A distressed mother brought her child to my office and lamented, “Docta, di teacha sey mi son cyah cum back ah school unless di ‘ringworm’ pon him head fix.” September is the time for back to school, and this condition is common at this time of the year when the infection is often noticed by the school nurse or class teacher.

Ringworm is a misnomer. The medical name for scalp ringworm is Tinea Capitis (TC). This infection is not caused by a worm but rather by a type of fungus called dermatophytes.

Dermatophytes have three major reservoirs:

* Humans

* Animals, eg cats and dogs

* Soil

Dermatophytes need keratin for growth, hence the hair, skin and nail, which consist of keratin, can become infected. TC (Tinea Capitis) is a very common infection among children throughout the world and is highly contagious through contact. There is usually a high incidence of the infection in children between the ages of three to seven years because there is more body contact with each other as well as with dirt and animals in this age group. Fungal spores can be transmitted through contact with infected persons, fallen infected hairs, infected cats and dogs, contaminated barber instruments, shared hats, and combs.

When the scalp is infected, a single or several patches of hair loss will occur which may or may not have flakes or pus. TC is usually associated with enlarged lymph nodes along the back of the neck. Depending on the virulence of the organism and the host’s defence, the scalp may develop an inflamed kerion, which is a boggy crusty pus-filled abscess on the scalp. Fever, intense itching and severe pain may accompany this infection. Inflammatory ringworm can result in permanent scarring and hair loss.

Management:

• This condition is contagious and should be confirmed and treated by a doctor/dermatologist.

• Tinea Capitis requires both oral and topical anti-fungal treatment for effective eradication. Shaving the scalp is unnecessary.

• Oral steroids may be given for inflamed Tinea Capitis.

• Shampoo with Selsun Blue, Head and Shoulders and ariSulfur bar daily in order to decrease the shedding of the fungal spores.

• Hairbrushes and combs should be replaced or cleansed with disinfectant such as bleach solution (one part of bleach to one part of water).

Implications for school attendance

Current recommendation from the Ministry of Health is that once an infected child is receiving treatment he/she may attend school. Infected children with hair loss and scalp abscess may be bullied and ridiculed at school. However, permission should be requested from the school authority to allow the child to wear a scarf or cap during treatment.

Dr Patricia Yap is a dermatologist at Apex Skin Care and Laser Center E-mail: apexskinclub@gmail.com