due resemblance in some common symptoms. A clear diagnosis can be drawn only through a detailed analysis with a Trichologist.

When you consult a Trichologist, a thorough study of your scalp and hair shaft will be carried out. He/she will also discuss daily routine, diet and lifestyle habits, along with medical case history. Once a diagnosis is drawn for Tinea Capitis, treatment options will include oral antifungal medication and medicated shampoos. The fungal infections may take upto one month to cure completely.

The trichologist may recommend starting oral antifungal medication as soon as the Tinea Capitis infection is suspected. However, in some cases, the trichologist may want specific laboratory results, that reveal the exact fungal species and start treatment accordingly. It is important to understand that topical ointments and creams do not work for Tinea Capitis, as these creams or ointments can’t reach the fungus deep in the hair roots.

In the case of children, who are more prone to this condition, it becomes essential to keep a complete tab of their environment. It is advised that children are warned not to share combs, towels, caps etc with other kids. Siblings with itchy scalp should also be checked! In case you have pets at home, have them checked with your vet.
It would also be appropriate to mention here that it will not necessarily help to shave your child’s hair or give him a close haircut forcefully or force him/her to wear a cap/ scarf. This is something many people resort to, but it offers no health benefit. Also, do ensure that the child returns to school only after a review with the trichologist.

Trust we have clarified the basics of Scalp Fungal Infections! If you wish for any further details or clarifications, you know where to reach us! Our experts are just a call away.

A gentle reminder – If you ever notice worrying changes in your or your child’s hair, such as soreness in the scalp, itchy scalp, persistent hair loss, and split ends or no growth, contact a trichologist immediately. Don’t postpone or hesitate.

For more on hair & scalp concerns, and for all things ‘Hair’, do follow our blogs on hair loss, hair care, treatments and solutions and interesting hair trivia!

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