Monthly Archives: April 2011

RingWorm of the Scalp – Tinea Capitis

Ringworm also known as Tinea or Dermatophytosis is actually a fungal infection of the skin. So why is it called ringworm, I hear you ask? The Ancient Greeks called it Herpes (which means circular or ring form) and the Romans associated the disease with the larval stage of Tinea, which is the genus for clothes moth. The two names were eventually combined to form the word “ringworm” before the actual cause of ringworm was known in the early 1800s.

Ringworm is given a specific name is depending on which area of the body is affected. The list below lists the various areas of the body that can be affected with ringworm (tinea) and the name given. In this article Tinea Capitis will be covered in the most detail.

Areas of the body where Ringworm can be found.

Head-Tinea Capitis
Beard -Tinea Barbae
Body- Tinea Corporis
Groin-Tinea Cruris
Face- Tinea Faciei
Hand-Tinea Mannuum
Foot-Tinea Pedis (“athlete’s foot”)
Nail-Tinea Unguium (Onychomycosis)

The fungi involved in Tinea Capitis are saprophytic T tonsurans fungi. These fungi are able to invade and break down the keratinized tissues of the skin, hair and nails. Their keratinophilia (keratin loving) behaviour allows them to use keratin as a growth substrate (food). Tinea Capitis can be a highly contagious infection. Whether or not a person becomes infected depends on the individual’s age and the strength of their immune system. For example a young child may easily contract scalp ringworm and spread it to other children

Clinical features of Tinea Capitis
As mentioned above the fungus that is the current predominant cause of tinea capitis is T. tonsurans. Scalp infections caused by this fungus are hard to diagnosis because of the wide and varying clinical presentations. However there are six main features to look out for:

•Grey Type-Grey circular patches of alopecia with scaling scalp.
•Black dots- This is where the hair has broken off at the scalp, leaving small lengths of hair shaft above the surface of the hair. The broken hair shafts appear as small dots on the surface of the scalp within angular patches of alopecia.
•Kerion- This results from a marked inflammatory response to the fungi. The scalp is usually boggy and swollen. Patients with kerion often have associated enlarged lymph nodes in the neck (cervical lymphadenopathy) or face.
•Diffuse pustular pattern-Pustules are seen scattered across the scalp. Painful lymphadenopathy may also be present.
•Moth Eaten- This appears as patchy hair loss with scaly scalp.
•Diffuse scale-This clinical feature can resemble dandruff. The scalp has widespread scale.

Treatment/ Management
Treatment for Tinea Capitis requires systemic antifungal drugs. The use of antifungal creams is unable to penetrate the hair shaft, and hence is not used to treat this infection.
If you suspect Tinea Capitis please visit your GP.

Hair Breakage and Chemical Procedures

Chemical Procedures and Hair Breakage
Chemical procedures such as hair permanent hair dyes, bleaching, relaxers and perms can cause hair breakage. Below briefly describes common chemical procedures and how they could potentially cause hair breakage.

1.Permanent Hair dyes
Permanent colour contains an oxidising (hydrogen peroxide) agent, an alkalizing agent (ammonium hydroxide) and a pigment. The ammonium hydroxide opens up the cuticle by raising the pH to 8-9.5 allowing the pigment molecules to enter into the hair shaft. Ammonia also decomposes hydrogen peroxide into oxygen. The oxygen released from the hydrogen peroxide breaks down the melanin in the hair producing oxy-melanin, which is colourless. Large pigment molecules are produced when the pigment comes into contact with the oxygen released from the hydrogen peroxide. These large molecules of pigment are unable to leave the hair shaft and this results in permanent hair colour within the hair shaft.

A) Melanin+ Nascent Oxygen (released from hydrogen peroxide) =Oxy-Melanin (colourless)

B) Oxy-Melanin + Pigments (from hair dye) =Permanent hair colour.

Figure. 1

The potential hair damage from permanent hair colouring arises when it is done too often or done without subsequent conditioning afterwards or carried out on weak hair to start with. The hair can become dry and brittle which can result in hair breakage.

2. Bleaching
Hydrogen peroxide is used to de-colourise the natural pigments in the hair. Ammonium hydroxide is also used in the process to speed up the release of oxygen from the hydrogen peroxide and to swell and open up the cuticle to allow the hydrogen peroxide to enter the hair shaft.
The damage done to hair during bleaching is listed below:

• Permanent loss of disulphide Bonds
Oxidation of cystine to cysteic acid in the disulphide bonds results in reduced tensile strength of the hair, which makes it more susceptible to breakage.
• Cuticle damage
If overlapping occurs during retouching then cuticle damage can occur. The cuticle can become rough and break away resulting in weak porous hair.
• Breakage of Polypeptide chains
Over bleaching can break polypeptide bonds in the hair which will result in hair shaft breakage.

