Tinea capitis typically appears as one or more round, scaly patches of hair loss on the scalp. The patches often have a grayish or white scale, and within them you may notice hairs that have broken off right at the skin’s surface, leaving behind small dark dots. Beyond this classic look, the infection can take several different forms depending on how the fungus invades the hair and how strongly your immune system reacts to it.
The Classic “Black Dot” Pattern
The most recognizable form of tinea capitis is the black dot pattern. The fungus grows inside the hair shaft, weakening it until it snaps off flush with the scalp. Those tiny stumps of broken hair look like dark dots scattered across a patch of bare skin. The surrounding scalp is usually covered in fine, grayish-white flakes. These patches tend to be roughly circular, sometimes described as resembling a monk’s tonsure (the shaved circle on top of the head). You might have one patch or several, and they can gradually widen over weeks.
Itching ranges from mild to intense. Some children scratch enough to cause redness and mild swelling, which can make the patches look more irritated than they would otherwise.
Gray Patch Pattern
In another common presentation, hairs don’t break off at the surface but instead snap a few millimeters above it, leaving short, dull-looking stubs across a scaly patch. The scale tends to be more prominent here, sometimes thick and white-gray, and the remaining hairs look coated or dusty. This happens when the fungus destroys the outer layer of the hair shaft rather than growing purely inside it, making the hair brittle and chalky in appearance.
Kerion: The Severely Inflamed Form
A kerion is what happens when the body mounts an aggressive immune response against the fungus. It starts out looking like a typical dry, scaly patch, but over days it transforms into a swollen, boggy mass that’s tender to touch. The surface becomes studded with small pustules and may develop honey-colored or bloody crusts. Pressing on the swollen area can release pus, and the whole lesion feels soft and spongy rather than firm.
Because a kerion looks so angry and infected, it’s often mistaken for a bacterial abscess. The key difference is that it develops from a fungal infection and the inflammation is driven by the immune system’s overreaction, not just bacteria. Swollen lymph nodes behind the ears or along the back of the neck frequently accompany a kerion. Without treatment, this form can cause permanent scarring and hair loss in the affected area.
Favus: The Rare Crusted Form
Favus is an uncommon but distinctive variant. It produces yellow, saucer-shaped crusts (called scutula) that form around individual hair follicles. Each crust is cup-like, with a dull gray hair poking through the center and red skin visible beneath. The crusts are made of packed fungal material and dead skin cells. A characteristic feature is a noticeable musty or “mousy” odor coming from the affected scalp. Favus can cause severe scarring and permanent hair loss if it goes untreated for a long time.
How It Differs From Other Causes of Hair Loss
The scaly patches of tinea capitis can look similar to other conditions, especially in children. Alopecia areata, an autoimmune condition, also causes round bald patches on the scalp, but those patches are typically smooth and shiny rather than scaly. Under close examination, alopecia areata produces distinctive “exclamation mark” hairs, which are short hairs that taper and become thinner near the scalp, plus small yellow dots on the skin. Tinea capitis, by contrast, shows comma-shaped or corkscrew-shaped broken hairs and white flaking. Scaling is the single most useful visual clue pointing toward a fungal infection rather than alopecia areata.
Seborrheic dermatitis (dandruff) can also cause flaking, but it doesn’t cause patches of broken hair. Psoriasis of the scalp produces thicker, silvery plaques and rarely leads to hair breakage at the follicle level.
Who Gets It and Where It Shows Up
Tinea capitis overwhelmingly affects children, particularly between ages 3 and 14. It’s uncommon in adults partly because the oils produced by a mature scalp contain fatty acids that inhibit fungal growth. The infection spreads easily through shared combs, hats, pillows, and direct head-to-head contact, which is why outbreaks happen in schools and households.
Patches can appear anywhere on the scalp but tend to favor the crown and sides. In some cases, the infection spreads to the eyebrows or eyelashes.
What Diagnosis Looks Like
A doctor may use a Wood lamp (a handheld ultraviolet light) to examine the scalp in a darkened room. Certain fungal species cause infected hairs to glow blue-green under this light, which makes the extent of the infection immediately visible. However, the most common species in many regions does not fluoresce, so a normal Wood lamp exam doesn’t rule out tinea capitis. In those cases, a scraping of scale or a plucked hair is sent for microscopic examination or fungal culture to confirm the diagnosis.
What Treatment Involves
Tinea capitis requires oral antifungal medication because topical creams and shampoos can’t penetrate deep enough into the hair follicle to clear the infection. Treatment length depends on the specific fungus involved. For the most common type, oral treatment typically lasts 2 to 4 weeks. For other species, treatment may extend to 8 to 12 weeks. An antifungal shampoo is often used alongside oral medication to reduce shedding of fungal spores and limit spread to others.
Hair regrowth in the affected patches usually begins within a few weeks of starting treatment, though it can take several months for the area to look fully normal. If a kerion developed, some permanent thinning or scarring in that spot is possible even after the infection clears.