Fungal infection is not a new disease. We often heard about this infection affecting the body such as feet, body and nails. Do you know that this infection can also affect the scalp? We may often associate scalp problems with dandruff and lice but we are pretty sure we are not so familiar with fungal infections affecting scalp. People tend to underestimate fungal infection on the scalp until it has caused great misery or discomfort by taking this matter into their hand without getting medical advice. In this DoctorOnCall’s article, we will be focusing on ringworm with a kerion on the scalp.
Ringworm is also known as tinea capitis. The fact that it is named with association of worms, does not have anything to do with the typical worm we all know in general. Ringworm is named as such because of the circular rash shaped like a ring similar to how a worm looks when it is touched end to end. It is commonly caused by fungal species of Microsporum, Epidermophyton and Trichophyton. These fungi can live on skin, surfaces and on household items such as clothing and bedding. The fungi are able to penetrate the hair follicle and grow downwards toward the scalp skin. It invades the keratin which in return makes the hair brittle and easily break. Tinea capitis cases can be seen almost everywhere in the world and most common in hot and humid climates which includes Southeast Asia.
Tinea capitis affects the children more than adults but that does not mean the severity of the infection is much more prominent in children. People with immunosuppression such as diabetes, cancer and usage of immunosuppressant or long-term steroid use, have a higher chance to acquire tinea capitis due to the impairment of the hair growth and strength. The infection can be easily transmitted by human skin contacts and sharing objects such as towels, hair brushes or bedding. It is also possible to catch this infection when a person pets an animal or touches the dirty ground.
The infection usually starts as a red bump on the scalp and gradually affects the whole scalp. Symptoms involve redness, itching scalp, formation of scale as if like a severe dandruff and can be associated with patches of hair loss (alopecia). Aside from the scalp, it may also cause symptoms to the eyelashes or eyebrows. In some cases, cervical lymphadenopathy (swelling of the lymph node around the neck) may appear. Symptoms may actually vary according to the fungal species infecting.
Thus, what does a ringworm with a kerion on the scalp really is? While ringworm is already known as tinea capitis and explained previously, kerion is the severe inflammatory form of tinea capitis with hypersensitivity reaction against dermatophytes. To better understand ringworm with kerion on scalp, it is best to know symptoms of tinea capitis in general first.
Infection of tinea capitis often begins as red bumps on the scalp that can be mistaken as acne but these red bumps gradually affect the whole scalp. Other symptoms include redness, itching scalp, formation of scale similar to severe dandruff appearance and patches of hair loss (alopecia). Apart from scalp, tinea capitis may also affect the eyelashes or eyebrows. In some cases, the appearance of cervical lymphadenopathy (swelling of the lymph nodes around the neck) can be seen. Symptoms vary according to the fungal species affecting it. In ringworm with kerion, the patient is typically presented with spreading of multiple small inflamed pus-filled pustules and is often painful. Hence, the differences between tinea capitis and ringworm with kerion lies in the symptoms and the extent of damages. Furthermore, tinea capitis does not involve the immune system to overreact towards the ringworm infection such as in ringworm with kerion.
Either way, both of these conditions can cause great discomfort and higher chances for permanent hair loss when it is not treated properly. Antifungal medications are the best medication to help these conditions. This can be in the form of griseofulvin, itraconazole and fluconazole. These antifungal medications are usually in tablet form and often combined with antifungal shampoo. Treatment can take weeks and even up to months. It is important for those with symptoms to get checked by a doctor so that they can get the right treatment and be prescribed with the right medication. This is indeed important as only with continuous long-term effective treatment can eradicate the infection.
Beside going through the right medication, it is necessary for patients to ensure infection is not furtherly spread. This can be done by cleaning or disinfecting hair tools. The best way is to replace hair tools with new ones to avoid re-infection. All household contacts should be screened for tinea capitis. Patients are advised to not share their individual objects such as hairbrushes, combs, pillows and caps with others to avoid spreading infections. Since the fungus causing kerion or tinea capitis often resides on a household pet and may infect those in direct contact with the animal, patients have to make sure that the pet is free from the infections by bringing them to the vet clinics for further evaluation.