Ringworm

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More about Ringworm: Causes and symptoms Diagnosis Treatment Alternative treatment Prognosis Prevention Resources

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

Dictionary: ring·worm  (rĭng'wûrm')

Any of a number of contagious skin diseases caused by several related fungi, characterized by ring-shaped, scaly, itching patches on the skin and generally classified by its location on the body. Also called tinea.

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]

For more information on ringworm, visit Britannica.com.

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.

The factual accuracy of this article is disputed.

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

Ringworm
Classification & external resources

Tinea capitis
ICD-10	B35.0-B36.
ICD-9	110.9
DiseasesDB	17492
eMedicine	emerg/592
MeSH	D014005

Ringworm, also known as "Tinea", is a contagious fungal infection of the skin, and can exist anywhere on the body. Contrary to its name, ringworm is not caused by a worm, but generally is a reddish to brownish raised or bumpy patch of skin that may be lighter in the center, giving the appearance of a 'ring'.

Fungi are tiny organisms that survive by eating plant or animal material. The ringworm fungi feed on keratin, the material found in the outer layer of skin, hair, and nails. These fungi thrive best on skin that is moist, hot, and hidden from the light. When this infection is found on the feet, it is commonly called athlete's foot; when it is found in the groin it is commonly called jock itch; and when it is found on the body it is still called ringworm. Up to 20 percent of the population has one of these infections at any given moment.^{[citation needed]}

Transmission

Ringworm is very common, especially among children, and may be spread by skin-to-skin contact, as well as via contact with contaminated items such as hairbrushes. Ringworm spreads readily, as those infected are contagious even before they show symptoms of the disease. Participants in contact sports such as wrestling have a risk of contracting the fungal infection through skin-to-skin contact.

Ringworm is mildly contagious. Ringworm is also a common infection in domestic animals, especially farm animals, dogs and cats. Humans can contract ringworm from these animals as humans are in close contact with them. Chickens may also be a source, due to the dirty conditions in which many poultry must live in which ringworm may thrive. Ringworm can also be caught from other humans, both by direct contact and by prolonged contact with flakes of shed skin (from sharing clothes or from house dust, for instance).

To catch ringworm, you have to be exposed to it and you have to be susceptible. Some people are much more susceptible than others. Those with eczema or other skin problems get ringworm more easily because the protective barrier of the skin's outer layer is less intact. Children are more susceptible before puberty. Some people are genetically predisposed, and can get it easily throughout life.

Types

A number of different species of fungi cause ringworm. Dermatophytes of the genera Trichophyton and Microsporum are the most common causative agents. These fungi attack various parts of the body and lead to the following conditions:

• Dermatophytosis
  • Tinea pedis (athlete's foot) affects the feet
  • Tinea unguinum affects the fingernails and toenails
  • Tinea corporis affects the arms, legs, and trunk
  • Tinea cruris (jock itch) affects the groin area
  • Tinea manuum affects the hands and palm area
  • Tinea capitis affects the scalp
  • Tinea barbae affects facial hair
  • Tinea faciei (face fungus) affects the face
• Other superficial mycoses
  • Tinea versicolor
  • Tinea nigra

Symptoms and diagnosis

The best known sign of ringworm in people is the appearance of one or more red raised itchy patches with defined edges, not unlike the herald rash of Pityriasis rosea. These patches are often lighter in the center, taking on the appearance of a ring. If the infected area involves the scalp or beard area, then bald patches may become evident. The affected area may become itchy for periods of time. If the nails are affected, they may thicken, discolor, and finally crumble and fall off.

Plucked hair treated with KOH showing ectothrix spores and hyphae from a case of feline ringworm

Doctors can diagnose ringworm on sight, or they may take a skin scraping, or in the case of animal ringworm or tinea capitis, examine plucked hairs for fungal elements. This is examined under a microscope, or put on an agar plate in a microbiology laboratory and allowed to grow.

Specialized agar plate, called Dermatophyte Test Medium is used to culture and identify ringworm organisms

Some of the fungi fluoresce under a black light examination.

In domestic animals, ringworm can cause a variety of symptoms, but most cases show scaling and patches of hair loss. Some cats can be carriers, but show no symptoms.

Sometimes a ringworm infection may cause skin lesions in a part of the body that is remote from the actual infection. Such lesions are called "dermatophytids". The lesions themselves are fungus-free, and normally disappear upon treatment of the actual infection. The most common example is an eruption in the hands resulting from a fungus infection of the feet. Dermatophytids are essentially a generalized allergic reaction to the fungus.

