Tinea capitis is primarily a fungal infection (caused by dermatophytes) of the skin when it is seen on the scalp. It is commonly caused as ringworm of the hair or scalp. It is contagious in nature. They cause pain, itchiness, brittleness and hair get brittle which begins to shed causing bald patches on the scalp.
The scalp can suffer from many afflictions that can damage the health of the scalp skin and even the hair follicles, leading to hair loss. One such condition is the skin infection known as Tinea capitis. While it affects children most often, it can also be seen in adults wherein the infection can cause so much damage to the hair follicles that evident hair loss and bald patches develop. The most important question arises here, does the hair grow back after ringworm of the scalp? Yes, tinea capitis hair loss is 100% treatable, if diagnosed and treated in time.
Tinea barbae and tinea capitis may be confused with each because they both are the infections of the skin where hair is present, but the term tinea capitis is specifically used for ringworm of the scalp, whereas tinea barbae is the when the ringworm infection is present in the beard and moustache of adult men.
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What Is Tinea Capitis Or Ringworm Of The Hair?
Tinea capitis is primarily a fungal infection of the skin when it is seen on the scalp. It is commonly caused as ringworm of the hair or scalp due to dermatophytosis. It is contagious in nature which means that the infection can spread from one person to another, from an infected animal (cat, dog, goat, etc.) to a human or by touching personal items like towels, hairbrush, comb, etc. of an infected person. The term ‘ringworm’ is used for tinea capitis infection because of the ring-like structure formed by the fungus. Though there is no worm as such involved in this skin concern.
Tinea capitis in children is more common than in adults, with young boys seeming to be more affected by the infection than girls. Infants can also contract this fungal infection. Tinea capitis in adults usually occurs by means of contracting the infection from another person or from their personal belongings which are infected.
What Are The Causes Of Tinea Capitis?
Tinea capitis is caused by a class of fungi known as dermatophytes (Microsporum and Trichophyton) These organisms are found living on areas that have a dead tissue, for example, the fingernails, outer layers of the skin and hair. A warm and moist atmosphere is most suitable for their growth.
The fungal cells attach to the keratinocytes and invade the hair shafts. They bring about various changes here and can even cause inflammation of the hair bulbs. Scaly patches form on the scalp and cause hair breakage at the tips or increased hair fall. Not maintaining personal hygiene such as showering regularly or after sweating can increase the chances of the fungus growing on the skin and causing tinea capitis infection.
Ringworm of the skin can also be formed when you come in contact with the area of ringworm on someone else’s body (infected person) or his/ her personal belongings.
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What Are The Types Of Tinea Capitis Infection?
Based on how the fungus invades the hair follicles and how the body’s immune system responds, this infection is divided into the following types –
1. Ectothrix Tinea capitis – The spores formed by the fungi are seen on the outside of the hair follicle with the penetration of the infection reaching mid-follicle level. Various Microsporum species and a few Trichophyton species cause ectothrix infection. When caused by the Microsporum, fluorescence can be observed under UV-A light or Wood’s light. Hair loss occurs above the scalp level in this type of the fungal infection. It is also called as Microsporosis.
2. Endothrix Tinea capitis – When the spores and fungal branches have penetrated and filled the hair shafts, it is referred to as endothrix tinea capitis. It is caused by different species of Trichophyton such as T. tonsurans, T. violaceum, and T. soudanense. No fluorescence is observed under Wood’s light or blacklight. Because the infection is within the hair shaft, it makes the hair brittle. Hair breaks just at the scalp level giving the appearance of black dots as the root of the hair remain in the follicle. This characteristic appearance gives it another name – Black Dot Tinea Capitis.
3. Favus Tinea capitis – The favus type of tinea capitis is caused by Trichophyton schoenleinii. Compared to the other types, the affected hair is not as damaged and in some cases, they even continue to grow.
4. Inflammatory Tinea capitis – This is caused by the fungus contracted from animals or from the soil. Inflammatory and painful patches form on the scalp that consists of loose, hanging hair. The hair follicles may ooze out pus in many cases. Such patches are called as kerions. These patches are accompanied with other tinea capitis symptoms like fever and itchiness. This type of infection can lead to permanent hair loss, if not treated as early as possible.
5. Grey Patch Tinea capitis – This type of tinea capitis is rare. Small, red lesions form on the scalp around the hair bulbs and these start to grow outwards to form scaly ring-like structures. The infected areas appear grey and dull.
