Tinea capitis (scalp ringworm) — the London diagnosis and treatment guide
Scalp ringworm is a fungal infection that eats hair from the inside. It needs oral antifungals — no topical will cure it — and it's contagious.
Dr. Amara Okafor
Consultant Trichologist · Harley Street
In short
- Requires oral antifungal — usually terbinafine or griseofulvin.
- Highly contagious; screen household contacts.
- Common in children under 10; adults with immunocompromise.
- Untreated can cause permanent scarring alopecia.
Tinea capitis is a fungal infection of the scalp and hair shafts. It's most common in children under 10 but rising in immunocompromised adults. Missing it costs hair permanently.
What to look for
- Circular patch of scaling and hair loss
- Broken hair stumps ('black dots') in the patch
- Sometimes boggy inflamed mass (kerion)
- Lymph nodes at the back of the neck often enlarged
Diagnosis and treatment
Diagnosis is confirmed by mycology — hair plucks sent to lab, results in 2–4 weeks. Wood's lamp examination helps for some species. Treatment is oral: terbinafine (adults) or griseofulvin (children under 6) for 4–8 weeks. Topical antifungal shampoo (ketoconazole) reduces shedding of spores but doesn't cure — the hair shaft harbours the fungus.
Household precautions
Don't share combs, hats, pillowcases. Wash bedding hot. Screen close contacts — especially other children.
Ringworm on the scalp isn't a shampoo problem. It's a pill problem.
Frequently asked
Common questions
Can I get it from a pet?+
Yes — cats and dogs (especially strays and kittens) are common vectors.
Will hair grow back?+
Usually yes, if treated within 3 months. Kerions can scar.
How long until I'm not contagious?+
After 2 weeks of oral treatment plus antifungal shampoo.
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