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Ringworm

Published by Bupa's health information team, May 2009.

This factsheet is for people who have ringworm or who would like more information about it.

Ringworm is a common type of fungal skin infection that causes red, itchy patches to appear on your skin. It can be treated with medicines that kill fungus (fungicides).

• About ringworm
• Symptoms of ringworm
• Causes of ringworm
• Diagnosis of ringworm
• Treatment of ringworm
• Questions and answers
• Related topics
• Sources

About ringworm

Ringworm is a general term used to cover a number of conditions caused by fungi called dermatophytes. It is called ringworm because of the ring-like rash left on the body. The fungus infects skin, nail or hair and infections are common. An estimated one to two out of every ten people have a dermatophyte infection at some point in their life. It can be spread between people and animals.

Symptoms of ringworm

There are several types of ringworm including:

Ringworm of the groin (Tinea cruris)

It causes an itchy, red rash on the thighs and the groin and surrounding area and is commonly seen in men who have been sweating a lot. There is usually an obvious edge to the rash and it doesn't often affect the penis or scrotum. Often you also have athlete's foot (Tinea pedis), and scratching your feet followed by the groin may spread the fungal spores.

Ringworm on the body (Tinea corporis)

This affects your body, often in exposed areas like the abdomen or on limbs, causing red patches. They are scaly at the edge and grow out from the centre. The middle of the rash may clear up over time, leaving a red ring or series of red rings. At the edge of the rash there may be pustules or papules. It can be caught from domestic animals.

Ringworm of the scalp (Tinea capitis)

This tends to affect young children and can cause hair loss with inflammation in the affected area. It's usually spread from person to person. Most people infected by this fungus don't actually develop the symptoms, but become carriers who can spread the infection to others, sometimes for years. It usually causes very scaly patches of skin on the scalp. If the ringworm has been caught from an animal, it tends to cause circular patches of hair loss, leaving scaly skin and sometimes pustules (pus-filled spots).

Scalp ringworm sometimes can be more severe, causing a painful, oozing swelling called a kerion. It can cause a fever or make your glands swell up, and may lead to scarring and permanent hair loss.

Causes of ringworm

Fungi break down living tissue to feed. Dermatophytes are particularly attracted to keratin which forms part of the skin and nails and hair. Ringworm can be spread between people and, more rarely, from animals. The fungal spores can survive for a long time in soil, or on objects such as combs, bed sheets and furniture before spreading to other people.

There are also a number of things that can make fungal infections more likely. You're more at risk from fungal infections if you:

• are very old or young
• have had a fungal skin infection before
• have been taking oral steroids
• have diabetes
• are obese
• have a weakened immune system caused, for example, by cancer or HIV/AIDS

Moist skin encourages fungal infections like ringworm. This means fungal infections are more likely when skin isn't dried properly after sweating or bathing, or when it's covered with a material that doesn't allow sweat to evaporate. Damage to the skin surface, such as a cut or graze, can also encourage fungi to grow.

Overcrowded living conditions or using shared facilities such as gyms or showers also make you more likely to catch fungal skin infections like ringworm.

Diagnosis of ringworm

If you think you have ringworm go and see your GP. He or she can sometimes make a diagnosis by examining you and asking you about your symptoms. If your GP isn't sure about what is causing the infection, or if it's severe or not getting better with treatment, he or she may take a sample to be analysed in a laboratory.

If it's a scalp infection he or she will collect scales and hair from the affected area. For infections on the body, your GP will scrape some skin off the edge of the infected area using a scalpel or glass slide.

If your GP suspects a fungal infection he or she may start your treatment before the results are back, and change it depending on what type of fungus is causing it when the results are returned.

Treatment of ringworm

Ringworm can be treated in several different ways depending on where it is and how severe it is. Usually your GP will be able to treat you, but if the infection is severe or keeps coming back he or she may refer you to see a dermatologist. He or she may be more likely to refer you to a dermatologist if your immune system is weakened, for example, if you are taking drugs to suppress your immune system after an organ transplant or if you have HIV/AIDS.

Self-help

Keeping the affected area clean and dry is important as moist conditions encourage fungus growth. Wash the affected area daily.

You should avoid scratching the affected areas as this can spread the infection to other parts of your body. You should also avoid sharing towels with others as this can spread the infection. You should also wash your towels frequently.

If you or your child has scalp ringworm, avoid sharing combs, hats or hairbrushes as this will spread the infection.

If you have groin ringworm, change your underwear daily. Groin infections often occur with athlete's foot. Make sure you get both treated to stop one site reinfecting the other.

If you think your pet is a source of ringworm infection, take it to the vet for a check-up.

Medicines

For mild ringworm on the body, your doctor will usually prescribe an antifungal cream such as imidazole or terbinafine. These need to be applied for between one to four weeks. You need to continue using the creams for a couple of weeks after the infection has completely cleared to stop it from coming back. If you're pregnant or breastfeeding, terbinafine isn't recommended. Your GP may prescribe you clotrimazole or miconazole if necessary.

If the ringworm is severe or affecting large areas, your GP will prescribe you oral antifungal medicines. Oral medicines are also used for treating scalp ringworm because lotions cannot kill the fungus in the hair shaft. You may be prescribed terbinafine, griseofulvin or itraconazole pills, for example. Your GP may change your prescription after the results of the skin sample come back, as different types of antifungals work on specific types of fungus that can cause the ringworm.

If you have scalp ringworm, your GP may also recommend using an antifungal shampoo as well as taking an antifungal pill.

Related topics

• Fungal skin infections
• Type 1 diabetes
• Type 2 diabetes

Sources

• Fungal (dermatophyte) skin infections. Clinical knowledge summaries. http://cks.library.nhs.uk, accessed 21 January 2009

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009