Ringworm on the scalp: treatment options

A scalp infection may produce itch, scale, broken hairs, circular patches or hair loss. Cream applied to the surface may not reach fungus within hair, so a clinician often considers oral antifungal treatment. The diagnosis can be confused with dandruff, eczema, psoriasis or bacterial inflammation; examination and, when needed, a sample help guide treatment. Hair usually grows back when the infection and inflammation are controlled, but a painful, untreated inflammatory area needs early attention.

Take prescribed medicine for the full instructed course, even if itching and scaling settle sooner. Tell the prescriber about liver problems, pregnancy, allergies and all medicines or supplements. A clinician may recommend an antifungal shampoo to reduce fungal shedding and household spread; shampoo alone is generally not the main treatment for infection in hair. Keep combs, brushes, hats, pillowcases and towels personal, and clean or launder them as advised. Do not use steroid cream alone on a suspected fungal rash.

Arrange prompt assessment for patchy hair loss, broken hairs, scalp swelling, pus, crusting or tenderness. Seek urgent advice if fever, severe pain, facial swelling or fast deterioration develops. If treatment causes a new widespread rash, breathing difficulty, yellowing of the skin or unusual severe illness, stop and seek medical help immediately. Persistent symptoms may mean the diagnosis or treatment needs review.

What findings support scalp ringworm? Do I need a sample? Which oral medicine suits my health history? Should I use an antifungal shampoo, and how should contacts protect themselves?