What is Tinea (Ringworm)?

Tinea is an itchy superficial fungal infection that can involve the skin, hair and nails. It is also termed “dermatophytic infection”, “dermatophytosis” and “ringworm”. “Ringworm” is a misnomer since it is not a worm infection but rather, it is a fungal infection. However, it is still called that as it resembles a worm in the shape of a ring — hence the name.

There are approximately 40 different species of fungi that can cause ringworm. These infections can affect both humans and animals. The infection initially appears as red patches on affected areas of the skin and may later spread to other parts of the body, scalp or nails.

Which areas can be affected?

Areas of the body that can be affected by ringworm include:

Feet (tinea pedis, commonly called “athlete’s foot”)
Groin, inner thighs (tinea cruris, commonly called “jock itch”)
Scalp (tinea capitis)
Beard (tinea barbae)
Hands (tinea manuum)
Toenails or fingernails (tinea unguium, also called “onychomycosis”).
Other parts of the body such as arms or legs (tinea corporis)

Symptoms of Ringworm Infections

The symptoms of ringworm usually depend on the part of the body which is infected, but they generally include:

Itchy skin.
Ring-shaped rash.
Red, scaly, cracked skin.
Hair loss in case of scalp involvement.

Symptoms typically appear within 2 weeks after the skin comes in contact with the fungi that cause ringworm.

Depending on the location of ringworm in the body, the site specific symptoms can be as follows:

Feet (athlete’s foot): Red, swollen, itchy skin between the toes (especially between the little toe and the one next to it) and peeling of the skin in those areas. The sole and heel of the foot may also be affected. In severe cases, the skin on the feet can blister.
Scalp (tinea capitis): Scaly, itchy, red, circular bald spots that can grow in size and multiple spots might develop if the infection spreads. Ringworm on the scalp is more common in children than it is in adults.
Groin (jock itch): Scaly, itchy, red circular plaques, usually on the inner sides of the skin folds of the thigh.
Beard (tinea barbae): Scaly, itchy, red spots on the cheeks, chin, and upper neck. The spots might become crusted over or filled with pus, and the affected hair might fall out.
Nails (Onychomycosis): If you’re experiencing dermatophytosis in your nails, they may become thicker or discolored (usually yellowish), or they may begin to crack.

How Ringworm Spreads

The fungi that cause ringworm can live on skin as well as the environment. There are three main ways that ringworm can spread:

From a person who has ringworm: People can get ringworm after coming in contact with someone who has ringworm.
From the environment: The fungi that cause ringworm can live on surfaces, particularly in damp areas like locker rooms and public showers. One should avoid sharing clothes, towels, combs, or other personal items with other people.
From an animal that has ringworm: People can get ringworm after coming in contact with an animal that has ringworm e.g. dogs and cats, especially kittens and puppies. Other animals, like cows, goats, pigs, and horses can also spread ringworm to people. Please click here for more information about pets and ringworm.

Risk Factors

If one shares clothing, bedding or towels with someone who has a fungal infection.
Those who wear tight or restrictive clothing.
Those who live in a warm climate.
Those who have close contact with an infected person or animal.
Those who participate in sports that feature skin-to-skin contact, such as wrestling.
Those who have a weak immune system.

Prevention

Keep your skin clean and dry.
Wear shoes that allow air to circulate freely around your feet.
Don’t walk barefoot in areas like locker rooms or public showers.
Clip your fingernails and toenails short and keep them clean.
Change your socks and underwear at least once a day.
Don’t share clothing, towels, sheets, or other personal items with someone who has ringworm.
If you play close contact sports, shower immediately after your practice session or match, and keep all of your sports gear and uniform clean.
Don’t share sports gear (helmet, etc.) with other players.
Avoid people or animals with ringworm if you have a weakened immune system.

My pet has ringworm and I’m worried about ringworm in my house. What should I do?

For people

Wash your hands with soap and running water after playing with your pet.
Wear gloves and long sleeves if you must handle animals with ringworm, and always wash your hands after handling the animal.
Disinfect areas the pet has spent time in, including surfaces and bedding.

Protect your pet’s health

If you suspect that your pet has ringworm, make sure to visit a specialist so that treatment can be started.
If one of your pets has ringworm, make sure your other pets also get checked for ringworm infection.

How is ringworm diagnosed?

Your skin specialist can usually diagnose ringworm by looking at the affected skin and asking questions about your symptoms. The skin doctor may also take a small skin scraping to be examined under a microscope or sent to a laboratory for a fungal culture.

If you’re getting a “KOH test”, your doctor will scrape off a small area of infected skin onto a slide and place drops of a liquid called “potassium hydroxide” (KOH) on it. The KOH breaks apart normal skin cells, making the fungal elements easier to see under a microscope.

Stages of Ringworm

You won’t see ringworm right away when the fungus has infected you. It can take up to 2 weeks before you start noticing symptoms. Some of the stages you may see include:

Initial stage. During this stage, you may notice a pink or red irritated patch of skin. Sometimes, it just appears very dry and scaly — not necessarily like ringworm.
Second stage. During this stage, you’ll notice the lesion starts to grow in size. The centre of the rash may resemble healthy skin with a surrounding scaly area.

Because ringworm is very contagious, the treatment should be started as soon as the first signs are noticed. If the treatment is delayed, it may spread and grow.

Ringworm v/s Eczema

Ringworm can closely resemble another condition, discoid eczema (also known as nummular eczema or nummular dermatitis). The two conditions are similar because they both cause round or coin-shaped lesions on the skin. The lesions are often itchy and scaly. Discoid eczema usually doesn’t have clearing in the centre, while ringworm does. Ringworm may also have pustules associated with it, while nummular eczema doesn’t. Sometimes the two conditions look so much alike that the only way to tell the difference is to see your skin doctor who specialises in the diagnosis and treatment of both these conditions. The doctor can take samples of the skin cells and send them to a laboratory for testing if required.

Doctors treat nummular eczema in a different way to ringworm. They use topical steroids, which, if used for ringworm infections, can mask as well as worsen the infection. Antifungal ointments won’t help nummular eczema.

Ringworm v/s Psoriasis

Psoriasis is another skin condition that can sometimes resemble ringworm. Plaque psoriasis is a disorder due to immune dysfunction that produces inflammatory plaques on the skin. It appears as pink plaques with heavy white scales. Small isolated plaques can sometimes look similar to ringworm. Both ringworm and psoriasis can cause red patches of skin as well as skin itching and scaling. However, ringworm on your trunk or limbs (tinea corporis) will usually have a circular appearance with clearing in the middle. Plaque psoriasis skin lesions are usually larger, involve more areas of the skin, and occur in distinct locations (lower back, elbows, knees). Psoriasis lesions also don’t have clearing (normal-appearing skin) in the middle of their lesions.

Treatment for Ringworm

Lifestyle adjustments

Washing clothes and bedsheets daily and drying them in the sun.
Drying the skin, especially areas around the skin folds thoroughly after bathing.
Wearing loose-fitting, cotton clothes.
Treating all infected areas (not treating one area can lead to recurrences in other areas)

Medications

Ringworm can usually be treated with non-prescription antifungal creams, lotions, or powders applied to the skin for around 4 weeks e.g. clotrimazole, miconazole, terbinafine, luliconazole etc.
Severe ringworm infections usually need to be treated with prescription antifungal medication taken by mouth for 1 to 3 months. Prescription antifungal medications used to treat ringworm on the scalp include griseofulvin, terbinafine, itraconazole, fluconazole etc.
Many people apply steroid creams to ringworm infections. However, that can cause a lot of harm and delay the healing process. Learn more about how steroid creams can make ringworm worse.