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Ringworm

Ringworm

Definition

Ringworm is a common fungal infection of the skin. The name is a misnomer because the disease is not caused by a worm.

Description

Ringworm is characterized by patches of rough, reddened skin. Raised eruptions usually form the circular pattern that gives the condition its name. As lesions grow, the centers start to heal. The inflamed borders expand and spread the infection. Ringworm may also be referred to as dermatophyte infection. It is more common in males than females, and is most common among children ages three to nine years.

Types of ringworm

Ringworm is a term that is commonly used to encompass several types of fungal infection. Sometimes, however, only body ringworm is classified as true ringworm.

Body ringworm (tinea corporis) can affect any part of the body except the scalp, feet, and facial area where a man's beard grows. The well-defined, flaky sores can be dry and scaly or moist and crusty.

Scalp ringworm (tinea capitis) is most common in children. It causes scaly, swollen blisters or a rash that looks like black dots. Sometimes inflamed and filled with pus, scalp ringworm lesions can cause crusting, flaking, and round bald patches. Most common in black children, scalp ringworm can cause scarring and permanent hair loss.

Ringworm of the groin (tinea cruris or jock itch) produces raised red sores with well-marked edges. It can spread to the buttocks, inner thighs, and external genitals.

Ringworm of the nails (tinea unguium) generally starts at the tip of one or more toenails, which gradually thicken and discolor. The nail may deteriorate or pull away from the nail bed. Fingernail infection is far less common.

Demographics

Ringworm can affect people at any age. It is more common among children, athletes, and people with poor hygiene habits.

Causes and symptoms

Ringworm can be transmitted by infected people or pets or by towels, hairbrushes, or other objects contaminated by them. Symptoms include inflammation, scaling, and sometimes, itching .

Diabetes mellitus increases susceptibility to ringworm. Dampness, humidity, and dirty, crowded living areas also increase susceptibility. Braiding hair tightly and using hair gel also raise the risk.

When to call the doctor

A health professional should be consulted when signs of ringworm appear or if exposure to someone with ringworm is suspected.

Diagnosis

Diagnosis is based on microscopic examination of scrapings taken from lesions. A dermatologist may also study the scalp of a person with suspected tinea capitis under ultraviolet light.

Treatment

Some infections disappear without treatment. Others respond to such topical antifungal medications as naftifine (Caldesene Medicated Powder) or tinactin (Desenex) or to griseofulvin (Fulvicin), which is taken by mouth. Medications should be continued for two weeks after lesions disappear.

A person with body ringworm should wear loose clothing and check daily for raw, open sores. Wet dressings applied to moist sores two or three times a day can lessen inflammation and loosen scales. The doctor may suggest placing special pads between folds of infected skin, and anything the person has touched or worn should be sterilized in boiling water.

Infected nails should be cut short and straight and carefully cleared of dead cells with an emery board.

People with jock itch should:

  • wear cotton underwear and change it more than once a day
  • keep the infected area dry
  • apply antifungal ointment over a thin film of antifungal powder

Shampoo containing selenium sulfide can help prevent spread of scalp ringworm, but prescription shampoo or oral medication is usually needed to cure the infection.

Alternative treatment

The fungal infection ringworm can be treated with homeopathic remedies. Among the homeopathic remedies recommended are:

  • sepia for brown, scaly patches
  • tellurium for prominent, well-defined, reddish sores
  • graphites for thick scales or heavy discharge
  • sulfur for excessive itching

Topical applications of antifungal herbs and essential oils also can help resolve ringworm. Tea tree oil (Melaleuca spp.), thuja (Thuja occidentalis ), and lavender (Lavandula officinalis ) are the most common. Two drops of essential oil in 0.25 oz (7 ml) of carrier oil is the dose recommended for topical application. Essential oils should not be applied to the skin undiluted. Botanical medicine can be taken internally to enhance the body's immune response. A person must be susceptible to exhibit this overgrowth of fungus on the skin. Echinacea (Echinacea spp.) and astragalus (Astragalus membranaceus ) are the two most common immune-enhancing herbs. A well-balanced diet, including protein, complex carbohydrates, fresh fruits and vegetables, and good quality fats, is also important in maintaining optimal immune function.

Prognosis

Ringworm can usually be cured, but recurrence is common. Chronic infection develops in one person in five.

It can take six to 12 months for new hair to cover bald patches, and three to 12 months to cure infected fingernails. Toenail infections do not always respond to treatment.

Prevention

Likelihood of infection can be lessened by avoiding contact with infected people or pets or contaminated objects and staying away from hot, damp places.

Parental concerns

Parents should monitor the children with whom their own children interact or play . Children should not be allowed to play with other children who have open skin sores or scratch excessively.

KEY TERMS

Dermatophyte A type of fungus that causes diseases of the skin, including tinea or ringworm.

