Can you attend school with ringworm (tinea infection)?

Can You Attend School with Ringworm?

Yes, children with ringworm should be allowed to attend school once appropriate treatment has been started, and school exclusion policies should be abandoned for most ringworm infections. 1

School Attendance Guidelines by Type of Ringworm

Tinea Capitis (Scalp Ringworm)

• Children receiving appropriate systemic antifungal therapy plus adjunctive topical treatment should be allowed to attend school or nursery. 1
• Most experts consider school exclusion impractical and unnecessary once treatment has begun. 1
• The American Academy of Pediatrics suggests a minimum of 2 weeks of systemic antifungal therapy before returning to school, though the British Association of Dermatologists takes a more permissive approach allowing return once treatment is initiated. 2
• Children should be discouraged from close head-to-head contact with classmates but do not need to be sent home. 1

Tinea Corporis (Body Ringworm)

• The American Academy of Pediatrics recommends staying out of school for a minimum of 72 hours after starting topical or systemic antifungal therapy, with lesions covered thereafter. 2
• This is a more conservative approach than for scalp ringworm, likely due to the ease of covering body lesions.
• Students should not participate in contact sports or swimming until lesions are covered and treatment has been initiated. 2

Tinea Pedis (Athlete's Foot) and Tinea Cruris (Jock Itch)

• No school exclusion is required for general attendance. 2
• Students should be excluded from swimming pools until treatment has been initiated. 2

Critical Treatment Requirements Before School Return

Systemic Therapy for Tinea Capitis

• Oral antifungal treatment is mandatory for scalp ringworm as topical therapy alone is ineffective. 1
• First-line options include griseofulvin or terbinafine, with treatment duration typically 2-8 weeks depending on the causative organism. 1
• Adjunctive topical antifungal shampoo (such as ketoconazole or selenium sulfide) should be used to reduce spore shedding. 1

Topical Therapy for Body Ringworm

• Topical antifungals (azoles, allylamines, or benzylamines) are generally sufficient for tinea corporis and cruris. 3, 4
• Treatment duration is typically 2 weeks for body and groin infections, and 4 weeks for foot infections. 4

Household and Environmental Management

Family Screening and Treatment

• More than 50% of family members may have occult infection, particularly with anthropophilic species like Trichophyton tonsurans. 1
• Screen all household members and close contacts, treating those who are positive to prevent reinfection. 1, 2
• Failure to treat the entire household results in high recurrence rates. 1

Environmental Decontamination

• Clean hairbrushes, combs, and other personal items with disinfectant such as bleach or 2% sodium hypochlorite solution. 1, 2
• Do not share towels, clothing, or personal items during active infection. 5

Common Pitfalls to Avoid

No-Nit Policies Are Inappropriate

• While the evidence provided focuses on head lice rather than ringworm, the principle of avoiding unnecessarily restrictive exclusion policies applies to both conditions. 1
• Prolonged school exclusion causes unnecessary educational disruption and is not supported by transmission data. 1

Ensure Adequate Treatment Duration

• The endpoint of treatment should be mycological cure, not just clinical improvement. 1
• Clinical appearance alone should not determine return to school—ensure the prescribed treatment duration has been completed. 2
• Follow-up with repeat mycology sampling is recommended until clearance is documented. 1

Address Reinfection Sources

• Untreated family members are the major source of reinfection and treatment failure. 1, 2, 5
• Consider treatment failure if there is no clinical improvement after appropriate therapy, but first rule out non-compliance, reinfection from household contacts, or inadequate environmental decontamination. 1

Practical Algorithm for School Return

1. Confirm diagnosis through clinical examination and ideally microscopy or culture. 5
2. Initiate appropriate treatment:
   • Scalp: systemic antifungal + topical antifungal shampoo
   • Body/groin: topical antifungal (systemic if extensive or resistant)
   • Feet: topical antifungal for 4 weeks
3. Allow school attendance:
   • Scalp ringworm: immediately once treatment started (British guidelines) or after 2 weeks (American guidelines)
   • Body ringworm: after 72 hours with lesions covered
   • Foot/groin ringworm: no exclusion needed
4. Screen and treat household contacts to prevent reinfection. 1, 2
5. Clean environmental fomites with disinfectant. 1, 2
6. Follow up until mycological cure is documented, not just clinical resolution. 1