ringworm

Definition

Ringworm is a common fungal infection of the skin. The name is a misnomer since the disease is not caused by a worm.

Description

More common in males than in females, ringworm is characterized by patches of rough, reddened skin. Raised eruptions usually form the circular pattern that gives the condition its name. Ringworm may also be referred to as dermatophyte infection.

As lesions grow, the centers start to heal. The inflamed borders expand and spread the infection.

Ringworm is a term that is commonly used to encompass several types of fungal infection. Sometimes, however, only body ringworm is classified as true ring-worm.

Body ringworm (tinea corporis) can affect any part of the body except the scalp, feet, and facial area where a man's beard grows. The well-defined, flaky sores can be dry and scaly or moist and crusty.

Scalp ringworm (tinea capitis) is most common in children. It causes scaly, swollen blisters or a rash that looks like black dots. Sometimes inflamed and filled with pus, scalp ringworm lesions can cause crusting, flaking, and round bald patches. Most common in black children, scalp ringworm can cause scarring and permanent hair loss.

Ringworm of the groin (tinea cruris or jock itch) produces raised red sores with well-marked edges. It can spread to the buttocks, inner thighs, and external genitals.

Ringworm of the nails (tinea unguium) generally starts at the tip of one or more toenails, which gradually thicken and discolor. The nail may deteriorate or pull away from the nail bed. Fingernail infection is far less common.

— Maureen Haggerty

For more information on ringworm, visit Britannica.com.

A fungal infection of the skin, nails, and hair caused primarily by dermatophytes, symptoms of which include inflammation, patching, and scaling of lesions.

Definition

Ringworm is a common fungal infection of the skin. The name is a misnomer because the disease is not caused by a worm.

Description

Ringworm is characterized by patches of rough, reddened skin. Raised eruptions usually form the circular pattern that gives the condition its name. As lesions grow, the centers start to heal. The inflamed borders expand and spread the infection. Ringworm may also be referred to as dermatophyte infection. It is more common in males than females, and is most common among children ages three to nine years.

Types of Ringworm

Ringworm is a term that is commonly used to encompass several types of fungal infection. Sometimes, however, only body ringworm is classified as true ringworm.

Body ringworm (tinea corporis) can affect any part of the body except the scalp, feet, and facial area where a man's beard grows. The well-defined, flaky sores can be dry and scaly or moist and crusty.

Scalp ringworm (tinea capitis) is most common in children. It causes scaly, swollen blisters or a rash that looks like black dots. Sometimes inflamed and filled with pus, scalp ringworm lesions can cause crusting, flaking, and round bald patches. Most common in black children, scalp ringworm can cause scarring and permanent hair loss.

Ringworm of the groin (tinea cruris or jock itch) produces raised red sores with well-marked edges. It can spread to the buttocks, inner thighs, and external genitals.

Ringworm of the nails (tinea unguium) generally starts at the tip of one or more toenails, which gradually thicken and discolor. The nail may deteriorate or pull away from the nail bed. Fingernail infection is far less common.

Demographics

Ringworm can affect people at any age. It is more common among children, athletes, and people with poor hygiene habits.

Causes and Symptoms

Ringworm can be transmitted by infected people or pets or by towels, hairbrushes, or other objects contaminated by them. Symptoms include inflammation, scaling, and sometimes, itching.

Diabetes mellitus increases susceptibility to ringworm. Dampness, humidity, and dirty, crowded living areas also increase susceptibility. Braiding hair tightly and using hair gel also raise the risk.

When to Call the Doctor

A health professional should be consulted when signs of ringworm appear or if exposure to someone with ringworm is suspected.

Diagnosis

Diagnosis is based on microscopic examination of scrapings taken from lesions. A dermatologist may also study the scalp of a person with suspected tinea capitis under ultraviolet light.

Treatment

Some infections disappear without treatment. Others respond to such topical antifungal medications as naftifine (Caldesene Medicated Powder) or tinactin (Desenex) or to griseofulvin (Fulvicin), which is taken by mouth. Medications should be continued for two weeks after lesions disappear.

A person with body ringworm should wear loose clothing and check daily for raw, open sores. Wet dressings applied to moist sores two or three times a day can lessen inflammation and loosen scales. The doctor may suggest placing special pads between folds of infected skin, and anything the person has touched or worn should be sterilized in boiling water.

Infected nails should be cut short and straight and carefully cleared of dead cells with an emery board.

