Ringworm

Types Of Ringworm

Ringworm can attack any part of the body and can also cause extensive infection all over the body. However, it commonly affects:

• Skin folds.

• Areas prone to sweating like armpits and back.

• Flexures like underbust, armpits, and groin.

• Areas between the fingers and toes get affected, especially in the rainy season.

• Tinea capitis: It occurs on the scalp causing itchiness and loss of hair.
• Tinea barbae: This is when the infection affects the beard area.
• Tinea manuum: It occurs on the hands or in between the fingers.
• Tinea cruris: Also known as jock itch, this infection affects the groin area due to excessive sweating and poor hygiene.
• Tinea pedis: Commonly known as athlete’s foot, it affects the feet and is commonly found between the toes.
• Tinea unguium: Also known as onychomycosis, this fungal infection affects the nails and nail plates causing them to deform and break easily.
• Tinea corporis: This affects the torso, back and upper portions of the limbs. 
• Tinea imbricata: Another variant of tinea corporis and is recognized clinically by its distinct, scaly plaques arranged in concentric rings.
• Tinea incognito: This is tinea corporis with an altered presentation due to corticosteroid treatment.

Symptoms Of Ringworm

The symptoms of the ringworm depend upon the location of the body invaded by the fungi but they broadly include: 

• Itchy or scaly patches that are red, brown, or grey, or raised areas of skin called plaques

• Patches that develop blisters or pustules

• Patches that resemble a ring with deeper colour on the outside

• Patches with edges that are defined and raised

• Overlapping rings

• Hair loss

Depending upon the site of infections, a person may experience following clinical manifestations:

1. Feet (tinea pedis or athlete’s foot)

It is the most common type of tinea infections. It usually occurs in men and young adults but children, women, and older people can also be affected. It is characterised by: 

• Red, swollen, peeling & itchy skin between the toes

• Whitening of the skin between the toes

• Scaling of the feet

• Blisters on the foot

2. Scalp (tinea capitis)

This type of infection involves skin and hair, usually affects children more than adults. Symptoms include: 

• Hair loss

• Dry scaly areas on the scalp

• Itching on the scalp

• Bald patches on the scalp

3. Beard (tinea barbae)

This infection affects beard and moustache areas of the face, and usually affects only adult men. The infections can be recognized by the following symptoms: 

• Presence of lumps around the hairs

• Easily pulling out of the hairs

• Presence of bald patches & itchy red spots on the cheeks, chin and around the neck 

• Fatigue

• Swollen lymph nodes

4. Body (tinea corporis)

This type of fungal infection can affect any part of the body except the hands, feet, scalp, face, beard, groin, and nails. The typical symptoms of tinea corporis include: 

• Pink to red round patches on the skin

• Itching 

5. Nails (tinea unguium)

It is also known as onychomycosis, it is the fungal infection of the fingernails or toenails. Onychomycosis affects toenails more often than fingernails and is most common among persons who have tinea pedis. Onychomycosis is more common in older adults and in persons with vascular disease, diabetes mellitus and trauma to nails. The nails of the person infected with tinea unguium are:

• Discolored

• Thick

• Fragile 

• Cracky

6. Hands (tinea manuum)

It refers to the fungal infection of the hands & involves following changes on the hands: 

• A ring-shaped, scaly rash

• Itchiness

• Clear, scaly, or bumpy center of the ring rash

• Slightly raised rings

• A round patch of itchy skin

7. Groin (tinea cruris)

This type of fungal infection often affects skin of the genitals that can spread to the upper inner thighs. The symptoms includes:

• Rash that can be painful or painless 

• Burning sensation in the groin area

• Continuous itching

Causes Of Ringworm

The causative organism behind ringworm infection is fungus. Approximately 40 different species of fungi are known to cause ringworm. Some of the common species that causes ringworm are: 

• Trichophyton

• Microsporum

• Epidermophyton

Once the fungi attach to the outer layer of the skin, they trigger an allergic reaction causing certain blood cells like eosinophils and chemicals called histamines to rush to the infected site. These cause the characteristic itching sensation. Scratching the area causes further damage to the skin. It helps the infection spread deeper and wider.

A person gets ringworm mainly from these three sources:

1. Humans: This is called anthropophilic transmission. It involves parasites that  prefer humans to animals. This is the most common form of transmission.

2. Animals: Known as zoophilic infection, this happens when animals become the preferred source of food for the fungus. The infected animal then goes on to infect a human.

