TE vs Tinea Capitis
Reviewed by
Steven P., FAAD
Board-certified dermatologist
Updated on
Reviewed for accuracy
Table of Contents
What is Tinea Capitis?
Tinea capitis is a fungal infection of the scalp that primarily affects children but can occur in adults as well. It is caused by dermatophyte fungi, which invade the hair shaft and scalp skin. This infection leads to patchy areas of hair loss, often accompanied by scaling, redness, and sometimes itching. The hair in affected areas may break off at the scalp, leaving behind short stubs or “black dots.”
The condition is commonly known as “scalp ringworm,” though it is not caused by a worm but by fungi. Tinea capitis is contagious and can spread through direct contact with an infected person, sharing personal items like hats or combs, or from contaminated surfaces. Prompt diagnosis and treatment are essential to prevent permanent hair loss and limit the spread of infection.
2-3 Months
6-12 Weeks
50-100 Hairs
Patchy vs Diffuse
Telogen Effluvium vs Tinea Capitis
Causes
Telogen effluvium is typically triggered by a significant physical or emotional stressor, such as a major illness, surgery, childbirth, or sudden hormonal changes. It can also result from certain medications, nutritional deficiencies, or underlying medical conditions. The stress causes more hair follicles than usual to enter the resting (telogen) phase, leading to increased shedding across the entire scalp.
In contrast, tinea capitis is caused by a fungal infection of the scalp. The fungi invade the hair shaft and scalp skin, resulting in localized inflammation and hair breakage. Unlike TE, tinea capitis is infectious and can be transmitted between individuals, especially in crowded environments or among children who share personal items.
Symptoms
The symptoms of telogen effluvium include diffuse hair thinning over the scalp without obvious bald patches. Hair may be seen on pillows, in the shower, or on hairbrushes. The scalp usually appears healthy without redness or scaling.
Tinea capitis, on the other hand, presents with patchy hair loss, areas of broken hairs, and visible scaling or flaking of the scalp. Itching and mild discomfort may also be present. In some cases, swollen lymph nodes in the neck may develop due to the infection.
Who is affected?
Telogen effluvium can affect people of any age or gender, though it is often seen in women following childbirth or in individuals experiencing significant stress or illness. It is not contagious and does not spread between people.
Tinea capitis most commonly affects children, especially those in close-contact settings such as schools or daycare centers. However, adults can also develop the infection, particularly if they have weakened immune systems. The contagious nature of tinea capitis makes it more likely to spread within families or communities.
Fungal Scalp Infection vs TE: Comparing the Causes
The underlying causes of telogen effluvium and tinea capitis are fundamentally different. Telogen effluvium is a reaction to a systemic event or internal imbalance, such as major surgery, severe illness, hormonal shifts, or nutritional deficiencies. These triggers disrupt the normal hair growth cycle, pushing a large number of hair follicles into the resting phase at once.
Tinea capitis, in contrast, is caused by dermatophyte fungi that infect the scalp. The infection can be acquired from direct contact with an infected person, animal, or contaminated objects. Unlike TE, which is not infectious, tinea capitis can spread through shared hats, combs, or bedding. The fungal invasion leads to localized inflammation, hair breakage, and scaling.
Ringworm Hair Loss: What Does It Look Like?
Hair loss from tinea capitis, also known as ringworm of the scalp, typically appears as round or irregular patches where hair has broken off near the scalp. These patches may have a scaly or flaky surface, and the skin underneath can appear red or inflamed. The broken hairs often look like black dots, which is a classic sign of this fungal infection.
In some cases, the affected areas may be tender or itchy, and severe infections can cause swelling or pus-filled lesions. The pattern of hair loss in tinea capitis is distinctly patchy, unlike the diffuse thinning seen in telogen effluvium. Recognizing these visual differences is important for accurate diagnosis and timely treatment.
Signs and Symptoms: Scaling, Itching, and More
Signs of Telogen Effluvium
Telogen effluvium is characterized by increased hair shedding that is usually noticed all over the scalp. Individuals may observe more hair than usual on their pillow, in the shower, or when brushing. The hair loss is diffuse, meaning it affects the entire scalp rather than specific patches.
The scalp in TE typically appears normal without redness, scaling, or significant itching. There are no visible bald spots, and the hair loss is often temporary, resolving once the underlying trigger is addressed.
Signs of Tinea Capitis
Tinea capitis presents with patchy areas of hair loss, often accompanied by scaling or flaking of the scalp. The affected skin may be red, inflamed, or itchy. Broken hairs that resemble black dots are a hallmark of this condition. In some cases, the infection can cause swollen lymph nodes in the neck or behind the ears.