Treatment

The treatment for ringworm is one of the many effective topical antifungal creams, such as miconazole (Tinactin) or clotrimazole (Lotrimin). Several of these antifungal creams are now available without a prescription. Treatment may require several weeks. Only by treating for at least one week after the resolution of symptoms can one guarantee eradication. (Pets can be treated with the same medicines, but this is difficult, since they often don't get a rash with their infections. Contact your pet's veterinarian to get up-to-date information on the best treatment for animals).

Topical antifungal drugs containing miconazole, clotrimazole, terbinafine, butenafine and tolnaftate, many available without a prescription, are used to clear up the infection. Brand names include Micatin, Tinactin, Monistat, Lotrimin, Bentax, Butop(India) and Lamisil. Generic equivalents may be available.

On September 28, 2007, the U.S. Food and Drug Administration stated that Lamisil (Terbinafine hydrochloride, by Novartis AG) is a new treatment approved for use by children aged 4 up. The antifungal granules that can be sprinkled on a child's food to treat ringworm of the scalp, Tinea capitis. ^[1]

Treatment may be obstructed by itching, burning, cracking, and scaling that accompany this condition and prevent effective treatment. Ointments may be mixed with hydrocortisone creams such as Cortaid to reduce inflammation and speed recovery. Fungal infections may take a while to clear up, but most ringworm infections should see improvement in a week or two. Types affecting the nails or scalp are very difficult to treat due to fungal infection in follicle roots or under the nail itself.

Griseofulvin is a traditional drug used to treat ringworm in both animals and people. It can be very effective, but likely requires a prescription and may produce side effects. In cats and cattle, sulfurated lime rinses are often used to treat ringworm; and dilute povidone iodine may be used as a wash in cattle. Enilconazole, as a rinse, is an effective ringworm treatment available in many countries for treating animals.

Lufenuron, the active ingredient in Program oral flea treatment, is also commonly prescribed by vets to treat ringworm infections in cats and dogs.

Folk remedies for ringworm include a 1:1 solution of cider vinegar and water. Another alternative is 2 drops of tea tree oil mixed with an ounce of water. Undecylenic acid (Castor oil derivative) has also been effective for some.A mustard powder salve mixed with water and applied for 20 minutes may be effective.

If conditions do not improve after a couple weeks, consult your medical provider.

Prevention

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

• Do not share clothing, sports equipment, towels, or sheets. If you think you have been exposed to ringworm, wash your clothes in hot water with fungus-killing (fungicidal) soap.
• Wear slippers or sandals in locker rooms, showers, and public bathing areas, especially during treatment.
• Shower and shampoo thoroughly after any sport that requires skin-to-skin contact.
• Wrestlers should regularly inspect the skin before practice, use protective bandages over infections while practicing or avoid competition until 1 week after symptoms resolve, and thoroughly disinfect gym pads and equipment.
• Wear loose-fitting cotton clothing. Change your socks and underwear at least once a day.
• Keep your skin clean and dry. Always dry yourself completely after showers or baths.
• If you have athlete's foot, put your socks on before your underwear so that fungi do not spread from your feet to your groin.
• Take your pet to the vet if it has patches of missing hair, which could be a sign of a fungal infection.
• Continue topical remedies for 2 to 4 weeks after symptoms have resolved.
• To prevent ringworm from returning after treatment, apply talcum or other drying powder to the affected area daily.

See also

• Folliculitis
• Pityriasis rosea
• Antifungal drugs

References

The Merck Manual, Twelfth Edition, 1972, p. 1451

External links

• Tinea photo library at Dermnet

Notes

1. ^ Reuters, US FDA approves oral granules for scalp ringworm

Mycoses (B35-B49, 110-118)
Tinea: Dermatophytosis	Tinea barbae/Tinea capitis - Tinea unguium/Onychomycosis - Tinea manuum - Athlete's foot - Tinea corporis - Tinea cruris
Tinea: Other superficial mycoses	Tinea versicolor - Tinea nigra - White piedra
Dimorphic fungi	Coccidioidomycosis - Histoplasmosis - Blastomycosis - Paracoccidioidomycosis - Sporotrichosis
Other	Candidiasis (Oral candidiasis) - Chromoblastomycosis - Aspergillosis - Cryptococcosis - Phycomycosis/Mucormycosis - Mycetoma (Eumycetoma, Maduromycosis, Actinomycetoma) - Lobo's disease - Pneumocystis pneumonia

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)

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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