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Ringworm Infection

Overview

Ringworm infection refers to the appearance of a characteristic rash on any part of the skin. Unlike its name, ringworm infection is not caused by a worm but by a fungus. The other names for this disease are known as tinea or dermatophytosis. The rash caused by this fungal infection appears like a worm in a ring shape. Ringworm is a contagious infection and can spread from one person to another by direct or indirect contact. 

Causes

There are about 40 different species of fungi that can cause ringworm infection, but the most common ones are Trichophyton, Microsporum, and Epidermophyton. These fungi can affect both humans and animals. Typically, this infection can spread through four different modes of transmission. One common way is through human-to-human contact. You can get infected if you come in contact with a person who already has a ringworm infection or if you share personal items with them. The second way is through animal-to-human contact. Pet animals such as cats and dogs are the common sources if they have been infected. You may also contract this infection if you touch something that an infected animal has used.

 

The third mode of transmission is through objects. This is observed more in public places such as a public shower or spa that multiple people share. You may catch this infection in such areas because the fungus thrives in a warm, damp environment. The fourth mode of transmission is through the soil. You can get infected if you come in contact with ground soil that carries causative fungi of this infection. 

Risk Factors And Epidemiology

Ringworm infection can affect people of any age, but it is more frequent among children because it spreads quickly through close contact. People living in a warm and humid climate have a higher risk of getting this infection. Those with diabetes, obesity or weakened immune system are also at increased risk. Coming in close contact with an infected person or animal can increase your probability of getting contaminated. Wearing tight clothing or using public showers or restrooms are other risk factors.

 

Around 20,000 to 25,000 out of 100,000 people are affected annually by ringworm infection worldwide. It is common among children in the age range of 5 to 15 years. This infection is more prevalent among females than males. 

Signs And Symptoms

Few symptoms and appearance of ringworm infection can vary depending on which part of the body it appears. In majority of the cases, you will notice a raised round patch with a clear center (ring shape). The area inside the ring may contain small bumps. Single or multiple patches can occur on your skin that may appear red, brown, gray, or skin-colored. These patches can also be scaly and overlap each other at some points. When it occurs on the body (trunk, arms, legs, buttocks), it is called tinea corporis. Tinea capitis refers to the infection on the scalp. It can also spread to your groin, nails, beard, and other regions. 

Diagnosis

Ringworm infection can be diagnosed on the basis of its clinical presentation alone in most cases. Your doctor may require a brief history to identify the possible transmission mode. Physical inspection will involve looking closely at the skin patches to identify characteristics. A black-light may also be used to observe fluorescent fungi if present. The conformational diagnosis can be achieved by scraping a small part of your affected skin region and observing it under a microscope. This test will visualize the presence of fungi in the skin scrapings. Skin biopsy is not necessary but only done in severe cases. 

Differential Diagnosis

Ringworm infection should be differentiated from other conditions that may present with raised, scaly patches on the skin. These include tinea versicolor, tinea nigra, superficial candidiasis, white piedra, black piedra, nummular eczema, psoriasis, subacute cutaneous lupus erythematosus, and granuloma annulare.

Treatment

Treatment of ringworm infection involves medications and lifestyle adaptations. Medications may include topical antifungal creams or lotions. In severe cases, oral antifungals can be prescribed to reduce the spread of this infection. Your doctor will also recommend wearing light, loose-fitted clothing along with medication. Towel dry your skin after a shower, and do not let the moisture stay for long hours. Clothing and bedding items should be washed regularly, and avoid sharing personal items such as towels, toothbrushes, combs, etc. Disinfection of commonly used objects such as toilet seats or other things is also suggested to limit the spread of this infection among family members.

 

Topical antifungals include imidazoles, allylamines, benzoic acid preparations, and other agents. These topical antifungals can be available as creams, lotions, gels, or sprays. Oral antifungals include griseofulvin, fluconazole, ketoconazole, itraconazole and terbinafine. 

Prognosis

Ringworm infection can be treated completely with antifungal medications and adaptation of some lifestyle changes. It may take 2 to 4 weeks for this infection to clear from your skin using medications. 

Prevention

As ringworm infection is very contagious, precautionary measures should be taken to prevent this infection. Wash your hands thoroughly after contact with animals, soil, or shared objects. If you have an infected family member or pet, keep their clothes and bedding items separate and avoid sharing common-use things. Also, disinfect your shelves, toilets, and other areas of common use to limit its spread. Change your clothes and socks frequently if you live or work in a warm, humid climate.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 27, 2023.

 

References

Ringworm: Signs and symptoms (aad.org)

https://www.aad.org/public/diseases/a-z/ringworm-symptoms

gjpamv15n5_10.pdf (ripublication.com)

https://www.ripublication.com/gjpam19/gjpamv15n5_10.pdf