Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The appearance of scalp ringworm can vary among affected individuals, but the most common signs are reddening, crusting, and scaling of the scalp. Intense itching usually occurs as well. Scalp ringworm can cause up to 50% of hair loss among children. Lymph nodes in the neck region may become enlarged with all types of scalp ringworm organisms, and some children may have high fevers. The specific pattern depends on the infecting organisms and how the immune system responds to the infection.
Black dot ringworm: The organism Trichophyton, which has become the most common fungus (causing 90% of tinea capitis in the United States), causes black dot ringworm. This organism causes infections within the hair shaft. The hair becomes extremely brittle and breaks off at the surface of the scalp. The remaining portion of the hair is left behind in the follicle, creating the "black dot" appearance. Patches of hair loss commonly result.
Gray patch ringworm: The organism Microsporum, which was the most common fungus in the United States in the 1940s and 1950s but now is a rare cause of ringworm of the scalp, causes gray patch ringworm. Today, it is much less common in North and Central America but continues to be the dominant cause of scalp ringworm in Southern and Eastern Europe. In this pattern, the lesions start as small, red bumps around the hair shaft. The lesions then grow outward, forming red, scaly, and circular "rings" that are dry but not inflamed. All hairs in the infected area appear gray and dull, and they frequently break off. Numerous areas of hair loss result. Intense itching is common.
Inflammatory ringworm: Fungi from animals or soil commonly cause this inflammatory form of ringworm, which can look like areas containing small pustules or abscesses or kerion formations. Kerions are elevated boggy masses oozing pus and studded with broken hairs. Fever, pain, itchiness, and tender, enlarged lymph nodes are common. Inflammatory ringworm can result in permanent scarring and hair loss. Oral or topical steroids may sometimes be prescribed for treatment, depending upon the severity, although this has not been shown to reduce permanent hair loss.
NOTE: Once effective antifungal therapy has started, the child may develop a widespread "id" reaction. This involves itchy, raised blister-like bumps that begin on the face and then spread to the trunk. The body's immune response causes this reaction to the dermatophyte and is probably not an allergic reaction to the medication. Usually, the medication treatment does not need to be changed or discontinued. However, a person who notices these changes should talk with the doctor to make sure cause of the reaction is not potentially dangerous.