Ringworm Of The Scalp
( Originally Published 1927 )
Ringworm of the Scalp (Tinea tonsurans). Introduction.—There are a number of reasons which contribute to the great importance of this form of ringworm. First and foremost is the great ease with which it may be transmitted to others; second, difficulty in obtaining a cure; third, the possibility of permanent hair loss, always a matter of great consideration especially in the case of a girl; and fourth the great loss of time with neglect of schooling. Certainly, here are sufficient reasons for urging parents to inspect their children's scalps and hair weekly, especially those of school age. Throughout the following pages, stress will be laid upon the ease with which ringworm of the scalp can be cured if seen early, and the many difficulties to be overcome once this disease has progressed. It is hoped that the full significance of these statements will be realized.
Ringworm of the scalp is one of the most common forms of this affection. It is a disease of child-hood, for it is very rare after the thirteenth year of life. It is highly contagious and is usually passed along through contact with infected persons or domestic animals such as cats, dogs, etc., and through infected clothing, especially hats.
Description.—Let us trace the journey of these parasites from the time they are deposited on the skin of the scalp until they succeed in destroying the hair or causing its fall. The first effort of these parasites is to obtain a foothold underneath the skin. As soon as this is accomplished, they multi-ply and spread among the horny cells. No sooner does the body take notice of their presence than the serum (the antiseptic part of the blood) is sent as near to the seat of trouble as possible. It must not be forgotten that this part of the skin is with-out nourishment and without blood vessels. Of course, this serum comes from the blood vessels in the true skin, which are now overflowing with blood. At this stage only, reddened, slightly raised patches appear on the surface of the scalp. It is realized that the amount of serum which reaches the seat of trouble is insufficient to cope with the situation, but every effort is made to limit the extent of the invasion by rushing large amounts of this defensive substance to areas just beyond the spread of the parasites. This accounts for the redness and elevation of the border of these patches.
So far, the parasites are near the surface, but they do not remain in this location indefinitely, for they spread downward into the deeper parts of the skin, searching to enter hair sacs. After reaching their goal, they grow and multiply within these sacs. Their first effort is to break up the firm union between the hair and its sac, as this step is necessary for the devitalization of the hair. Once this is accomplished, the parasites grow and multi-ply in the spaces between these two structures, after which they are prepared to deal with the hair itself.
When a mechanic wants to build a new entrance into a house, he first makes a hole in the wall and then proceeds to install the door. The ringworm parasites proceed in exactly the same manner. They desire to break an entrance into the hair, so they send the young and vigorous parasites (giant spores) who work so quickly and with such force that they succeed in breaking the outer tough coating of the hair. With their entrance, it is but a short while when the other parasites follow, and soon they are seen growing within the hair as well as along its wall. It is fortunate that the progress of these parasites stops short of the living portion of the hair and at this point they present a fringe-like arrangement called the "fringe of Adamson," after an English dermatologist who recorded this observation. By this time, the hair is thoroughly devitalized and may fall or appear as a short stump; it is easily extracted and is clothed with masses of the parasitic growth, after the manner of a sheath.
If a patch of ringworm-infected scalp were to be inspected at this stage, the outstanding features would be the absence of marked redness, a rather definite border, considerable scaling representing nature's effort to rid herself of the damaged cells, more or less hair fall, here and there, wide-open mouths of hair sacs and gnawed-off stumps of hair, white and thickened. This is the picture of this disease usually seen in the United States and England.
A number of years ago, Dr. Wallace devisee a very simple test for the recognition of ringworm of the scalp, based on the fact that, in this condition, the hair can be extracted with ease. This consisted in taking a piece of absorbent cotton, wetting it with alcohol and then rubbing the parts in question. If much hair appeared on the cotton, ringworm was believed present, and if not, ringworm was supposed to be absent.
There are other forms of ringworm of the scalp. In one variety, there is only a thinning of the hair with more or less scaling, suggesting a condition of dandruff. Sometimes, either as a result of added infection with pus-producing germs, or overtreatment, or because of the extraordinary strength of the parasites, ringworm presents a picture highly suggestive of carbuncles, except that the gnawed-off hairs, characteristic of this disease, are also present.
Course.—The duration of ringworm of the scalp varies from a number of months to a year or two, or even longer, depending upon the response to treatment.
The Contagiousness of Ringworm Infection.—Ringworm of the scalp is very contagious, indeed, at times it may become widely prevalent in the community. It is particularly common in children's schools and institutions, in "homes," day nurseries, and other charitable institutions, where the opportunities for exposure and contact are great. Barber shops, hairdressing and beauty parlors, and laundries furnish many opportunities for the spread of this disease. Hair brushes, combs, and particularly the patent hair clippers are also active spreaders. The ringworm germs are so strong that they can live in the seams of a cap or hat, so that exchange of hats or caps, so common among children at play, is a frequent means of spread. It can also be spread through contact with infected domestic animals such as the cat, dog, horse or cow. Cats having mangy hair, which can be easily pulled out, usually have ringworm.
Suggestions for Prevention and Treatment.—As ringworm of the scalp is contagious, it is of the greatest importance to stop its spread. All the clothing touching the diseased part should be sterilized before use. All the towels, linens, as well as combs and brushes, should be thoroughly sterilized and should be used only by the infected person. In ringworm of the scalp, the mother should be instructed to put clean pieces of white paper in the child's cap, changing them daily and burning each piece as it is removed. In this way the liability for the spread of the disease to unaffected parts of the scalp is reduced. The scalp should be washed daily with soap and water, and the hair cut short. The child should be kept out of school so as not to endanger others. Where there are other children, great precautions must be used as to combs, brushes, caps, etc., so as to lessen the risk of transmission.
These closing remarks are addressed to the 'parents as a warning of their responsibility in looking after the scalp and hair of their children of school age, and in paying attention to all areas of scaling patches, unless these disappear very promptly. Ringworm of the scalp often begins most innocently and with only slight scaling and redness. At this stage, treatment achieves brilliant results, rather quickly. Once the parasites obtain a foothold in the hair sacs, their eradication is most difficult and the treatment a prolonged one. Picture a household with a number of children, one of whom is afflicted with ringworm of the scalp! Look at the care this child requires, the constant watch necessary over the other children for fear that they may contract this disease, the worry over the possibility of permanent hair loss, the neglect of the child's education, and figure the penalty which is paid for ignorance and neglect!
The treatment of ringworm of the scalp requires the services of a skin specialist.