Diabetes mellitus The clinical name for common diabetes. It is a chronic disease characterized by the inability of the body to produce or respond properly to insulin, a hormone required by the body to convert glucose to energy.

Resources

BOOKS

Bennett, John C. "Diagnosis and Treatment of Fungal Infections." In Harrison's Principles of Internal Medicine. 15th ed. Ed. by Eugene Braunwald et al., New York, McGraw Hill, 2001, 116870.

Darmstadt, Gary L and Sidbury, Robert. "Diseases of the Epidermis." In Nelson Textbook of Pediatrics. 17th ed. Ed. by Richard E. Behrman, et al., Philadelphia: Saunders, 2003, 21959.

PERIODICALS

Gupta, A.K., et al. "Optimal management of fungal infections of the skin, hair, and nails." American Journal of Clinical Dermatology 5, no. 4 (2004): 225-37.

McLeod, R.P. "Lumps, bumps, and things that go itch in your office!" Journal of School Nursing 20, no. 2 (2004): 115-6.

Sladden, M.J. and G.A. Johnston. "Common skin infections in children." British Medical Journal 329, no. 7457 (2004): 95-9.

ORGANIZATIONS

American Academy of Dermatology, 930 N. Meacham Road, PO Box 4014, Schaumburg, IL 60168-4014. (847) 330-0230. Fax: (847) 330-0050. Web site: <www.aad.org>.

WEB SITES

"Ringworm on Scalp." eMedicine. Available online at: <www.emedicinehealth.com/articles/15983-1.asp>.

"Ringworm." Directors of Health Promotion and Education. Available online at: <www.astdhpphe.org/infect/ringworm.html>.

"Tinea." Kid's Health. Available online at: <kidshealth.org/parent/infections/fungal/ringworm.html>.

L. Fleming Fallon, Jr., MD, DrPH

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Ringworm

Ringworm

Definition

Ringworm is a common fungal infection of the skin. The name is a misnomer since the disease is not caused by a worm.

Description

More common in males than in females, ringworm is characterized by patches of rough, reddened skin. Raised eruptions usually form the circular pattern that gives the condition its name. Ringworm may also be referred to as dermatophyte infection.

As lesions grow, the centers start to heal. The inflamed borders expand and spread the infection.

Types of ringworm

Ringworm is a term that is commonly used to encompass several types of fungal infection. Sometimes, however, only body ringworm is classified as true ringworm.

Body ringworm (tinea corporis) can affect any part of the body except the scalp, feet, and facial area where a man's beard grows. The well-defined, flaky sores can be dry and scaly or moist and crusty.

Scalp ringworm (tinea capitis) is most common in children. It causes scaly, swollen blisters or a rash that looks like black dots. Sometimes inflamed and filled with pus, scalp ringworm lesions can cause crusting, flaking, and round bald patches. Most common in black children, scalp ringworm can cause scarring and permanent hair loss.

Ringworm of the groin (tinea cruris or jock itch ) produces raised red sores with well-marked edges. It can spread to the buttocks, inner thighs, and external genitals.

Ringworm of the nails (tinea unguium) generally starts at the tip of one or more toenails, which gradually thicken and discolor. The nail may deteriorate or pull away from the nail bed. Fingernail infection is far less common.

Causes and symptoms

Ringworm can be transmitted by infected people or pets or by towels, hairbrushes, or other objects contaminated by them. Symptoms include inflammation, scaling, and sometimes, itching.

Diabetes mellitus increases susceptibility to ringworm. So do dampness, humidity, and dirty, crowded living areas. Braiding hair tightly and using hair gel also raise the risk.

Diagnosis

Diagnosis is based on microscopic examination of scrapings taken from lesions. A dermatologist may also study the scalp of a patient with suspected tinea capitis under ultraviolet light.

Treatment

Some infections disappear without treatment. Others respond to such topical antifungal medications as naftifine (Caldesene Medicated Powder) or tinactin (Desenex) or to griseofulvin (Fulvicin), which is taken by mouth. Medications should be continued for two weeks after lesions disappear.

A person with body ringworm should wear loose clothing and check daily for raw, open sores. Wet dressings applied to moist sores two or three times a day can lessen inflammation and loosen scales. The doctor may suggest placing special pads between folds of infected skin, and anything the patient has touched or worn should be sterilized in boiling water.

Infected nails should be cut short and straight and carefully cleared of dead cells with an emery board.

Patients with jock itch should:

  • wear cotton underwear and change it more than once a day
  • keep the infected area dry
  • apply antifungal ointment over a thin film of antifungal powder

Shampoo containing selenium sulfide can help prevent spread of scalp ringworm, but prescription shampoo or oral medication is usually needed to cure the infection.

