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Fungal skin infection - scalp - Management
How should I treat scalp ringworm?

  • If a kerion (pustular boggy mass) is suspected, refer immediately to dermatology. If infection is milder:
    • In adults, treat with an oral antifungal.
      • A positive microscopy or a positive culture of skin scrapings is recommended before starting treatment.
      • If test results are negative, but the clinical appearance is very suggestive of fungal infection, repeat the sample and start treatment.
    • If oral antifungal treatment is being considered in children, seeking specialist advice is usually advisable.
      • Consider prescribing only if confident of the diagnosis and experienced in treating scalp ringworm in children.
    • Use topical antifungal treatment twice weekly (ketoconazole shampoo, selenium sulphide shampoo, or topical terbinafine cream), in addition to oral antifungal treatment, during the first 2 weeks of treatment to reduce transmission.
    • Topical corticosteroids are not recommended.
    • Remove crusts if itch or secondary infection are problematic.
      • Crust removal can be painful, therefore soak them first with lukewarm water or saline applied topically in moistened dressings.
      • The softened crusts can then be gently teased away.
    • If secondary infection is present, treat with an oral antibiotic such as flucloxacillin and an antifungal cream active against Gram-positive organisms (such as miconazole, clotrimazole, econazole).

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