3. Perming
During the perming process, hair bonds are broken through a chemical reaction called reduction. The reducing agents used in perms are called thiol compounds, usually ammonium thioglycollate is used. Another chemical used in perming is ammonium hydroxide, this opens up the cuticle to allow the thioglycollate to penetrate the hair shaft.
Once thioglycollate is in the cortex of the hair, it breaks the disulphide bonds in the hair by adding hydrogen atoms. The broken bonds are then reformed around perm rods (rollers) by oxidation using hydrogen peroxide.
Hair breakage during and after perming can be a result of the following:

• Cuticle damage caused when the ammonium hydroxide is applied the hair.
• Loss of protein during over- oxidation of the hair and lack of subsequent conditioning.
• Too much tension applied to the hair as it is curled around the rollers.
• Over-processing (reduction) results in too many cystine bonds broken. These broken bonds weaken the hair and make it susceptible to breaking.
• Over-neutralising with hydrogen peroxide results in cystine changing to cysteic acid which does not form linkages.

4. Relaxing
There two types of relaxers available, one type contains sodium hydroxide also known as lye relaxers and the other ‘No lye’ relaxer is based on two ingredients; calcium hydroxide and guanidine carbonate. The two ingredients in ‘No Lye’ relaxers are added together to form the alkaline relaxer (see fig 2 below).

Calcium hydroxide + guanidine carbonate →guanidine hydroxide (alkaline relaxer) + calcium carbonate

Relaxers break the disulphide bonds by a process called hydrolysis. The hair is permanently straightened and left very alkaline. When the relaxing process is complete the relaxer must be rinsed off using an acid balanced shampoo to neutralise the hydroxide ions and lower the pH of the hair.
Relaxers are very harsh alkaline chemicals which can cause breakage of the hair because of the following reasons:

• Relaxed hair is torsionally stressed and can break easily.
• Incomplete rinsing of the hair could leave the hair alkaline and result in dry brittle hair that breaks easily.
• Incorrect relaxing solutions and timing mistakes could also cause hair breakage. If relaxers are too alkaline and left on the hair too long they could have a depilatory action.
• Lack of conditioning treatments following relaxing.

Figure 3 on the left shows hair breakage on a black person who has had their hair relaxed.

The chemcials used in these procedures can be seriously damage your hair. Please make sure if you have any of the above procedures that they are carried out by a fully qualified professional.

J Norris-property of Roots2Ends

Types of Hair Breakage

Hair breakage is not an uncommon thing to see on a daily basis, but there are different types and causes. The common types and their causes are covered below:

1.Idiopathic Trichoclasia (Gk-Thrix-Hair, Klasia-Breakage)
As the name suggests this type of hair breakage arises spontaneously or from an obscure unknown cause (idiopathic).
This hair condition is not classified to any particular age or nationality.The cause is usually attributed to harsh brushing or scratching of scalp.

2.Monilethrix (Latin-Monile-Necklace, GK-Thrix-Hair).
This hair breakage condition is also known as “beaded hairs” hence the name Monilethrix, because the hair can resemble beads on a necklace.
The hair is characterised by beaded hair fragile hair. This can be a lifelong disease which can spontaneously improve after puberty or during pregnancy.
This hair condition is often seen in infancy. It is not more prevalent in any sex or nationality.
This condition is due to a mutation in human hair keratin gene.

• The hair is fragile with varying degrees of breaking and alopecia
• The hair breaks to 0.5-2.5 cm and appears to be burnt 1.
• Usually occurs on scalp hair but can occasionally be seen in hair on other parts of the body such as the eyelashes, eyebrows, auxiliary and limb hairs.
• Lanugo hair appears normal after birth but is replaced after a few months with moniliform hair which is fragile, dry and lustless

There is currently no treatment for this hair condition, although retinoids, acitretin and minoxidil have shown limited and variable success. To minimise hair breakage, individuals with this hair condition should avoid hair trauma and chemical processing of the hair.

This is a self induced hair condition, in which the individual breaks of his or her hair. This condition is usually seen in neurotic patients hence the ‘mania’ part of word.


This condition is commonly known as ‘split ends’ (splitting of the hair shaft).
Below list the common causes of Trichoptiliosis:
• Over use of chemical treatments (relaxers, perming lotions, hair dyes)
• Excessive styling products especially products with high levels of alcohol (alcohol has the tendency to dry the hair out making it more susceptible to splitting).
• Heat damage (hairdryers, tong, flat irons etc)
• Improper detangling tools
• Improper detangling techniques
• Over washing

Regular trims help to prevent split ends and subsequent breakage.

5. Trichorrhexis Nodosa (Gk-Orrhexis-rupture, breaking, Nodosa-Nodes)

the picture shows Trichorrhexis Nodosa-fraying is seen at the site of a nodule or node.
This hair condition is diagnosed when small white dots are seen along the hair shaft.The hair will break very easily at these nodes.
Trichorrhexis Nodosa can either be caused by trauma (such as excessive brushing, back combing, heat styling or chemical procedures) or it can be congenital.

Treatment is aimed around minimising trauma to the hair from both chemical and physical avenues.