Scalp Ringworm: A Major Cause of Permanent Hair Loss

     When discussing pediatric scalp issues, parents often confuse Scalp Ringworm (Tinea Capitis) and Kerion. Medically, they are related stages of the same fungal infection, commonly affecting infants and primary school-aged children. If left untreated or mismanaged, the condition can lead to permanent hair loss, potentially impacting a child’s long-term self-confidence.

"Scalp Ringworm" VS "Kerion"

1. Tinea Capitis

     Scalp Ringworm or "Tinea Capitis" is a general term for a fungal infection caused by dermatophytes that affect the outermost layer of the skin and hair shafts. The fungus consumes the outer layer of the skin and the hair core, making the hair brittle and prone to breaking. If the body reacts too severely to the fungus, it can lead to a condition known as "Kerion."

2.  Kerion

     Kerion is an advanced stage of infection characterized by severe skin inflammation, resulting in raised swellings or pus-filled lesions covered by thick yellow crusts. If neglected, this intense inflammation can destroy hair follicles, leading to "fibrosis or scarring," which prevents hair from ever regrowing.

Warning Signs You Should Not Ignore

Doctors often see cases where parents bring their children in due to intense itching and scratching that leads to wounds. This disease can manifest in several ways:

• Patchy hair loss with scales: Circular patches with clear borders where hair has broken off or fallen out.
• Black dots on the scalp: Caused by hair strands breaking off right at the follicle opening.
• Brittle hair: Hair in the infected area becomes very fragile and can fall out or be pulled out easily with just a light touch.
• Pustules appearing on the scalp: In addition to swellings and pus, the child may experience tenderness in the area. You might also notice swollen lymph nodes in the neck or behind the ears as the body tries to fight the severe infection.

Is Scalp Ringworm Contagious Among Children?

"It is highly contagious and can spread even before symptoms appear." The fungus can spread through three main routes:

• Person to person: Direct skin-to-skin contact with an infected person.
• Animal to person: Pets can be carriers without showing any skin symptoms, especially kittens, puppies, and farm animals like cows, goats, and horses.
• Object to person: The fungus can survive on objects for a long time, such as combs, hats, towels, pillowcases, or even shared chairs.

Beliefs About Herbs and "Ineffective" Treatment

     There are common beliefs about using herbs like Thong Phan Chang (Snake Jasmine) or Galangal as poultices. While these herbs may have mild antifungal properties, they "do not fully eliminate the infection." This is because the fungus on a child's scalp isn't just on the surface but deep within the hair follicles. Applying fresh herbs may not treat the root cause and can irritate a child's delicate skin, potentially making the inflammation worse.

"Steroid Creams": Another Point of Concern

     Most importantly, do not purchase topical medications yourself if you are unsure of the actual condition. General anti-itch creams often contain "Steroids," which suppress inflammation to reduce pain and itching but actually help the fungus grow and spread deeper. Medically, this condition is known as "Tinea Incognito."

Observations When Using Steroid Groups

• Steroids mask primary symptoms: Red rings may disappear and previously clear borders become blurred, leading parents to mistakenly believe the condition is improving.
• More aggressive spreading: When steroids reduce local immunity, the fungus invades deeper into the follicles and rapidly expands its reach.
• "Rebound" effect: When the steroid cream is stopped, the inflammation can return much more severely, with significantly more pustules and itching.

Not using topical medication before knowing the actual disease helps prevent misdiagnosis.

What to Do if Scalp Ringworm Won't Go Away?

If your child's scalp fungal infection recurs frequently, doctors will take a more systematic approach to treatment:

• In-depth laboratory testing: Doctors may use a Wood’s Lamp (ultraviolet light), a KOH test (scraping scales for microscopic examination), or a fungal culture to identify the specific type of fungus.
• Oral medication: Since topical creams cannot reach the hair roots, the standard treatment is oral antifungal medication for 4-8 weeks, even if symptoms appear to have resolved, to prevent difficult-to-treat recurrences.
• Caring for the child and household: Because this disease is highly contagious, everyone in the home should use antifungal shampoo during the treatment period to reduce spores and prevent reinfection within the family.

Treating Kerion requires "Patience" and "Discipline" in taking medication. If parents notice even minor abnormalities, seeking an early diagnosis from a pediatric dermatologist will help prevent progression to scarring and permanent hair loss.

References

American Academy of Dermatology. (2026). Ringworm: Diagnosis and treatment. https://www.aad.org/public/diseases/a-z/ringworm-treatment 

Mayo Clinic Staff. (2022, January 22). Ringworm (scalp). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ringworm-scalp/symptoms-causes/syc-20354918

Oakley, A. (2017, November). Tinea incognito. DermNet. https://dermnetnz.org/topics/tinea-incognito

Persson, C., Gerena-Maldonado, C., & Woolhiser, E. (2025). Tinea incognito and topical steroid misuse in skin of color: A hidden epidemic. JOJ Dermatology & Cosmetics, 6(5), 1-15. https://doi.org/10.19080/JOJDC.2025.06.555700