“Ringworm” is the most common terminology used to describe fungal infections of the scalp? Traditionally, if you would happen to acquire this type of infection, you would lose hair in a round patch of baldness. However, in my many years of diagnosing and treating hair loss, I have encountered many individuals with fungal infections and hair loss that did not match the classical picture.
Widespread areas of dryness and scaling that you would attribute to a dandruff problem is one of the more common ways in which fungal infections can show up on the scalp. While this version is more common in children, I have made this diagnosis in grandmothers in their 70’s and 80’s. One of the clues to making this diagnosis is the presence of scattered black dots on the scalp which occur because hairs infected with the fungus break off at the surface of the scalp. However, these broken off hairs may or may not form bald spots, so often times the only finding is the dandruff like dryness and flaking.
Another way that fungal infections can show up on the scalp is by causing you to develop small pimple like bumps which is most commonly associated with bacterial infections or folliculitis. However, microscopic evaluation of a scraping from the scalp or culturing a lesion can confirm that the problem is really a fungal infection. This version of fungus infection seems to be more common in men, but can really affect women as well. When the problem persists and goes untreated, then larger infected skin lesions can appear. In more extreme cases, these infected lesions can be swollen and protrude from the scalp similar to a boil on other parts of the body.
The most common source for fungal infections of the scalp is from another human, but it is also possible to acquire the problem from contact with animals or direct contact of the scalp with dirt or soil. Human to human contact can develop as a result of sharing combs and brushes between parents and children, or inadvertent transfer at barbershops or salons, or casual contact with surfaces that can serve as a reservoir for spores such as head rests or other forms of seating.
When fungal infections of the scalp occur, effective treatment would mean that you would have to take medication internally for usually 4 to 8 weeks, plus usually topical therapy as well to help prevent further spread of the infection. When a bacterial infection is present at the same time, additional medication might be required for 10 to 14 days to get the responsible organisms to go away.
You know that individuals can lose hair due to a number of reasons, but fungal infections might not be on the top of your list of possibilities, especially for adults. For that reason, the problem tends to be more advanced in adults when the diagnosis if finally made.
So if you find yourself bothered with persistent pimples, or ongoing flaking and itching of the scalp with or without hair loss, it would be best for you to get evaluated, diagnosed and treated to make sure that a fungal infection is not masquerading as something else.
Once present, the problem does not really go away until you get the appropriate treatment. I have had patients come in with this problem going undetected for as long as six years before a diagnosis was made, so it’s one of those things that does not usually go away on its own.
Your dermatologist can perform a fungal scraping or culture that can provide guidance to the treatment that will give you relief and help your scalp get back to normal.