Ringworm

Overview

Ringworm of the body, also known as tinea corporis, is a common fungal infection that appears as an itchy, circular rash with a distinct, clearer area in the centre. Despite its name, ringworm does not involve worms. It is named for its characteristic ring-like appearance.

This condition is closely related to other fungal infections, including athlete's foot (tinea pedis), scalp ringworm (tinea capitis), and jock itch (tinea cruris). It is highly contagious and typically spreads through direct skin-to-skin contact with an infected person or animal.

Mild cases of ringworm usually respond well to topical antifungal treatments, but more severe or widespread infections may require oral antifungal medications for several weeks to ensure effective resolution.

What is Ringworm?

A fungus, not a worm, causes ringworm. This common and contagious skin infection occurs in warm, humid environments like locker rooms and public showers. Its name comes from the red, itchy, ring-shaped rash it creates on the skin. Ringworm spreads easily through close contact with an infected person, animal, or contaminated object.

The infection is named based on the area of the body it affects. When it occurs on the body, it is called tinea corporis, typically appearing on the arms, legs, torso, or face. Treatment for ringworm involves antifungal medications, which are available both over the counter and by prescription.

Types of Ringworm

Ringworm is classified based on the part of the body it affects. Common types include:

Jock Itch (Tinea Cruris): Red, itchy rash in the groin and thighs, often seen in athletes or people who sweat heavily.

Athlete's Foot (Tinea Pedis): Affects the skin between the toes or soles, causing scaly, cracked skin, blisters, itchiness, and odour. It is common in sweaty feet and tight shoes.

Scalp Ringworm (Tinea Capitis): Common in children, it causes an itchy scalp with bald, scaly patches that may expand if untreated.

Nail Ringworm (Tinea Unguium): Thickens, discolours, and weakens nails, often affecting toenails and linked to athlete’s foot.

Beard Ringworm (Tinea Barbae): Causes red, scaly spots, hair loss, and bumps in bearded areas, often from contact with infected animals.

Hand Ringworm (Tinea Manuum): Leads to dry, cracked palms or ring-shaped patches on the back of the hands.

Ringworm Symptoms

The primary indicator of ringworm is a flat, red, scaly patch on lighter skin or a flat brown or grey patch on darker skin. It may also present as itchy bumps that can evolve into a ring- or circle-shaped patch over time. As the infection spreads, multiple rings or patches may develop. The centre of these patches is often clear or scaly, while the outer edge may appear slightly raised and bumpy. In some cases, these bumps can progress to pustules.

The appearance of ringworm varies depending on the affected area, such as the feet, nails, groin, beard area, and scalp. In areas with hair, the infection can lead to hair loss. When it affects the nails, discolouration and breakage may occur. In the groin region, individuals often experience itching.

Causes of Ringworm

Ringworm is extremely contagious and is caused by mould-like parasites, living on the outer layer of the skin. It can spread through several routes:

Soil-to-Human: In rare cases, prolonged contact with highly infected soil can lead to ringworm.

Animal-to-Human: Touching an infected animal, such as a dog, cat, or cow, can transmit ringworm. Petting or grooming infected animals is a common source.

Human-to-Human: Direct skin-to-skin contact with an infected person is the most common way ringworm spreads.

Object-to-Human: Ringworm can spread through contact with contaminated objects or surfaces, including clothing, towels, bedding, combs, and brushes.

How is Ringworm Diagnosed?

Doctors typically diagnose ringworm by examining the affected skin and may use a black light to identify the fungus. Certain types of fungi will fluoresce under the light, helping with detection. To confirm the diagnosis, your doctor may perform additional tests:

KOH Exam: The doctor scrapes a small portion of the affected skin onto a slide and adds potassium hydroxide (KOH). The KOH dissolves normal skin cells, making fungal elements more visible under a microscope.

Skin Biopsy or Culture: A small sample of skin or fluid from a blister is collected and sent to a lab to check for fungal infection.

Treatment Required for Ringworm

Ringworm is treated with antifungal medications available in over-the-counter (OTC) and prescription forms. The choice of treatment depends on the severity and location of the infection.

Oral Antifungal Medications: Severe or widespread infections, including scalp ringworm, may require oral antifungals like Itraconazole (Sporanox®), Griseofulvin (Grisactin®), Terbinafine (Lamisil®) and Fluconazole (Diflucan®). Courses of these medicines typically last 1–3 months.

Topical Antifungal Treatments: Mild cases respond well to OTC creams, gels, or powders like Tolnaftate (Tinactin®), Terbinafine (Lamisil AT®), Miconazole (Desenex®), Clotrimazole (Lotrimin®). Apply as directed for at least two weeks. Consult a doctor if symptoms persist.

Home Remedies and Cleaning: Home remedies like tea tree oil or apple cider vinegar have limited benefits. Disinfect surfaces with products like Lysol® or bleach. One can wash clothes, towels, and bedding in hot water to prevent spread.

Antifungal Shampoos: Shampoos like ketoconazole (Nizoral A-D®) can help control scalp ringworm but must be used with oral antifungals.

Avoid Steroid Creams: Steroid creams may reduce inflammation but can worsen fungal infections. Use only antifungal-specific treatments. Proper treatment and hygiene can effectively resolve ringworm.

Ringworm Prevention

While fungi that cause ringworm are common, there are steps you can take to reduce your risk and prevent the infection from spreading:

• Always wear flip-flops in locker rooms, public showers, and pools to avoid contact with infected surfaces.
• Keep your skin clean and dry as fungi thrive in warm, moist environments, so maintaining dryness is key.
• If you play sports, wash your gear and uniform after every use and avoid sharing with teammates.
• If you touch an area of your body with ringworm, wash your hands with soap and water before touching another body part or surface.
• Do not share clothing, combs, brushes, towels, or other personal items.
• Wash your hands with soap and water after touching pets, especially if they have ringworm. If your pet is infected, take them to the vet.
• Ensure you change into clean, dry socks and underwear at least once a day.
• Wash towels, sheets, and clothes in hot water with detergent to kill any fungal spores.
• Clean gym equipment, exercise mats, and other shared surfaces regularly to prevent contamination.

Myths and Facts Related to Ringworm

Here are all the most important myths and facts related to ringworm you must keep in mind:

Myth 1: Ringworm Only Affects the Skin
Fact: While ringworm is most commonly seen on the skin, it can also affect the fingernails or toenails. Nail ringworm does not form a ring-shaped pattern but causes nails to become thick, yellow, and brittle.

Myth 2: A Worm Causes the Ringworm
Fact: Despite the name, ringworm has nothing to do with worms. It is a fungal infection caused by various types of fungi, with more than 40 species known to cause the condition.

Myth 3: Ringworm Only Affects Children
Fact: Although children are more prone to ringworm, it can affect people of all ages. Those with weakened immune systems are particularly at higher risk of developing this infection.