Dr Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
Ringworm, or tinea, refers to several types of contagious fungal infections of the top layer of the skin, scalp, and nails. It is called ringworm because the itchy red rash has a ring-like appearance. However, ringworm has nothing to do with worms.
Ringworm can affect different parts of the body. It is caused by a fungus that eats keratin, a protein found in skin, hair, and nails. Children under 15 are particularly susceptible to ringworm.
CAUSES
Ringworm is caused by a type of fungus that eats keratin. These are called dermatophytes. Dermatophytes attack the skin, scalp, hair, and nails because those are the only parts of the body with enough keratin to attract them. Dermatophytes are microscopic spores that can survive on the surface of the skin for months. They can also survive in towels, combs, the soil, and other household objects. They are very resilient.
If a person or animal has the infection, they may deposit fungal spores on objects and surfaces when they touch them. Anyone who touches those objects may become infected. Children usually show symptoms when they become infected, but many adults do not. The older an individual is, the more likely their immune system will protect them. However, they may still be a carrier.
RISK FACTORS
The following risk factors either increase the chances of developing ringworm or make the symptoms worse:
* 15 years and younger
* Having a weakened immune system
* Using medications that lower the immune system
* Living in a warm, humid climate
* Being close to people or animals that are infected
* Sharing clothing or towels with someone who has the infection
* Having hyperhidrosis, a condition in which the individual sweats more than usual
* Playing contact sports, for instance, wrestling
* Wearing tight clothing
SYMPTOMS
Different types of ringworm affect different parts of the body.
Scalp ringworm (tinea capitis): This is most common in younger children, and occasionally it affects adults. It is more common in urban environments where people live closer together, giving the fungus more opportunities to spread. This is characterised by small patches of scaly skin that appear on the scalp. The patches may feel tender or painful and be inflamed. Hair breaks away on or near the patches kerion, or large inflamed sores, form on the scalp, and they may ooze pus. The person may have a temperature and swollen glands or lymph nodes, but this is uncommon.
* Body (skin) ringworm (tinea corporis): This can affect infants, children, and adults. This is seen with a rash with a ring-like appearance, the skin may be red and inflamed around the outside of the ring, but look fine in the middle, merging rings that feel slightly raised itchiness, especially under the rash.
* Groin infections (tinea cruris): Also known as jock itch, this is more common among young men. Persons may feel itchiness, especially in and around the groin, redness and a burning sensation in the affected area, of flaky and scaly skin on the inner thighs. These symptoms worsen when walking, running, or exercising, and tight clothing makes symptoms worse.
* Tinea pedis: Athlete’s foot is a common foot infection.
* Tinea unguium: Also known as onychomycosis, it is an infection of the nail bed.
* Ringworm in the beard area: This affects males who can grow facial hair, and it often results from contact with an animal that has ringworm. This can involve: redness, swelling, and pus-filled bumps, with hair loss, which usually resolves after treatment of swollen glands raw, open skin and raised, soft, spongy patches that weep tiredness
DIAGNOSIS
Health care workers can normally diagnose ringworm or a groin infection after examining the affected area and asking the patient about their medical history and symptoms. They may take a small scraping of the skin, which will not hurt, and examine it under a microscope to look for characteristics of fungi.
The skin problem is being caused by some other disorder, such as psoriasis. Further testing is not usually needed, unless symptoms are particularly severe. If symptoms have not improved after treatment, there may be a need to remove a small piece of infected skin and send it to the lab to be analysed.
TREATMENT
Treatment depends on the type of ringworm:
* SCALP RINGWORM
The most common treatments for scalp ringworm are oral antifungals (tablets). However, the choice of medication will depend on the type of fungi involved.
* Terbinafine (Lamisil): The side effects are normally mild and do not last long. They may include diarrhea and nausea. People with a history of liver disease should not take terbinafine.
* Griseofulvin (Grisovin): The side effects, which usually go away fairly quickly, may include headache, indigestion, and nausea.
* Anti-fungal shampoos: These help prevent the spread of ringworm, and may speed up recovery, but they do not cure it.
* Shaving a child’s head: There is no evidence that this reduces ringworm infection or accelerates recovery time.
SKIN RINGWORM AND GROIN INFECTION
Most cases are treated with anti-fungal creams. If symptoms are severe, or if they cover a large area of the body and do not respond to OTC medications, doctors may prescribe a prescription-strength topical medication or an oral medication. Oral medications can have some side effects, including stomach upset, rash, or abnormal liver function.
CARING FOR THE SKIN DURING INFECTION
It is important to wash the area gently. Care for the skin properly can help speed recovery.
* Wash the skin gently
* Dry the skin thoroughly, but gently.
* Pat the skin with a towel in tender areas, but do not rub.
* Make sure any folds and areas between the toes are dried thoroughly.
* Change socks or underwear more often than usual if they cover an infected area.
* Always treat the feet and groin at the same time, as infection often spreads from one area to another.
* Where possible, wear loose-fitting clothing and undergarments, such as boxers.
COMPLICATIONS
Fungal infections rarely spread below the surface of the skin. The risk of any serious illness is very small. However, without treatment, ringworm can spread from one part of the body to another. If the skin is broken, bacteria may enter and cause an infection.
People with HIV and other conditions that weaken the immune system are more likely to experience a spreading of ringworm. It is more difficult to get rid of the infection if the immune system is weak.
PREVENTION
The following tips may help prevent ringworm if it occurs in a household:
* If a pet is the source of the infection, it should be treated by a vet.
* Everyone should wash their hands regularly and thoroughly with soap.
* All household members should check themselves for signs of ringworm.
* People should not share combs, hairbrushes, clothing, bed linen, towels, or footwear.
* Anyone who has ringworm should not scratch affected areas as this increases the risk of spreading the infection.
* People should avoid walking around the house with bare feet.
* Clothes should be washed in hot water with fungicidal soap.
* Keeping cool and wearing loose clothing may help reduce the risk.
Ringworm is an easily treatable skin disease, and requires an early intervention by healthcare workers to avoid long term scarring.
