The signs and symptoms of ringworm of the scalp include:

• One or more round patches of scaly skin where the hair has broken off at or just above the scalp
• Patches that slowly expand or enlarge
• Scaly, gray or reddened areas
• Patches that have small black dots if your child has dark hair
• Brittle or fragile hair that easily pulls out
• Tender or painful areas on the scalp

Ringworm of the scalp is persistent and contagious if not treated. It spreads easily through person-to-person contact or through contact with pets and shared objects.

When to see a doctor
If you suspect your child has ringworm of the scalp, see your doctor. A prescription medication is needed to cure the infection.

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Fungal infections, such as ringworm, are caused by microorganisms that become parasites on the body. These mold-like fungi (dermatophytes) attack the outer layer of skin on the scalp and invade the hair shaft, causing it to break.

Ringworm is contagious and can spread in the following ways:

• Human to human. Ringworm often spreads through direct skin-to-skin contact with an infected person.
• Object to human. Ringworm can spread through contact with objects or surfaces that an infected person or animal has touched, such as clothing, towels, bed linens, combs or brushes.
• Animal to human. Dogs, cats, ferrets, rabbits, goats, pigs and horses can spread ringworm to humans. Your child can contract ringworm by grooming or petting an animal with ringworm.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

• Exposure to other children. Though adults can get ringworm of the scalp, it occurs most often in toddlers and school-age children. Outbreaks of ringworm are common in schools and child care centers where the infection easily spreads through close physical contact or by touching common items, such as door handles.
• Exposure to pets. In addition, children with pets are at increased risk of ringworm. A pet, such as a cat or dog, can have the infection without showing any signs. Children can get the infection by touching or petting the animal.

Others factors that increase the risk of ringworm of the scalp include:

• Poor hygiene
• Overcrowded living conditions

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

In some cases, ringworm of the scalp causes kerion — a severe, painful inflammation of the scalp. Kerion appears as soft, raised swellings that drain pus and cause thick, yellow crusting on the scalp. Instead of breaking, the hair falls out or can be easily pulled out. Kerion may be caused by an overly vigorous reaction to the fungus and can lead to permanent scars and hair loss.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your family doctor or a skin specialist (dermatologist) can diagnose ringworm of the scalp. Because appointments can be brief and there's often a lot of ground to cover, it can help to be well prepared. Here are some tips to help you get ready for your appointment and what to expect from your doctor.

What you can do
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your appointment. List your questions from most important to least important in case time runs out. For ringworm, some basic questions to ask your doctor include:

• What might be causing the signs and symptoms?
• Are tests needed to confirm the diagnosis?
• What is the best course of action?
• Is this condition temporary or chronic?
• Is there a generic alternative to the medicine you're prescribing?
• Can I wait to see if the condition goes away on its own?
• What can I do to prevent the infection from spreading?
• What hair care routines do you recommend while the condition heals?

What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

• When did you first notice symptoms?
• What did the scalp look like when it first started?
• Is the rash painful or itchy?
• What, if anything, makes it better?
• What, if anything, makes it worse?
• Does a pet or family member already have ringworm?

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor will determine if your child has ringworm or another skin disorder, such as seborrheic dermatitis or psoriasis. He or she will ask about possible exposure to contaminated areas or contact with people or animals with ringworm.

Your doctor may take skin scrapings or samples of a few hairs plucked from the infected area and examine them under a microscope. If a sample shows fungi, treatment includes an antifungal medication. If the test is negative but your doctor still suspects ringworm, a sample may be sent to a lab for further testing. Your doctor may also order tests if your child's condition doesn't respond to treatment.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Medications approved for treating ringworm of the scalp include:

• Griseofulvin (Grifulvin V, Gris-Peg), which is taken by mouth as a liquid or tablet
• Terbinafine hydrochloride (Lamisil), an oral granule medication that can be sprinkled on food

Your child may take one of these medications for up to six weeks or more. Medications you apply directly to the head aren't as effective because they're less able to penetrate the scalp and hair.

After starting the medication, you may not notice any changes in your child's condition right away. Your child still needs to continue taking the medication as directed by your doctor, however.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Your doctor may recommend that you wash your child's hair with a medicated shampoo that contains selenium sulfide (Selsun, others). This may kill the ringworm spores and prevent the spread of the infection to other people or to other areas of your child's scalp or body.

For best use:

• Lather your child's hair with the medicated shampoo. Let the shampoo sit on your child's scalp for five minutes before rinsing.
• Use the medicated shampoo two to three times a week for about a month, or as otherwise directed by your doctor. Use a milder, nonmedicated shampoo on the other days.

Have your child wear a hat or scarf if he or she is self-conscious about the bald patches. You don't need to shave the scalp.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Ringworm is difficult to prevent. The fungus that causes ringworm is common and contagious even before signs and symptoms appear. However, you can help reduce the risk of ringworm by taking these steps:

• Educate yourself and others. Be aware of the risk of ringworm from infected persons or pets. Tell your children about ringworm, what to watch for and how to avoid the infection.
• Shampoo regularly. Be sure to wash your child's scalp regularly, especially after haircuts.
• Keep clean. Be sure your child washes his or her hands often to avoid the spread of infection. Keep common or shared areas clean, especially in schools, child care centers, gyms and locker rooms.
• Avoid infected animals. The infection often looks like a patch of skin where fur is missing. In some cases, though, you may not notice any signs of the disease. Ask your veterinarian to check your pets and domesticated animals for ringworm.
• Don't share personal items. Don't let others use your clothing, towels, hairbrushes or other personal items. Refrain from borrowing these items from others as well.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.