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Fungal skin infection - scalp - Management
How should I diagnose scalp ringworm?
- Look for typical features suggestive of scalp ringworm:
- Scalp scaling.
- Patchy, irregular hair loss.
- Lymphadenopathy (postauricular and cervical).
- Itch.
- In some people, a more severe inflammatory reaction can occur, causing:
- Erythema.
- Pustules.
- Crusting.
- Pustular boggy masses (kerion).
- Permanent alopecia and scarring of hair follicles.
- Itchy papules around the outer helix of the ear (a reactive phenomenon known as an id response).
- Wood's light examination is not routinely recommended to diagnose fungal scalp infections.
- Exclude other diagnoses:
- Seborrhoeic dermatitis — scaling of the scalp without significant hair loss. See the CKS topic on Seborrhoeic dermatitis.
- Alopecia areata — usually there is complete alopecia in the affected areas (rather than the patchy alopecia seen with scalp ringworm) with little or no scaling or inflammation. See the CKS topic on Alopecia areata.
- Traction alopecia — stress on the hair and hair shaft by tight braiding.
- Trichotillomania — obsessive compulsive disorder of pulling one's own hair. Hair within the lesion is of various lengths and there is little scalp involvement.
- Psoriasis — usually more scaling is present.
- Always carry out investigations to confirm the diagnosis.
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