Rashes that spread · 8 weeks
Child Scalp Ringworm: Doctor & Household Plan
Scalp ringworm needs medicine by mouth from a doctor — creams and shampoos alone do not clear it. This plan helps you get it diagnosed, give every dose, stop it spreading at home, school and the barber's, and know when to go back.
- Length
- 8 weeks
- For
- Children (with a parent)
- Evidence A
- Strong evidence: guidelines or reviews of trials
- What to expect
- The doctor will set the length of treatment (usually several weeks). Scaling settles over weeks; hair regrows over 2–3 months. A kerion (painful swollen lump) can scar if not treated quickly.
The goal: A clear scalp and regrowth in most children who complete the doctor's treatment, and fewer reinfections in the family.
Oral antifungal medicine is essential (BAD guideline and Cochrane review, Grade A). Household checks are Grade B; shampoo and cleaning measures only support the medicine (Grade C).
Start this program
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The plan
Week 1
Diagnose & start
See a doctor this week; start the oral medicine; start the household plan.
The fungus lives inside the hair root, out of reach of creams; an oral antifungal chosen by the type of fungus is needed.
Morning
See a doctor this weekDoctor or pharmacist
Signs: scaly patches with broken hairs or black dots, round bald patches, itch, swollen glands at the neck, or a painful boggy lump (kerion). Ask for a scraping or hair sample to confirm the fungus type.
Why: BAD and Cochrane: topical treatment alone does not clear scalp ringworm; the right oral medicine depends on the fungus, and Nigerian studies show a different fungus mix from Europe.
Evening
Oral antifungal — exactly as the doctor prescribesDoctor or pharmacist
Your doctor will choose the medicine (often terbinafine or griseofulvin, depending on the fungus) and advise the dose and duration. Give every dose, with food if the doctor says so. Finish the full course even when the scalp looks better. If doses are missed, tell the doctor rather than doubling up.
Why: Cochrane 2016: terbinafine and griseofulvin both work, and the best choice depends on the fungus type.
Chen et al. Systemic antifungal therapy for tinea capitis in children (Cochrane Review, 2016)
Medicated shampoo days
Antifungal shampoo (supports, does not replace, the medicine)
Twice a week: ketoconazole 2% or selenium sulfide 1% shampoo (or povidone-iodine shampoo) on the scalp; lather, leave 5 minutes, rinse well. For braided or cornrowed hair, apply along the partings. Check the label suits your child's age; for babies and toddlers ask the pharmacist. Keep out of the eyes.
Leave on: leave 5 min
Why: BAD: these shampoos reduce the spores that spread infection to others; they support, but never replace, the oral medicine.
Habits
A kerion is not a boil
Do not let anyone cut or drain a swollen scalp lump; it is usually the fungus and needs antifungal medicine from a doctor.
Why: Kerion is often mistaken for an abscess; cutting it can cause scarring.
Skip harmful remedies
No kerosene, engine oil, "Robb" or rubs, bleach, or steroid creams on the scalp.
Why: They burn the skin, do not reach the fungus, and steroids make ringworm spread.
Weeks 2–6
Treat & stop spread
Every dose given; household checked; combs, caps and clippers cleaned.
Over half of family members may carry the fungus without symptoms, and spores survive on combs, caps and clippers.
Morning
Oral medicine — every doseDoctor or pharmacist
Keep giving the medicine exactly as prescribed; a dose chart on the fridge helps. Your doctor or pharmacist will advise if anything changes.
Why: Missed doses are the commonest reason ringworm returns.
Chen et al. Systemic antifungal therapy for tinea capitis in children (Cochrane Review, 2016)
Evening
Own comb, own pillow
Each child has their own comb, brush, towel, cap and pillowcase; no sharing in bed if possible.
Why: Shared items spread the spores.
Medicated shampoo days
Antifungal shampoo for the child
As before: twice a week, scalp only, leave 5 minutes, rinse well. Continue for the whole treatment course or as advised.
Leave on: leave 5 min
Why: Reduces spread while the medicine works.
Habits
Check the household
Brothers, sisters and adults who share beds or combs should have their scalps checked by the doctor; carriers may need shampoo or treatment. Adults who are pregnant or breastfeeding should ask a doctor before any oral antifungal.
Why: BAD: screening household members reduces reinfection.
Clean combs, brushes, caps and clippers
Soak combs and brushes in diluted household bleach, then rinse and dry; wash caps, scarves and pillowcases hot. Take your own clippers to the barber, or confirm they are disinfected between customers. Tell the braiding salon.
Why: BAD advises disinfecting combs and brushes, and barbers disinfecting shared equipment.
School is OK on treatment
Children taking treatment can go to school. Tell the teacher so shared caps and combs are avoided.
Why: BAD: exclusion is not needed once treatment has started.
Pets
If a cat or dog has bald or scaly patches, have it checked by a vet.
Why: Some ringworm fungi come from animals.
Weeks 7–8
Finish & confirm
Complete the course; doctor confirms it is clear.
Stopping before the doctor confirms clearance lets the fungus come back.
Morning
Doctor review to confirm it is clearDoctor or pharmacist
Go back as the doctor asked, or sooner if not improving. Do not stop the medicine early unless the doctor says so. Your doctor will advise.
Why: Treatment is judged by the scalp and sometimes a repeat sample.
Evening
Own comb, own pillow
As before.
Why: Prevents reinfection.
Medicated shampoo days
Antifungal shampoo for the child
As before, until the course ends or as advised.
Leave on: leave 5 min
Why: Reduces spread.
Habits
Regrowth takes time
Hair regrows over 2–3 months. Keep styles loose; no tight braids or relaxers on healing patches.
Why: Tension on healing scalp slows regrowth.
Keep the hygiene habits
Own combs and caps, clean clippers, check siblings if new patches appear.
Why: Scalp ringworm is very common in Nigerian school children; reinfection is easy.
Ayanbimpe et al. Tinea capitis among primary school children in some parts of central Nigeria (2008)
Milestones
Your weekly check-in
Ask yourself these once a week. If an answer worries you, stop and see a doctor or pharmacist.
Stop and see a doctor if
- No doctor seen yet: shampoo alone will not clear scalp ringworm — see a doctor this week
- A painful swollen lump (kerion), fever or spreading redness: see a doctor the same day
- Yellow skin or eyes, dark urine, vomiting or a severe rash on the medicine: stop and see a doctor urgently
- Not improving after the course, or new patches: go back to the doctor
- A smooth bald patch that does not regrow
In an emergency, call 112112999911911.
Sources
- Fuller et al. British Association of Dermatologists guidelines for the management of tinea capitis 2014 (Br J Dermatol)
- Chen et al. Systemic antifungal therapy for tinea capitis in children (Cochrane Review, 2016)
- DermNet: Tinea capitis
- Ayanbimpe et al. Tinea capitis among primary school children in some parts of central Nigeria (2008)
Education, not diagnosis. This plan cannot examine you; pending physician review where marked.
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