People with jock itch should:

• wear cotton underwear and change it more than once a day
• keep the infected area dry
• apply antifungal ointment over a thin film of antifungal powder

Shampoo containing selenium sulfide can help prevent spread of scalp ringworm, but prescription shampoo or oral medication is usually needed to cure the infection.

Alternative Treatment

The fungal infection ringworm can be treated with homeopathic remedies. Among the homeopathic remedies recommended are:

• sepia for brown, scaly patches
• tellurium for prominent, well-defined, reddish sores
• graphites for thick scales or heavy discharge
• sulfur for excessive itching

Topical applications of antifungal herbs and essential oils also can help resolve ringworm. Tea tree oil (Melaleuca spp.), thuja (Thuja occidentalis), and lavender (Lavandula officinalis) are the most common. Two drops of essential oil in 0.25 oz (7 ml) of carrier oil is the dose recommended for topical application. Essential oils should not be applied to the skin undiluted. Botanical medicine can be taken internally to enhance the body's immune response. A person must be susceptible to exhibit this overgrowth of fungus on the skin. Echinacea (Echinacea spp.) and astragalus (Astragalus membranaceus) are the two most common immune-enhancing herbs. A well-balanced diet, including protein, complex carbohydrates, fresh fruits and vegetables, and good quality fats, is also important in maintaining optimal immune function.

Prognosis

Ringworm can usually be cured, but recurrence is common. Chronic infection develops in one person in five.

It can take six to 12 months for new hair to cover bald patches, and three to 12 months to cure infected fingernails. Toenail infections do not always respond to treatment.

Prevention

Likelihood of infection can be lessened by avoiding contact with infected people or pets or contaminated objects and staying away from hot, damp places.

Parental Concerns

Parents should monitor the children with whom their own children interact or play. Children should not be allowed to play with other children who have open skin sores or scratch excessively.

Resources

Books

Bennett, John C. "Diagnosis and Treatment of Fungal Infections." In Harrison's Principles of Internal Medicine. 15th ed. Ed. by Eugene Braunwald et al., New York, McGraw Hill, 2001, 1168–70.

Darmstadt, Gary L and Sidbury, Robert. "Diseases of the Epidermis." In Nelson Textbook of Pediatrics. 17th ed. Ed. by Richard E. Behrman, et al., Philadelphia: Saunders, 2003, 2195–9.

Periodicals

Gupta, A.K., et al. "Optimal management of fungal infections of the skin, hair, and nails." American Journal of Clinical Dermatology 5, no. 4 (2004): 225-37.

McLeod, R.P. "Lumps, bumps, and things that go itch in your office!" Journal of School Nursing 20, no. 2 (2004): 115-6.

Sladden, M.J. and G.A. Johnston. "Common skin infections in children." British Medical Journal 329, no. 7457 (2004): 95-9.

Organizations

American Academy of Dermatology, 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. Web site: www.aad.org.

Web Sites

"Ringworm on Scalp." eMedicine. Available online at: www.emedicinehealth.com/articles/15983-1.asp.

"Ringworm." Directors of Health Promotion and Education. Available online at: www.astdhpphe.org/infect/ringworm.html.

"Tinea." Kid's Health. Available online at: .

[Article by: L. Fleming Fallon, Jr., MD, DrPH]

An infection of the skin, hair, or nails by a microscopic fungus (including Tinea and Epidermophyton). The infection usually develops as a dry, scaly, circular area on the skin. See also athlete's foot, dhobie itch.

An infection of the superficial layers of the skin and the hair fibers with one of a group of dermatophytic fungi. Some of the fungi are obligate parasites of animals, others have the same relationship with humans, and some are freeliving in the soil and only invade animal skins in unusual circumstances. See also tinea. The common species are trichophyton verrucosum in cattle, T. equinum in horses; in dogs and cats the infections are microsporum canis, M. gypseum and T. mentagrophytes. In sheep and goats the infection is usually T. verrucosum and in pigs M. nanum.
The infection is very superficial and does almost no injury to animals but efforts are usually made to prevent its spread because it is highly infectious, including for humans. In companion animals this zoonotic aspect is very important in management of cases. Called also dermatophytosis.

Ringworm lesions in a horse. By permission from Knottenbelt DC, Pascoe RR, Diseases and Disorders of the Horse, Saunders, 2003

• honeycomb r. — see favus.

This article is about the fungal infection. For the band, see Ringworm (band).

