IN recent months cases of scalp ringworm (Tinea capitis infection) among children have been increasing at an alarming rate in many countries.

Animal-to-human spread has been implicated as a route of infection, however the predominant spread has been directly from child to child at home or school, and through contaminated equipment and tools used at hair salons or barbershops. Most cases of the infection have been noticeable during and after summer months, in settings where hair tools and equipment are shared without keen attention being paid to hygiene and sanitation, especially during the month of August when hair-grooming activities increase ahead of students returning to school.

Description of scalp ringworm

Scalp ringworm is of two main types, namely: inflammatory and non-inflammatory. The infection is caused by a fungus that develops inside the hair follicle or on the scalp. The fungus causes the hair follicles to break and often results in itchy bald spots on the scalp or excessive scaling of the hair. Some individuals with scalp ringworm may also experience a low-grade fever, inflammation of the lymph nodes — in particular those located in the back of the head — and a pus-filled boggy mass that may occur at the affected area of the scalp. The fungus that causes the infection can also survive on surfaces for a long time. Contaminated hair linen, equipment, and tools such as combs, brushes, and shears are perfect mediums for the survival of the fungus.

Prevention of scalp ringworm infection

When considering using the services at a hair salon or barbershop ensure that:

(a) the establishment/facility is licensed by the municipality in which the business is located. Cosmetologists and barbers should also be certified by the Ministry of Health.

(b) the hair equipment, tools, and linen the cosmetologist or barber uses are washed and, where applicable, disinfected — whether through the application of heat sterilisation in an autoclave or through the use of chemicals such as a barbicide. Seventy per cent of isopropyl alcohol is acceptable as a disinfecting agent for hair tools and equipment.

When disinfection of hair tools and equipment is done by the use of chemicals or heat from an autoclave the tools and equipment must be allowed to remain for the required time in contact with the heat or the chemical. Spraying barbicide or alcohol onto hair equipment or tools and immediately wiping the said surface is unacceptable given the risk.

Avoid sharing personal items such as combs, hairbrushes, pillows, hats, and towels, particularly in communal settings such as schools and day-care establishments.

Due to the contagious nature of the fungus, parents, teachers, and childcare providers should take special precautions to ensure that children with scalp ringworm remain isolated from those who do not have the infection. Ideally, schools and day-care centres should have policies stipulating that a child receives medical attention once suspected of having the infection.

Hand washing is key in preventing this infection; cosmetologists, barbers, and caregivers should be careful to observe hand hygiene at required intervals. Children should be encouraged to wash their hands after play.

Bed linen should be changed and washed frequently, especially in communal settings where the likelihood of the spread of this infection is high.

If a pet is suspected of having ringworm pet owners should ensure the animal is seen by a veterinarian.

Areas where pets with the fungus have spent time should be properly disinfected. The spores of the fungus can be killed by applying ¼ cup of regular household bleach (5-9 per cent sodium hypochlorite) to one gallon of water onto a contaminated surface.

Treatment of scalp ringworm

Using over-the-counter medication such as shampoos may be effective in treating the infection in some instances, however individuals suspected of having the infection should seek medical attention so that the condition can be properly diagnosed and treated.

Scalp ringworm is not just a regular summer rash. The incidence of fungal infections such as scalp ringworm is a growing public health concern as, contrary to some beliefs, the infection is not an ordinary summer rash. Whilst the true burden of infections associated with fungal pathogens is difficult to assess it should not be ignored that since the year 2023 countries such as the United States of America and Mexico have reported emerging cases of drug-resistant ringworm infections. Greater regulatory controls and strategies geared towards ensuring improvement in sanitation and hygiene practices amongst the implicated trades and establishments are urgently required so that the incidence of scalp ringworm and other fungal infections such as those associated with cosmetic surgeries can be reduced or averted where possible.

Dr Karlene Atkinson is a public health specialist and lecturer at the School of Public Health, University of Technology, Jamaica.