3. Soil: Ringworm-causing fungi can also be the earth-loving variety that cause geophilic ringworm infection.

Risk Factors For Ringworm

Your risk of getting ringworm increases, if you:

• Live in a tropical area

• Spend time in hot, humid weather

• Sweat heavily

• Wrestle, play football, or participate in another contact sport

• Live in close contact with infected person or animal

• Share towels, clothes, razors, and other things with infected person

• Are obese

• Have diabetes

• Wear tight clothes

• Have weak immune system

• Use public showers or locker rooms

Note: Ringworm can easily transfer from animals to humans. You can get the infection through touching the skin and belongings of the infected animal. 

Diagnosis Of Ringworm

To confirm a ringworm infection, your healthcare provider can perform following tests: 

1. Physical examination

Ringworm are characterised by its specific lesions which are examined by the doctor. The severity and the stage of the infection can also be diagnosed by examining the lesions under black light.

2. Microscopy

In this, scrapings of the lesions are placed in potassium hydroxide (KOH) solution and examined under the microscope. The method is highly specific and cost effective.

3. Fungal culture

It is the most reliable method to diagnose ringworm wherein scrapings taken from the infected area are allowed to grow in an artificial medium. The method is more specific than any other tests but requires more time. 

4. Polymerase chain reaction (PCR)

If KOH and fungal culture clinical evaluations are inconclusive, a polymerase chain reaction (PCR) test for fungal deoxyribonucleic acid (DNA) identification can be done.

5. Wood’s lamp examination

In this, the skin is examined under ultraviolet (UV) light using a wood lamp in a dark room. The fungal infection is confirmed through the colour changes of the skin under UV rays.  

Prevention Of Ringworm

Proper preventive measures help the patient in speedy recovery. One can prevent the ringworm infection by practicing following measures such as:

• Maintaining good hygiene by regular bathing. 

• Wearing fresh socks and undergarments daily.

• Avoiding tight clothes. 

• Drying off the upper body followed by drying the lower body (feet) after taking a shower.

• Regularly trimming and cleaning of nails.

• Washing infected clothes in hot water with antifungal agent.

• Taking shower after playing sports that involves skin to skin coat.

• Avoiding sharing personal items of infected people such as clothes, towels, hair brushes, and combs. 

• Wearing shoes or slippers in locker rooms and public showers

• Disinfecting exercise machines regularly

• Wearing gloves while handling infected pets

• Disinfecting surfaces and pet bedding 

• Wearing loose shoes to allow air to circulate 

• Avoiding sharing of sports gears such as helmets with other players

Specialist To Visit

Ringworm is a mild condition and usually resolves with OTC medication. However, consult a doctor immediately if: 

• You have been using OTC antifungal medication for 2 weeks without any improvement.

• You have ringworm infection on the scalp.

• Your infection is spreading fast affecting larger areas of your body.

• Your ringworm patches have become inflamed and are painful.

• You are immunocompromised.

Doctors who can help in the diagnosis and treatment of ringworm are:

• General physician

• Dermatologist

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Treatment Of Ringworm

Ringworm is a fungal infection and can be treated by antifungal creams, lotions, sprays, tablets, and shampoos. The treatment that is given to the patient depends upon severity of the diseases and the affected body part such as hair, skin, and nails. 

Some ringworm infections can be treated by over-the-counter drugs whereas some severe forms require prescription medications. The following treatment can be given as per the need and severity of the disease: 

Topical antifungal medications

These are available in the form of creams, gels, lotions, powders, and shampoos. Shampoos are used for the fungal infections of the scalp and are generally instructed to apply twice a week initially. Topical antifungal formulations such as creams, lotions, gels, and sprays are meant to apply on the affected area of the skin. 

Antifungal nail paints are also available in the market for the fungal infections of the nail. Some of the medicines used for ringworm are: 

• Terbinafine (cream or solution)

• Butenafine (cream)

• Clotrimazole (cream, solution, or lotion)

• Econazole (cream)

• Ketoconazole (cream or shampoo)

• Miconazole  (cream, spray, lotion, or powder)

• Oxiconazole (cream or lotion)

• Ciclopirox (cream, lotion or nail lacquers)

• Tolnaftate (cream, solution, or powder)

• Selenium sulphide (shampoo)

• Naftifine (cream or gel)

• Sulconazole (cream or lotion)

Onychomycosis mostly does not respond to topical therapy although ciclopirox nail lacquer applied daily for a year is occasionally beneficial. Itraconazole and terbinafine both accumulate in the nail plate and can be used to treat onychomycosis.

Oral antifungal medications

Oral antifungal agents are prescribed in case of severe infection, failed topical treatment or immunocompromised patients. Thses are available in the form of tablets and capsules. Some of the common examples include: 

• Terbinafine

• Griseofulvin

• Itraconazole

• Fluconazole 

Surgical care

Surgical treatment is usually not indicated except for drainage of superficial vesicles, bullae, pustules, or deep abscesses.

