How is fungal infection of the scalp treated?

Scalp fungal infection, medically termed tinea capitis, is a dermatophyte infection affecting the hair shafts and follicles of the scalp. It is most commonly seen in children but can occur in adults, particularly those with compromised immune function, poor hygiene, or close contact with infected individuals or animals. The causative organisms are typically dermatophytes such as *Trichophyton tonsurans*, *Microsporum canis*, or *Trichophyton violaceum*, depending on geographic region and exposure.

Diagnosis requires clinical evaluation and confirmation via potassium hydroxide (KOH) microscopy of plucked hairs or scalp scrapings, fungal culture, or, increasingly, polymerase chain reaction (PCR) testing for rapid species identification. Dermoscopy may reveal characteristic findings such as comma hairs, corkscrew hairs, or black dots—representing broken-off infected hairs at the scalp surface.

Treatment necessitates systemic antifungal therapy because topical agents cannot adequately penetrate the hair follicle and infected keratin. First-line oral agents include griseofulvin (especially in younger children) and newer azoles such as terbinafine, itraconazole, or fluconazole—selected based on age, weight, drug interactions, and local resistance patterns. Treatment duration typically ranges from 4 to 8 weeks, guided by clinical response and mycological clearance. Concurrent use of antifungal shampoos containing ketoconazole or selenium sulfide helps reduce surface spore burden and limits transmission but does not replace systemic therapy.

Close contacts—including household members and classmates—should be evaluated and treated if symptomatic or colonized. Environmental decontamination (e.g., washing combs, hats, bedding in hot water; disinfecting shared surfaces) is essential to prevent reinfection. Untreated or inadequately treated tinea capitis may lead to complications including kerion formation (a severe inflammatory reaction), scarring alopecia, or permanent hair loss.