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Ring worm

What is ringworm?

Tineacorporis is ringworm.  Ringworm is not really a worm of any sort; it is actually a fungal infection.  Fungi are ubiquitous (everywhere in our environment) micro-organisms (like bacteria, viruses, or parasites).  These fungi are collectively called a dermophytes


Dermophytes are a group of fungi that enjoy eating and living in dead skin.  The most common dermophytes responsible for ringworm include:  trichophytonrubrum, microsporumcanis, and trichophytonmentagrophytes.


These dermophytesare usually kept to low manageable levels by our immune systems.  However, when there is a large amount of exposure, or when the environmental conditions favor their growth, the concentration of dermophytes causes a localized, superficial infection in otherwise healthy people.   Also we can become infected when our immune system is stressed (maybe due to another infection, or maybe from emotional or physical exhaustion) as things that normally don’t cause infections in our bodies may find a way to bypass our defenses.


A superficial fungal infection is on the toes, it’s called tineapedis (athlete’s foot).  On the scalp, it’s called tineacapitus.  And there are many other “tineas” that describe various locations that fungi can infect on our bodies.


What are the symptoms of ringworm?

Characteristic round/oval rash.  Rash typically about the size of a coin, with small red bumps on the edges, and the middle may be unaffected.  So the rash may look more like a target.  The edges are elevated, dry, scaly, flakey, and itch.  Typically the hair is loss with evidence of stubble suggesting the hair was “eaten” off rather than “fell out.”


What causes ringworm?

Remember that the fungi are ubiquitous, so it’s always around.  So the focus is rather, what causes their population to increase to the point of invading the superficial layer of the skin and cause a rash?


As mentioned, stress and immunosuppression/distraction allows these little fungi to grow unchecked.  Warm, moist environments contribute to their growth.  Exposure to a large number of fungi will overwhelm first line defenses – such as brushing up against a rash, or sharing hygiene products with someone who has too many fungi on their skin.  And the likelihood of coming into contact with someone with tinea increases when people live in crowded conditions, when the temperature is warm and humid, when the immediate environment of the skin is warm and humid (excessive sweating, wet bathing suits).  And even pets (cats and dogs) can have (and spread) ringworm.


How is ringworm diagnosed?

Usually ringworm’s characteristic rash, together with symptoms such as itching and hair los, is enough to initiate treatment.  Skin scrapings and cultures that can be done, but this is typically reserved for unusual cases where the rash is extensive, or unresponsive to treatment.


Could it be something else?

There are other illnesses that have round rashes that may mimic ringworm, such as lyme disease, erythema multiforme, erythema migrans, bacterial infections.  Also realize that coins in pockets that get hot may cause a circular pressure-type discoloration that may mimic tinea.

But if the rash is itchy, and there are no other symptoms such as headache, fever, or joint pains, a singular round characteristic rash is almost always treated as tinea unless otherwise warranted.


How is ringworm prevented?

Good hygiene will decrease the fungal load on the hands/body.  Avoid touching other people’s rashes.  Make sure pets/animals are not infected.  Keep skin clean and dry.  And keep stress as low as possible so your immune system functions optimally.



How is ringworm treated?

Treatment consists of topical (skin) application of antifungals that can be purchased over the counter.  Treatment requires application to the rash twice a day for about 2 – 3 weeks.  In more severe (atypical) cases, an oral antifungal may be used.  But oral antifungals have systemic (bodily organ) side effects and should not typically be first line treatment.

Topical antifungals include the following and are the active ingredient is most formulations of antifungal therapy (including yeast infections, newborn thrush, athlete’s foot, jock itch, diaper rash, etc):

  • Miconazole
  • Ketoconazole
  • Clotrimazole
  • Nystatin