I saw a 4 year old lad in A and E last week and noticed incidentally that he had scalp ringworm.  Apparently his mum has been faithfully using an antifungal shampoo for 2 years and shaving his head intermittently but the scaliness and little spots keep coming back.  Hence featuring the management of tinea capitis in September’s Paediatric Pearls as a reminder.  Most of the infections in this area are caused by Tinea tonsurans, a dermatophyte which lives in the hair shaft and thus well protected from any shampoos people try to throw at it.  Treatment is systemic, not topical, and the only licensed treatment in children is oral griseofulvin.   There are a few new papers around documenting incidence and the different organisms that cause tinea but not much has changed from a management perspective since the 2000 guideline which is available in full from the British Association of Dermatologists’ website.  Don’t be put off by its being listed under “BAD guidelines”…    www.bad.org.uk/Portals/_Bad/Guidelines/Clinical%20Guidelines/Tinea%20Capitis.pdf