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Fungal skin infection - scalp - Management
Are diagnostic tests required?

  • Always use laboratory methods to confirm the diagnosis, unless a kerion (pustular boggy mass) is suspected, in which case the person should be referred immediately to dermatology.
  • If there is clinical suspicion of scalp ringworm, scrape affected areas with a blunt scalpel blade or similar implement, to collect affected hairs, broken-off hair stubs, and scalp scale. Also pluck hairs from affected areas if possible (this may be difficult for children to tolerate).
    • This method of sampling is not suitable for detecting carriers as they do not have any abnormal areas from which to take scrapings.
  • If this is not possible, or the person is thought to be an asymptomatic carrier, brush with an unused toothbrush or cytobrush (the brush normally used to take cervical smears), passing the brush through the hair several times in the area of clinical abnormality (or in suspected carriers, different areas of the scalp), and then send the brush for culture.
  • When taking samples, it is important to:
    • Wipe off any treatment creams before sampling.
    • Collect at least 5 mm2 of skin flakes and hair.
    • Collect the sample into folded dark paper squares (secure with a paper clip), or use a commercially available fungal packet.
    • Keep samples at room temperature. Do not refrigerate.
    • Ensure clinical details are stated, including any treatment, animal contact, and overseas travel.
    • Send samples for microscopy (results available within 24 hours) and culture (takes 2–3 weeks).

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