Ringworm on Scalp (cont.)
When to Seek Medical Care for Scalp Ringworm
A doctor should examine any child with scalp itch, scaling, or areas of hair loss for evidence of scalp ringworm as many other skin conditions such as psoriasis and dandruff (seborrheic dermatitis) can look like scalp ringworm and are treated differently.
Treatment occurs over a course of weeks to months, so generally, scalp ringworm infections are not emergencies, but should be examined by a doctor to start appropriate treatment.
Exams and Tests for Scalp Ringworm
- When the scalp is examined with a Wood lamp that transmits ultraviolet light, the base of the hair shaft will light up a blue-green fluorescent band if Microsporum species is present. This is due to deposits of metabolic byproducts that this species leaves. Because this species is no longer common in the United States, this technique is less useful and not routinely performed.
- More commonly, the doctor can diagnose scalp ringworm with a visual inspection and by observing the symptoms present. However, scrapings examined in the laboratory are sometimes needed to confirm the diagnosis and may be helpful if repeated to make sure the ringworm is treated.
- The following are methods of collecting tissue samples for microscopy:
- Scraping the scalp with a surgical blade and removing the hair with a needle and forceps
- Running a toothbrush over the scalp about 10 times to collect the scales and hair (this is the best method)
- Cotton swabs
- Moistened gauze
- Once tissues have been collected, a 10%-15% solution of KOH (potassium hydroxide) is added and the slide is studied under a microscope to look for fungal spores. This method is fast, but it is effective in demonstrating fungal spores only 50% of the time.
- The best method of diagnosis is culture. The collected specimen is placed in a medium that provides fungal food to see if growth takes place. This method naturally takes more time, and an answer takes seven to 10 days.
Ringworm on Scalp Home Remedies
Sometimes, scalp ringworm can heal without treatment, but consulting a doctor is advised. To ensure timely management of the infection, it must be treated with a course of oral antifungal medications. Shaving the scalp is unnecessary.
- Shampoo with selenium sulfide (1%-2.5%), zinc pyrithione (1%-2%), or ketoconazole used two to three times weekly at home can help decrease shedding of spores, decrease spread of the infection to other people, and should be used together with the oral medications. Shampoos include Head & Shoulders Intensive Treatment, Selsun, Selsun Blue, Selsun Gold for Women, and Nizoral. Stronger medicated shampoos are sometimes prescribed by doctors, but in general, over-the-counter shampoos can be used.
- Because family members may be carriers, some doctors recommend that family members should also use the medicated shampoo to reduce the number of spores and prevent the infection from returning.
Hairbrushes and combs should be replaced or cleansed with disinfectant such as bleach solution. Bleach solution can be made by combining one part bleach to one part water, then soak the hairbrushes or combs for one hour daily for the first three days after using the shampoo and oral medication.
Home remedies such as vinegar (acetic acid) and tea tree oil have not been shown to improve scalp ringworm and may further irritate the skin and worsen the condition.
Medically Reviewed by a Doctor on 2/12/2016
Lisandro Irizarry, MD, MPH, FAAEM
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