Ringworm is a fungal infection and can occur anywhere on the body, but if it develops on the scalp it can cause patches of hair loss (tinea capitis). Ringworm is the same thing as athlete’s foot, and the same kind of fungal infection can affect the nails too. Ringworm of the scalp usually begins 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, scaly patches that may blister and ooze. The patches are usually redder around the outside with a more normal skin tone in the center. This may create the appearance of a ring, hence the name, ringworm. Ringworm is contagious (can be passed from one person to the next by direct skin-to-skin contact). You can also catch ringworm through contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces. Treatment: Griseofulvin is very effective against fungi in hair and skin but it is not so good at treating yeast or bacterial infections. It binds with keratin which is a key component of hair, skin and nails. The Griseofulvin blocks the fungus from infecting the keratin. If resistant to Griseofulvin, newer anti-fungal drugs like Terbinafine, Itraconazole, and Fluconazole can be prescribed.
Folliculitis is a bacterial, fungal and viral infection that causes focal inflammation of hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle. In the early stages of a folliculitis the hair fiber may still be present in the middle of the folliculitis, but as the folliculitis progresses the hair often falls out. When folliculitis is severe, the inflammation is so intense that it can actually permanently destroy the hair follicles, leaving little bald patches. Staphylococcus aureus is a common cause. "Hot tub folliculitis" is caused by Pseudomonas aeruginosa which grows in inadequately chlorinated water. It is also possible to have viral, fungal, or yeast induced folliculitis involving Herpes simplex, Herpes zoster, Pityrosporum ovale, Trichophyton rubrum and other causative agents. Treatment: topical antibiotics like bacitracin, mycitracin, or neomycin can be used to treat minor folliculitis. For more serious infections oral antibiotics such as erythromycin, or griseofulvin if the infection is fungal in nature, may be used.
Demodex folliculorum is a little worm-like creature that likes to live on skin and in hair follicles. Demodex feeds on dead skin and oils, so it particularly likes to live in hair follicles where there are lots of both. About 70% of adults have some Demodex in their hair follicles. For the most part, we never know they are there. The most common problem with Demodex is that they may cause irritation, particularly in the eyelashes. If you have itchy eyelashes it may be Demodex is the problem. However, this is as much as Demodex can do to you. It does not cause hair loss. Treatment: debridement and eradication of the Demodex.
Seborrheic dermatitis is not an infectious disease. It is first and foremost a skin condition, but it can also involve temporary hair loss if the dermatitis is located on the scalp or other terminal-haired skin areas. The dermatitis presents as scaly, sometimes oily, inflamed skin that can be itchy or even painful to touch. This is an inflammatory condition the cause of which is not well understood, although there does seem to be a genetic component and Caucasians, particularly of Celtic descent, are most susceptible. It seems that the sebaceous glands attached to the hair follicles begin to produce a very rich form of sebum. The sebum contains fewer free fatty acids and squalene but increased amounts of triglycerides and cholesterol. Times of hormonal fluctuation, such as during puberty, can activate the onset of seborrheic dermatitis. Conditions including Parkinson's disease, head injury, and stroke can also be associated with seborrheic dermatitis, and things like stress and chronic fatigue can make it worse. Treatment: anti-dandruff type shampoos to control the skin proliferation and scaling. Shampoos for seborrheic dermatitis may contain sulfur, selenium sulfide, zinc pyrithione, tar, salicylic acid, or oil of Cade or Ketoconazole (Nizoral). The inflammation may be directly treated using a corticosteroid cream or lotion to control the immune response.
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