Note: Relapse of tinea cruris and tinea pedis are common and should be treated early with creams to avoid development of more extensive disease. 

Home-care For Ringworm

1. Hygiene

Ringworm is a highly contagious disease. Hence, maintaining good hygiene is necessary to prevent spreading of the infection to other parts of the body, to other people and to pets. Practising cleanliness also ensures faster recovery. 

The following measures can be taken to adopt a fungus free environment: 

• Wash your hands with a soap and water after applying medication to the affected area.

• Shower daily and after playing any sports.

• Wash the belongings of the patients such as towels, clothes, and bedding in hot water.

• Wear washed clothes everyday.

• Keep your body and clothes clean and dry.

• Disinfect your shoes regularly.

• Take measures to reduce sweat.

2. Duration of treatment

Generally, antifungal medications show improvement in the lesions quickly and patients discontinue taking or applying medicines. Take the medications as per the recommendations of your doctor to avoid recurrence of the infection.

3. Consult veterinarian 

Ringworm can be spread from your pets such as dogs and cats to humans or vice versa. All the preventive measures taken by the patient and family members should be followed for the pets too. If a pet is showing any symptoms of ringworm, consult a veterinarian.

4. Keep in touch with your dermatologist 

Most of the ringworm infections often started to show improvement with the first treatment within 1 to 2 weeks. If infections persist and are not responding to the treatment, follow up with your doctor. 

5. Eat right

Diet alone cannot treat fungal infections but some food helps in speedy recovery through their anti-inflammatory properties such as:

• Protein rich foods like meats, pulses & beans

• Food rich in omega-3-fatty acids that includes nuts, seeds & fish

• Green vegetables

• Yoghourt

• Garlic in the form of food 

Avoid excess sugar and processed foods as high sugar serves as a medium for the growth of fungi that may delay your recovery and healing process. 

Complications Of Ringworm

As ringworm is a superficial fungal infection, the complications are rare. As it is highly contagious, leaving it untreated can lead to several complications by spreading to other parts of the body. Some of the possible complications include: 

• Dark spots on the skin known as post inflammatory hyperpigmentation (PIH).

• Hair loss.

• Nail deformities such as change in shape of the nails.

• Deep infections such as Majocchi’s granuloma in which fungi invade deeper skin layers.

• Secondary bacterial infections, if bacteria penetrates broken skin.

• Kerion, a type of abscess filled with pus.

Interface dermatitis (ID) reaction

Fungal reactions can trigger interface dermatitis (ID) reaction. It is characterised by an itchy rash with small, water-filled blisters, usually seen on the sides of fingers. ID reaction is thought to be an allergic or autoimmune reaction in which the immune system starts to attack and target the skin.

Alternative Therapies For Ringworm

Some of the alternative therapies that can be easily applied at home include: 

1. Tea tree oil

Tea tree oil is an essential oil that is extracted from a tree that is found in Australia. Studies have shown that tea tree oil has antibacterial and antifungal properties. It is commonly used to treat ringworm. It is applied directly on the affected area of the skin. 

Note: People with sensitive skin should dilute tea tree oil in some medium such as coconut oil. 

2. Coconut oil

Also known as “tree of life”, it is one of the most popular and widely available home remedies to treat ringworm infections. Studies suggest that there are various fatty acids present in coconut oil that possess antifungal properties.

It can be applied directly on the skin and scalp. It is a convenient way to treat the ringworm of the scalp because of its ease of application. 

3. Aloe vera

It has been used for many years for its several skin care properties. According to various studies, it also possesses antifungal properties. The gel of the aloe vera can be applied on the affected skin 3 to 4 times daily.

Additionally, it also provides symptomatic relief from itching as it has cooling properties. 

4. Garlic (lehsun)

It has shown properties against various species of Candida. It is applied in the form of paste that is made by blending crushed garlic cloves with coconut oil.

Note: Do not reapply and rinse off immediately, if you have stinging, swelling or redness after applying the paste.         . 

5. Turmeric (haldi)

It is known to exhibit excellent anti-inflammatory properties. Mix about half a teaspoon of turmeric powder with coconut oil and apply on the infected skin. 

6. Epsom salt

Studies have shown that epsom salt works as an antifungal agent. For this, it has to be mixed with some warm water and should be applied on the skin.

7. Eucalyptus oil 

The anti-inflammatory effect of this oil serves as a tool to inhibit the growth of fungus. It has to be applied on the skin with some warm water. 

8. Apple cider vinegar

It is also known to have antifungal properties against some fungi. It is wiped on the infected area to treat ringworm. 

Watch the video to know more about the benefits of apple cider vinegar.