This article needs additional citations for verification. Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (December 2008)

Ringworm
Classification and external resources
Ringworm on the arm
ICD-10	B35.4
ICD-9	110.9
DiseasesDB	17492
eMedicine	emerg/592
MeSH	D014005

Ringworm is a fungal infection of the skin in humans and domestic animals such as sheep and cattle. Fungi are organisms that survive by eating plant or animal material. Those that cause parasitic infection (dermatophytes) feed on keratin, the material found in the outer layer of skin, hair, and nails. These fungi thrive best on skin that is warm and moist. It is not deadly.

This condition has been prevalent since before 1906, at which time ringworm was treated with compounds of mercury. Hairy areas of skin were considered too difficult to treat, so the scalp was treated with x-rays and followed up with antiparasitic medication ^[1].

It is estimated that in current times, up to twenty percent of the population is infected by ringworm or one of the other dermatophytoses. It is especially common among people who play sports, wrestling in particular; wrestlers with ringworm may be disqualified. ^[2]

Misdiagnosis and treatment of ringworm with a topical steroid can result in tinea incognito, a condition where ringworm fungus will grow without typical features like a distinctive raised border.

Contents 1 Prevention 2 Diagnosis in pets 3 Treatment 4 See also 5 Notes 6 External links

Prevention

Fungi thrive in moist, warm areas, such as locker rooms, tanning beds, swimming pools and in skin folds. The fungi may be present without any symptoms.

Advice often given to prevent ringworm includes:

• Avoidance of sharing clothing, sports equipment, towels, or sheets.
• Washing clothes in hot water with fungicidal soap after suspected exposure to ringworm.
• Avoidance of walking barefoot, wearing of appropriate protective shoes to the beach and flip-flops (thongs) in locker rooms.^[3][4][5][5]
• After being exposed to places where the potential of being infected is great ^[6], one should wash with an antibacterial and anti-fungal soap or one that contains tea tree oil, which contains terpinen-4-ol.^[7][8]
• Avoid touching pets with bald spots as they are often carriers of the fungus.
• Avoid showering at night which causes the scalp to become moist. And then waking up in the morning, the scalp could be dry and flaky.

Diagnosis in pets

To determine if your pet has ringworm, it can be as simple as observing the circular bare patches on the skin. But, to truly know if it is ringworm, your vet can do 1 of 3 tests.

Woods Test- This is simply a black light with a magnifying lens. About 50% of the ringworm fungus will show up as fluorescent under the black light.

Microscopic test- Your vet will take a hair from around the infected area and place it in a special solution and view it under the microscope. This is effective for about 40%-70% of the infections.

Culture Test- The most effective, yet longest, way to determine if there is ringworm in your pet is to have a vet collect scales from the area and have it cultured.^[9]

Treatment

Antifungal treatments include topical agents such as Miconazole, Terbinafine, Clotrimazole, Ketoconazole, or Tolnaftate applied twice daily until symptoms resolve (usually within two weeks), however if constantly touched it can leave a dark patch of skin where it had been. In more severe cases or where there is scalp ringworm, systemic treatment with oral medications may be given.

Most treatments should be continued for up to 14 days after the disease ceases to produce any visible symptoms. If the antifungal treatment is prematurely stopped, the infection is very likely to reappear, in which case it may also be more difficult to overcome. Thus, it is very important to use the appropriate treatment in the first place and respect the doctor's or pharmacist's instructions in order to obtain the best results and minimize the risks of relapse.

When confronted with ringworm, it is very important to maintain proper hygiene and take a set of precautions in order to prevent the infection from spreading to other places on the body (the lesions should be covered with band-aid or a soft, sterile cloth). For instance, ringworm of the foot can spread to the toenails over the course of a few weeks if neglected, causing difficult to treat nail infections called tinea unguium. Similarly, common forms of ringworm of the body may become less responsive to regular treatments if they spread to body areas such as armpits, hands, palms or crotch. By maintaining proper hygiene and avoiding the exposure of the affected regions of the body over the entire course of treatment, you will also minimize the chances of contaminating other persons.^[10]