Severe cases of tinea capitis may lead to the formation of kerion, a boggy, pus-filled swelling on the scalp. Early recognition of these signs is important to prevent permanent hair loss and to reduce the risk of spreading the infection to others.
Diagnosis: How Doctors Tell Them Apart
Tests and Examinations
Diagnosing telogen effluvium and tinea capitis begins with a thorough medical history and physical examination. For TE, doctors assess recent stressors, illnesses, medications, and nutritional status. The pattern of hair loss is also evaluated, with diffuse thinning suggesting TE.
In tinea capitis, the presence of patchy hair loss, scaling, and broken hairs raises suspicion for a fungal infection. A dermatologist may use a special light (Wood’s lamp) or examine the scalp closely to look for signs of infection. Additional tests may be needed to confirm the diagnosis.
When Scalp Culture Is Used
If a fungal infection is suspected, a scalp culture or microscopic examination of plucked hairs may be performed. This involves taking a sample of hair or scalp skin and sending it to a laboratory to identify the specific fungus. A positive culture confirms tinea capitis and helps guide treatment.
Scalp cultures are not typically needed for telogen effluvium, as TE is not caused by an infection. However, blood tests may be ordered to rule out nutritional deficiencies or underlying medical conditions if TE is suspected.
Treatment Options for TE and Tinea Capitis
The treatment approach for telogen effluvium focuses on addressing the underlying cause. If the hair loss is due to a recent illness, surgery, or stress, hair regrowth typically occurs once the trigger is resolved. No specific medication is usually required for TE, but optimizing nutrition and minimizing hair trauma can support recovery. In cases related to medication side effects, discontinuing or changing the drug may help.
Tinea capitis requires antifungal therapy to eliminate the infection. Oral antifungal medications such as terbinafine, griseofulvin, or itraconazole are commonly prescribed, often for at least 6 to 12 weeks. Medicated shampoos containing selenium sulfide or ketoconazole may be used alongside oral treatment to reduce fungal spread. Early treatment is important to prevent permanent hair loss and reduce transmission.
Preventing Hair Loss From Both Conditions
Preventing telogen effluvium involves minimizing physical and emotional stress, maintaining a balanced diet, and avoiding unnecessary hair trauma from styling or harsh chemicals. Addressing underlying medical conditions and ensuring adequate intake of nutrients like protein, iron, zinc, and biotin can also help reduce the risk of TE.
To prevent tinea capitis, good scalp hygiene is essential. Avoid sharing hats, combs, brushes, or bedding with others, especially in communal settings. Regularly washing hair and keeping the scalp clean can lower the risk of fungal infection. Prompt treatment of infected individuals and thorough cleaning of personal items can help prevent outbreaks.
FAQ
Can both conditions happen at once?
While telogen effluvium and tinea capitis have different causes, it is possible for someone to experience both conditions if they are exposed to the respective triggers. For example, a person under significant stress who also contracts a fungal scalp infection could develop both types of hair loss.
Is tinea capitis contagious?
Yes, tinea capitis is a contagious fungal infection. It can spread through direct contact with an infected person, sharing personal items, or contact with contaminated surfaces. Preventive measures include good hygiene and avoiding shared hair care items.
Does telogen effluvium cause scalp scaling?
No, telogen effluvium does not typically cause scaling or redness of the scalp. The scalp usually appears healthy, and the main symptom is diffuse hair shedding. Scaling is more characteristic of tinea capitis or other scalp conditions.
How long does recovery take for each?
Recovery from telogen effluvium often begins once the underlying trigger is resolved, with hair regrowth occurring over several months. For tinea capitis, antifungal treatment is required for at least 6 to 12 weeks, and hair regrowth may be slow, especially if the infection was severe.
Can adults get tinea capitis?
Although tinea capitis is more common in children, adults can also be affected, particularly those with weakened immune systems or close contact with infected individuals.
Are swollen lymph nodes a sign of infection?
Swollen lymph nodes in the neck or behind the ears can occur with tinea capitis, especially if the infection is severe. This is a sign that the body is responding to the infection.
What specialist treats these disorders?
Dermatologists are the specialists who diagnose and treat both telogen effluvium and tinea capitis. They can provide guidance on appropriate testing, treatment, and prevention strategies.
Fact Checked
Updated: December 30, 2025
Reviewed for accuracy against authoritative clinical sources and peer reviewed dermatology references. Educational content only.
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Reviewed by
Steven P., FAAD
Board-certified dermatologist
Updated on
Reviewed for accuracy