Tinea Capitis Signs And Symptoms
• Itchy, scaly patches form on the scalp
• Hair becomes brittle
• Hair loss in the scaly patches leading to bald spots
• Pain in the infected areas
• Enlarged or swollen lymph nodes
• Scaly lesions may transform to red ‘rings’
• Pus (present when kerions form)
• Yellow, crusty swellings
• Black dots on the scalp (in the case of endothrix tinea capitis)
All of the tinea capitis symptoms may not be present at the same time. Usually, a combination of them are present depending on the type of the infection. Tinea capitis alopecia is also seen in the later stages of the infection. For people who are carriers and do not have an active infection, mild tinea capitis in the form of intermittent or mild scaling can be seen.
Differential diagnosis of tinea capitis with seborrheic dermatitis is often done as some similar symptoms can appear too. A laboratory test to identify the fungus is conducted as part of the diagnosis, so that appropriate treatment can be administered.
Does The Hair Grow Back After Ringworm Of The Scalp?
Yes, hair will grow back after ringworm on the scalp in most cases. Management of tinea capitis is straightforward when the infection is diagnosed and classified as early as possible. Early diagnosis will give the fungi lesser time to infect the hair follicles and cause hair loss. When no permanent scarring has occurred, like in inflammatory tinea capitis, hair regrowth after treatment is definitely possible.
What Are The Treatments For Tinea Capitis?
Being a fungal infection, the primary course of treatment for tinea capitis involves antifungals – both in the oral and topical form. The course of treatment for tinea capitis in infants should be carefully administered and directed by an experienced paediatric dermatologist. In general, for treatment of tinea capitis, the following methods are utilized –
1. Over the counter treatment – It involves using an antifungal shampoo. This may work in the case of mild tinea capitis only and must be prescribed by an expert dermatologist
2. Medicated shampoos – They contain ketoconazole or selenium sulphide which are prescribed by doctors for topical treatment of tinea capitis. The shampoos prescribed contain a considerable amount of antifungal agents mentioned and can prevent the infection from spreading further.
3. Medicines – The topical treatment must be accompanied with oral medication for best treatment of tinea capitis, so that the infection is cleared completely from the scalp and body. Griseofulvin and fluconazole are popularly prescribed by dermatologists for effective killing of the fungus and elimination of the infection. Tinea capitis treatment in children usually involves giving a regulated dosage of griseofulvin. Terbinafine hydrochloride is a recent addition to the list of antifungals that has been deemed safe for usage in children aged 4 years or older by the FDA.
4. Cosmetic procedures – Tinea capitis treatment in adults can also comprise of using cosmetic treatments meant to restore hair growth and cover up the bald spots formed by the infection. Topical sprays containing minoxidil and finasteride can be used as prescribed by the dermatologist, once the infection has cleared. These FDA approved medications improve the hair growth rate and reduce hair fall.
5. PRP – Another effective treatment course that can be used in adults to induce hair regrowth after scalp ringworm is PRP therapy. PRP stands for platelet rich plasma. This therapy supplies the hair follicles with necessary nutrients and growth factors by injecting activated platelets into the scalp. These platelets are separated from the blood extracted from the patient himself/herself. Results with this treatment are noticeable just after a few sessions. Hair growth is restored and hair volume also increases. While PRP treatment is very beneficial, it should only be performed once the infection has cleared completely from the body. The dermatologist would be able to determine a suitable time for PRP treatment, post-recovery from tinea capitis.
Prevention Tips For Tinea Capitis
Tinea capitis is contagious and can spread via several means, which makes prevention of this infection little difficult. Maintaining good personal hygiene is extremely important to prevent the dermatophytes from multiplying and spreading the infection further. Make sure to shower and wash your hands regularly. Some more tips include –
• Do not share personal items such as hair brushes, combs, hats, etc. with anybody. And disinfect your own belongings at least 1-2 times a week to prevent any contamination
• Regularly shampoo your hair to keep your scalp free from any type of infection.
• If you have pets, schedule regular visits with a veterinarian to ensure your pet does not have the ringworm infection.
• Do not touch stray animals that have patches of fur missing.
• Bedding, towels and linen should be washed regularly, preferably with an antimicrobial detergent.
Ringworm of the scalp or tinea capitis can cause hair loss. This hair loss can be minor and can easily progress to bald patches or alopecia. Do not get intimidated by this fungal infection, the tinea capitis treatment guidelines followed by dermatologists have been tried and tested for their efficacy. With powerful antifungal agents, tinea capitis can be cured and your scalp can be free of scaly patches in just a few weeks.