See also

• Folliculitis
• Pityriasis rosea

Notes

1. ^ Sequeira, J. H. (1906) The Varieties of Ringworm And Their Treatment, British Medical Journal, http://www.bmj.com/cgi/reprint/2/2378/193.pdf
2. ^ MaryAnn Decorby, Director of British Columbia Wrestling Association. "www.amateurwrestler.com: The Truth About Ring Worm". http://www.amateurwrestler.com/health/ring_worm.html. Retrieved 11 August 2009. 
3. ^ Keeping footloose on trips by Lori Klemm, podiatrist, Will County Medical Associates S.C. for The Herald News April 2, 2008
4. ^ Fort Dodge Animal Health: Milestones from Wyeth.com. Accessed April 28, 2008
5. ^ ^{a b} Ringworm In Your Dog Cat Or Other Pet: Prevention by Ron Hines DVM PhD 5/4/06. Accessed April 28, 2008
6. ^ InteliHealth:
7. ^ http://www3.interscience.wiley.com/journal/118896515/abstract?CRETRY=1&SRETRY=0
8. ^ http://jac.oxfordjournals.org/cgi/content/abstract/59/5/934
9. ^ Ringworm in Dogs Diagnosis
10. ^ Ringworm Medications

External links

• Tinea photo library at Dermnet

v • d • e Infectious diseases · Mycoses and Mesomycetozoea (B35-B49, 110-118) Superficial and cutaneous (dermatomycosis): Tinea=skin; Piedra (exothrix/endothrix)=hair Ascomycota Dermatophyte (Dermatophytosis) By location Tinea barbae/Tinea capitis (Kerion) · Tinea corporis (Ringworm) · Tinea cruris · Tinea manuum · Tinea pedis (Athlete's foot) · Tinea unguium/Onychomycosis By organism Epidermophyton floccosum · Microsporum canis · Microsporum audouinii · Trichophyton interdigitale/mentagrophytes · Trichophyton tonsurans · Trichophyton schoenleini · Trichophyton rubrum Other Hortaea werneckii (Tinea nigra) · Piedraia hortae (Black piedra) Basidiomycota Malassezia furfur (Tinea versicolor) · Trichosporon beigelii (White piedra) Subcutaneous, systemic, and opportunistic Ascomycota Dimorphic (yeast+mold) Onygenales Coccidioides immitis/Coccidioides posadasii (Coccidioidomycosis) · Histoplasma capsulatum (Histoplasmosis) · Lacazia loboi (Lobo's disease) · Paracoccidioides brasiliensis (Paracoccidioidomycosis) Other Blastomyces dermatitidis (Blastomycosis) · Sporothrix schenckii (Sporotrichosis) · Penicillium marneffei (Penicilliosis) Yeast-like Candida albicans (Candidiasis, Oral, Esophageal, Chronic mucocutaneous) · C. glabrata · C. tropicalis · C. lusitaniae · Pneumocystis jirovecii (Pneumocystosis, Pneumocystis pneumonia) Mold-like Aspergillus (Aspergillosis, Aspergilloma, Allergic bronchopulmonary aspergillosis) · Exophiala jeanselmei (Eumycetoma) · Fonsecaea pedrosoi/Fonsecaea compacta/Phialophora verrucosa (Chromoblastomycosis) · Geotrichum candidum (Geotrichosis) · Pseudallescheria boydii (Allescheriasis) Basidiomycota Cryptococcus neoformans (Cryptococcosis) Zygomycota (Zygomycosis) Mucorales (Mucormycosis) Rhizopus oryzae · Mucor indicus · Absidia corymbifera · Syncephalastrum racemosum Entomophthorales (Entomophthoramycosis) Basidiobolus ranarum (Basidiobolomycosis) · Conidiobolus coronatus/Conidiobolus incongruus (Conidiobolomycosis) Microsporidia (Microsporidiosis) Enterocytozoon bieneusi/Encephalitozoon intestinalis Mesomycetozoea Rhinosporidium seeberi (Rhinosporidiosis) see also drugs

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Dansk (Danish)
n. - [zool.] ringorm

Nederlands (Dutch)
ringworm

Français (French)
n. - herpès circiné, mycose, teigne

Deutsch (German)
n. - Flechte, Kopfgrind

Ελληνική (Greek)
n. - (παθολ.) τριχοφυτία

Italiano (Italian)
tigna

Português (Portuguese)
n. - tinha (f) (Med.)

Русский (Russian)
стригущий лишай

Español (Spanish)
n. - tiña

Svenska (Swedish)
n. - revorm

中文（简体）(Chinese (Simplified))
轮癣, 金钱癣

中文（繁體）(Chinese (Traditional))
n. - 輪癬, 金錢癬

한국어 (Korean)
n. - 동전 버짐, 백선

日本語 (Japanese)
n. - 白癬

العربيه (Arabic)
‏(الاسم) مرض جلدي معدي القوبا الحلقيه‏

עברית (Hebrew)
n. - ‮גזזת (מחלת עור)‬

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