Alternative treatment

The fungal infection ringworm can be treated with homeopathic remedies. Among the homeopathic remedies recommended are:

  • sepia for brown, scaly patches
  • tellurium for prominent, well-defined, reddish sores
  • graphites for thick scales or heavy discharge
  • sulphur for excessive itching.

Topical applications of antifungal herbs and essential oils also can help resolve ringworm. Tea tree oil (Melaleuca spp.), thuja (Thuja occidentalis ), and lavender (Lavandula officinalis ) are the most common. Two drops of essential oil in 1/4 oz of carrier oil is the dose recommended for topical application. Essential oils should not be applied to the skin undiluted. Botanical medicine can be taken internally to enhance the body's immune response. A person must be susceptible to exhibit this overgrowth of fungus on the skin. Echinacea (Echinacea spp.) and astragalus (Astragalus membranaceus ) are the two most common immune-enhancing herbs. A well-balanced diet, including protein, complex carbohydrates, fresh fruits and vegetables, and good quality fats, is also important in maintaining optimal immune function.

Prognosis

Ringworm can usually be cured, but recurrence is common. Chronic infection develops in one patient in five.

It can take six to 12 months for new hair to cover bald patches, and three to 12 months to cure infected fingernails. Toenail infections do not always respond to treatment.

Prevention

Likelihood of infection can be lessened by avoiding contact with infected people or pets or contaminated objects and staying away from hot, damp places.

Resources

OTHER

"Ringworm." YourHealth.com Page. April 7, 1998. http://www.yourhealth.com.

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ringworm

ringworm or tinea (tĬn´ēə), superficial eruption of the skin caused by a fungus, chiefly Microsporum, Trichophyton, or Epidermophyton. Any area of the skin may be affected, including the scalp and nails, but the most common site is the feet. That disorder is often called athlete's foot in the belief that the infection is contracted during the use of communal shower facilities. Actually, fungi are present on the bodies of most persons, but some individuals are more resistant to fungus invasion than others. Moreover, a prolonged moist, airless condition caused by excessive perspiration may subject a formerly resistant person to fungus invasion. Ringworm infection causes dry, scaly patches or blisterlike elevations, usually with burning or itching. Griseofulvin, a modified form of penicillin, is effective against scalp infection but is ineffective against foot fungi. In mild cases of athlete's foot, often the only treatment is to keep the feet scrupulously dry. In more persistent cases local antifungal ointments, sprays, or soaks are recommended.

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Ringworm

RINGWORM

DEFINITION


Ringworm is a common infection with a misleading name. The disease is actually caused by a fungus, not a worm. There are many types of ringworm and each is caused by a different type of fungus.

DESCRIPTION


Ringworm gets its name from its appearance, not from the agent that causes it. The characteristic feature of ringworm is patches of rough, reddened skin. The patches often contain circular lesions (pronounced LEE-zhuns), open wounds, that look as if they were caused by tiny worms under the skin.

Over time, the lesions grow outward from their center. The center heals up and becomes hard and crusty. But the outer edges of the lesions become inflamed and spread outwards.

Types of Ringworm

The most common types of ringworm are often named for the part of the body on which they occur.

Body ringworm is also known as tinea corporis (pronounced tin-EE-uh KORE-pur-iss). It can affect any part of the body except the scalp, feet, and facial area where a man's beard grows. These areas are infected with other types of ringworm. Tinea corporis causes well-defined flaky sores. The sores can be dry and scaly or moist and crusty.

Scalp ringworm is called tinea capitis (pronounced tin-EE-uh KAP-ih-tiss). This type of ringworm is seen most commonly in children. It causes scaly, swollen blisters or a rash that looks like black dots. Scalp ringworm sometimes becomes inflamed and filled with pus. These areas can cause crusty, flaky, round bald patches. Scalp ringworm can cause scarring and permanent hair loss.

Ringworm of the groin is also called tinea cruris (pronounced tin-EE-uh KROOR-iss) or "jock itch." It causes raised red sores with well-marked edges. This type of ringworm can spread to the buttocks, inner thighs, and external genitalia.

Ringworm of the nails is also known as tinea unguium (pronounced tin-EE-uh UN-gwee-um). It usually starts at the tip of a toenail. The nail gradually becomes thicker and discolored. It may begin to die off and pull away from the nail bed. Infections of the fingernails are much less common.

Tinea pedis is ringworm of the feet and is more commonly known as athlete's foot (see athlete's foot entry).

CAUSES


The fungus that causes ringworm is spread from one person to another. Sometimes this happens through direct contact. An infected person may touch someone who does not have the disease and directly transfer the fungus to the second person.

At other times, the fungus is transferred indirectly. For example, people with ringworm may leave the fungus on towels, hairbrushes, or other objects. A second person may then pick up the fungus while handling these objects.

Certain conditions increase the risk of spreading the fungi (more than one fungus) that cause ringworm. These include dampness, humidity, and dirty, crowded living conditions.

