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Column originally published Oct 12, 2004
Column last revised/updated on Sep 7, 2018

Treatment Of Fungal Infection Can Take A Long Time

Question: Our five-year-old son was recently admitted to the hospital with a painful swelling on the top of his head. After some tests, the doctor told us that he has a fungal infection and he has to take a medicine for six weeks. We live on a dairy farm, and he likes to help out when we milk the cows. A few months ago, both of us had ringworm on our arms and body. We used a cream that we picked up from the pharmacy and quickly got better. The doctor told us that he likely picked up the infection from our cows, but his infection was much more serious than ours. Both of us wonder whether this is at all possible.


I have to agree with your doctor. Your son most likely has the medical condition called tinea capitis. It is a fungal infection of the scalp.

Of the thousands of fungal species in the world, about 100 to 200 of them can infect humans. The most common and best known fungal infection is Candida, which causes yeast infections in the mouth (this is called oral thrush), and in the diaper area of young infants. Candida can also cause yeast infection in the female genitalia.

More serious fungal infections of the lungs, the brain, and other internal organs are much less common. They tend to occur in those whose immunity has been suppressed by chemotherapy and other cancer treatments.

Fungus infection of the skin, on the contrary, is fairly common. There are around 40 different species of fungus that can cause human infections. Some of them can infect humans only, while others are present in the soil and we pick up the infection by accident. Many of them, however, primarily infect animals like cats, dogs, and cattle. Unfortunately, when humans come into contact with infected animals, we can pick up the fungi and develop skin infections.

Depending on the part of the body that is infected, various medical terms have been used to describe fungal infection of the skin. If the infection is on the scalp, it is called tinea capitis (capitis means head). When the infection is on the body, the arms, or the legs, it is called tinea coporis. Tinea pedis describes infection of the feet, while tinea manuum means infection of the hands. If infection is restricted to finger and toe nails, it is called onychomycosis. So much for medical terminology!

Tinea capitis is an infection that seems to affect children only. The same species may infect an adult, but doesn’t cause serious infection on the scalp. However, children tend to suffer much more serious scalp infection.

When a person is infected with a fungus, it invades the skin by spreading branches between skin cells. These branches are called hyphae. The fungus can reproduce and spread the infection to another person by producing spores. These spores are very hardy and can stay alive for many months.

When the spores land on the skin of a person, they become attached to the skin cells and, within hours, germinate and invade the skin. The initial infection is very slow, and it probably takes weeks to establish an infection to the point that one can recognize that an infection is going on.

In your family’s situation, it is very likely that some of your cows have fungal infection, and you might not even have noticed it. You also could have picked up the infection from some other animals on the farm, especially the barn cats, which are present on most farms.

Regardless, it does appear that both of you were infected in the last few months. Whether your son picked up the fungal infection from one of you, or from infected cattle when he was helping to milk the cows, or even from other farm animals, would be very difficult to prove.

In the early stages, tinea capitis can appear as a dry patch on the scalp. Some of the hairs can be broken off. However, the infection can progress over time into a large swelling that is very red and somewhat tender. This swelling is called kerion. The hair over the kerion can break off very easily, and the scalp becomes very soft and friable. Unfortunately, because the kerion is tender, most children would resist examination by parents and doctors.

Most of the time, this kerion is caused by the body’s reaction to the fungus infection, although occasionally secondary bacterial infection can set in, requiring drainage of the pus.

Fungal infection of the body, the hands, and the feet can be treated with topical anti-fungal medicine that one can pick up from the local pharmacy. These infections are generally more superficial, and local treatment is enough to kill off the fungus.

Tinea capitis, however, is a much deeper infection, especially when it has progressed into a swelling. Local treatment is ineffective, and would only prolong the infection. Treatment of tinea capitis require anti-fungal medicine by mouth, which is absorbed into the blood stream, and then distributed to the deeper layers of the scalp to fight the fungal infection.

The old standard treatment is a medicine called griseofulvin. It is very effective, but it takes two to three months to eradicate the fungus. Because there is little demand for this medicine in recent years, drug companies are not manufacturing it in Canada any more.

Newer medicines, including itraconazole and terbinafine, are much more effective. They can be taken once a day, and can cure tinea capitis in about 6 weeks. Unfortunately, both of them are rather expensive.

I should mention here that fungal infection of the nails (onychomycosis) can be treated with anti-fungal medicine applied directly to the affected nails.  The treatment is quite long, and recurrence can still occur.

You may wonder whether it is possible to prevent fungal infection. The short answer is both yes and no. Fungi that infect humans can be found in the soil, in other animals, as well as other people that we encounter every day. Sharing of towels, for example, can spread fungus from one person to another. One can pick up fungal infection by using another person’s comb. Therefore, avoiding sharing personal items can decrease human to human spread of fungal infection.

I hope I have given you some information about fungal infection, and especially about scalp infection in your son’s situation. It is important to remember that you have to give him long enough treatment with the medicine that your doctor has prescribed, otherwise the infection can come back within a short period of time.