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Clinical Review

Diagnosis and management of scalp ringworm

BMJ 2003; 326 doi: (Published 08 March 2003) Cite this as: BMJ 2003;326:539

This article has a correction. Please see:

  1. L C Fuller (, consultant dermatologista,
  2. F J Child, consultant dermatologista,
  3. G Midgley, medical mycologistb,
  4. E M Higgins, consultant dermatologista
  1. a King's College Hospital, London SE5 9RS
  2. b Medical Mycology Department, St John's Institute of Dermatology, St Thomas's Hospital, London SE1 7EH
  1. Correspondence to: L C Fuller
  • Accepted 5 February 2003

Scalp ringworm is reaching epidemic proportions in parts of Britain's cities. Prompt diagnosis is needed to stop it spreading from child to child, but the varied presentation makes it easy to miss

Scalp ringworm, or tinea capitis, largely disappeared in Great Britain after oral griseofulvin was introduced in the late 1950s.1 Over the past few years, however, dermatology departments in London, Bristol, and Birmingham have seen a large increase in cases, with rates of positive scalp isolates up to 20 times higher than previous baseline rates.24 A community point prevalence study from London suggested a disease prevalence of about 2.5% with a carriage rate of between 12% and 47% among schoolchildren.5 AfroCaribbean children seem to be particularly vulnerable to infection.3 Scalp ringworm is also increasing in Europe and North America. 6 7 We discuss the current epidemic, illustrate the clinical presentations of the disease, and describe the methods for diagnosis and management.

Summary points

Scalp ringworm is common among innercity children in the United Kingdom

Diagnosis is difficult because of the wide range of clinical presentations

Systemic therapy is required to clear scalp ringworm

The diagnosis should be confirmed by mycological analysis before starting treatment

Antifungal shampoos may reduce the risk of transmission


We based this review on our extensive clinical experience in managing patients in a dedicated tinea capitis clinic at a teaching hospital. It also draws on information derived from a study assessing the impact of the problem on the local community and a detailed review of English language publications.

Source of infection

Scalp ringworm is caused by the dermatophyte group …

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