Ringworm

Ringworm has nothing to do with worms; it is actually a fungal infection. Ringworm is primarily an infectious skin condition that can occur anywhere on the body. If it develops on the scalp, it can cause patches of hair loss. When it occurs on the scalp, the professional term for ringworm is “tinea capitis”. Ringworm is the same thing as athlete’s foot, and the same kind of fungal infection can also affect the nails. Ringworm of the scalp usually starts as a small pimple that progressively expands in size, leaving scaly patches of temporary baldness. The fungus gets into the hair fibers in the affected area, and these hairs become brittle and break off easily, leaving a bald patch of skin. The affected areas are often itchy, red, and inflamed, with scaly patches that may blister and ooze. The patches are usually redder around the edges and have a more normal skin tone in the center. This may create the appearance of a ring, hence the name “ringworm.”

Worldwide, the fungus Microsporum audouinii is a very common cause of ringworm. However, Trichophyton tonsurans is increasingly recognized as a cause of tinea capitis, especially in Latin American countries. Other fungi that may cause tinea capitis include Trichophyton schoenleinii, Trichophyton megninii in Southern Europe and Africa, and Trichophyton violaceum in the Middle East. The fungus Microsporum gypseum can sometimes cause tinea capitis. This fungus is common in soil and can be transferred to humans through contact with infected animals. Ringworm can also be contracted from pets that carry the fungus, with cats being particularly common carriers. Ringworm is contagious and can be transmitted through direct skin-to-skin contact or contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces.

Treatment for ringworm varies depending on the specific fungus involved. Some types of ringworm infections will resolve spontaneously, so no treatment may be necessary. However, most commonly, an antifungal medication called Griseofulvin is used. Griseofulvin is highly effective against fungi in hair and skin, but it is not as effective against yeast or bacterial infections. Griseofulvin gradually accumulates in the skin and hair, binding with keratin, a key component of hair, skin, and nails. This blocks the fungus from infecting the keratin. In recent years, some fungi causing tinea capitis have shown resistance to Griseofulvin, necessitating higher doses and longer courses of treatment. As an alternative, newer antifungal drugs like Terbinafine, Itraconazole, and Fluconazole can be prescribed.

Folliculitis

Folliculitis is a term for localized inflammation of hair follicles. It resembles acne, with small rings of inflammation surrounding the opening of a hair follicle. In the early stages of folliculitis, the hair fiber may still be present in the center, but as the condition progresses, the hair often falls out. Severe folliculitis can lead to permanent destruction of hair follicles, resulting in small bald patches. Some forms of folliculitis are non-infectious and caused by oils and greases that clog hair follicles. However, folliculitis is usually due to a bacterial infection, most commonly by Staphylococcus aureus. “Hot tub folliculitis” is caused by Pseudomonas aeruginosa, which thrives in inadequately chlorinated water. Viral, fungal, or yeast-induced folliculitis can also occur, involving agents like Herpes simplex, Herpes zoster, Pityrosporum ovale, and Trichophyton rubrum. Non-prescription topical antibiotics like bacitracin, mycitracin, or neomycin can be used to treat minor folliculitis, while more serious infections may require oral antibiotics such as erythromycin or antifungal treatments like Griseofulvin for fungal infections.

Piedra

Piedra (Trichomycosis Nodularis) is a condition where hair fibers are infected by a fungus. The visible sign of a piedra infection is the development of hard nodules on hair fibers. “Piedra” is Spanish for stone. These nodules are concretions of hyphae and fruiting bodies of the fungus, known as an ascostroma, from which fungal spores are released. There are two main types of piedra: black piedra and white piedra, named after the color of the nodules formed on the hair fibers. Black piedra is caused by the fungus Piedraia hortae and is mostly found in tropical countries, while white piedra is due to Trichosporon beigelii and is more common in Europe and southern parts of the USA.

The infection can affect hairs on the scalp, body, and genital areas. Usually, the infection is relatively benign. In parts of Malaysia, the nodules of black piedra are considered attractive, and traditionally, women encourage its growth by burying their hair in the soil while sleeping. However, severe infections can weaken hair fibers, leading to patchy or diffuse hair loss. Treatment generally involves shaving off affected areas or applying topical agents like salicylic acid or formaldehyde. White piedra is resistant to azole-based antifungals, but these treatments can be used for black piedra. Oral therapy with ketoconazole or terbinafine has also been effective.

Demodex folliculorum

In some communities, there’s a popular belief that Demodex folliculorum contributes to hair loss and that removing these creatures will promote hair regrowth. Demodex is a tiny worm-like creature that resides on the skin and in hair follicles. It feeds on dead skin and oils, thriving in hair follicles where these substances are abundant. While common, Demodex is mostly benign. We are born free of Demodex, but through contact with others during childhood, our skin can become infected by them. About 70% of adults have some Demodex in their hair follicles. In most cases, their presence goes unnoticed. They can cause irritation, especially in eyelashes, but this is the extent of their impact. They do not cause hair loss.