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Ringworm May Be Rising Among Children


The leading cause of the scalp infection known as ringworm is not a worm but a fungus, Trichophyton tonsurans, and the authors of a new study believe the prevalence of ringworm is rising among children in inner city areas. Ringworm, if not treated, can result in permanent hair loss.

The new study, led by Susan Abdel-Rahman, PharmD., professor of pediatrics and pharmacy at Children’s Mercy Hospitals and Clinics, evaluated 10,514 children in grades K through 5 in the bi-state Kansas City metropolitan area. Overall, 6.6 percent of children were infected with T. tonsurans, but the infection rates differed greatly depending on the age and race of the children.

Among African American children in kindergarten and first grade, the infection rate was 18 percent, but it dropped by more than half (to 7 percent) by fifth grade. Infection rates among Caucasian children were 1.1 percent and among Hispanic children, 1.6 percent. The authors did not identify the reason for the higher rates among African American children.

In an earlier study conducted at the Ohio State University Medical Center, researchers found that among a group of 189 children with a positive scalp culture for Tinea capitis (fungal infection of the hair follicles of the scalp), 89 percent of the cases were caused by T. tonsurans, and that African American children were affected more than whites.

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Trichophyton tonsurans has not always been the main cause of ringworm in the United States. Organisms from the Microsporum species, which are passed along to humans from pets, especially cats but also dogs, used to be more prominent. T. tonsurans is spread directly between people, often on items that touch the hair that individuals may share, such as hair brushes, pillows, towels, combs, hats, and hair ties.

Ringworm mainly affects the scalp, but it can also infect the fingers, toe nails, and feet. Ringworm of the scalp usually begins as a small pimple that becomes larger and leaves scaly patches of temporary baldness. Any hair that is infected breaks off easily. Ringworm of the body appears as flat, ring-shaped areas, thus the name. Individuals usually show signs of ringworm infection within 10 to 14 days of exposure to the fungus.

Dr. Abdel-Rahman noted that their study results support the rising number of cases of children with ringworm that she and her colleagues are seeing in the metropolitan areas. “There is also some evidence that it may worsen seemingly unrelated problems such as asthma and allergic rhinitis,” she said.

This latest study is the largest one to date to evaluate the prevalence of scalp fungus in children who live in a metropolitan area, yet the implications extend across the nation. Eradication of T. tonsurans is difficult because even when patients take the necessary antifungal medication, the fungus is not completely eliminated in many children. Parents who suspect their child may have ringworm should contact their healthcare provider as soon as possible so treatment can begin immediately.

Coloe JR. et al. Mycoses 2009 Mar 17.
Golin Harris International