Ringworm: Words to Know

Fungus:
A large group of organisms that includes mold, mildew, rust fungi, yeast, and mushrooms, some of which may cause disease in humans and other animals.
Lesion:
A change in the structure or appearance of a part of the body as the result of an injury or infection.
Tinea corporis:
Scientific name for body ringworm, a fungal infection of the skin that it can affect any part of the body except the scalp, feet, and facial area.
Tinea capitis:
Scalp ringworm, a fungal infection of the scalp.
Tinea cruris;
An fungal infection that affects the groin and can spread to the buttocks, inner thighs, and external genitalia; also called "jock itch."
Tinea unguium:
Ringworm of the nails; a fungal infection that usually begins at the tip of a toenail.

SYMPTOMS


Symptoms of ringworm include inflammation and scaling of the infected area, along with itching.

DIAGNOSIS


The various types of ringworm have distinctive appearances. A doctor or nurse will often suspect the disease simply from looking at a patient's skin. This preliminary diagnosis can be confirmed by taking scrapings of the infected skin. A small knife is used to scrape off a small amount of the infected material. The material can then be examined under a microscope where any fungi that may be present can be seen.

TREATMENT


Some cases of ringworm disappear without treatment. Other cases can be treated with various forms of medication. Some medications are applied directly to the infected skin in the form of powder or cream. Others must be taken orally (by mouth). Doctors recommend that medications be continued for two weeks after symptoms disappear. This precaution guarantees that all fungi are killed.

There are also specific treatments for each type of ringworm. These include:

  • Body ringworm: Wear loose clothing and check daily for open sores. Apply wet dressings to those sores two to three times a day.
  • Ringworm of the nails: Cut infected nails short and clear dead cells with an emery board.
  • Ringworm of the groin: Wear cotton underwear and change it more than once a day. Keep the infected area dry. Use antifungal powder and/or lotion.
  • Scalp ringworm: Use antifungal shampoo containing selenium sulfide or a prescription shampoo.

Alternative Treatment

Both homeopathic and herbal remedies are recommended for the treatment of ringworm. Some homeopathic products suggested include sepia, tellurium, graphite, and sulfur.

Herbs recommended for the treatment of ringworm include tea tree oil, thuja, and lavender. Practitioners may recommend other herbs to improve the body's immune system in general. Echinacea and astragalus are the two herbs most commonly recommended for this purpose. Alternative practitioners also suggest a well-balanced diet that includes protein, complex carbohydrates, fresh fruits and vegetables, and good quality fats to strengthen the immune system.

PROGNOSIS


Ringworm infections usually clear up with treatment. However, they tend to reoccur. About one in five patients experience a chronic infection that reappears time and time again.

Once scalp ringworm has cleared up, new hair starts to grow back. It usually takes six to twelve months for new hair to cover bald patches. New fingernails also grow out to replace those lost to ringworm of the nails. Complete recovery usually takes three to twelve months. Infections of the toenail are among the most difficult of all ringworm infections to cure.

PREVENTION


The best way to avoid getting ringworm is to avoid coming into contact with the fungi that cause the disease. That means staying away from people who have ringworm. It also means not handling objects that may have been used by an infected patient.

See also: Athlete's foot.

FOR MORE INFORMATION


Books

Cummings, Stephen, and Dana Ullman. Everyone's Guide to Homeopathic Medicine. Los Angeles: Jeremy P. Tarcher, 1984.

Shaw, Michael. Everything You Need to Know about Diseases. Springhouse, PA: Springhouse Corporation, 1996.

Web sites

Athlete's Foot, Jock Itch and Ringworm. [Online] http://www.2.ccf.org/ed/pated/kiosk/hinfo/docs/0039.htm (accessed on April 7, 1998).

"Ringworm." Thriveonline. [Online] http://www.thriveonline.com/health/Library/pedillsymp/pedillsymp361.html (accessed on April 5, 1998).

Ringworm. [Online] http://www.yourhealth.com/ohl/1282/html (accessed April 7, 1998).

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Ringworm

Ringworm

What Is Ringworm?

Is Ringworm Common?

How Do People Contract Ringworm?

How Do People Know They Have Ringworm?

How Do Doctors Diagnose Ringworm?

How Is Ringworm Treated?

Can Ringworm Be Prevented?

Resources

Ringworm, or tinea (TIH-nee-uh), is a fungal infection of the skin, scalp, or nails. It usually causes red, dry, flaky skin.

KEYWORDS

for searching the Internet and other reference sources

Athletes foot

Dermatophyte

Jock itch

Microsporum

Tinea

Trichophyton

Latin Lesson

Capitis (KAH-pih-tis): from the Latin word for head

Corporis (KOR-poor-us): the Latin word for body

Cruris (KRU-ris): from the Latin word for leg

Pedis (PEE-dis): the Latin word for foot

Unguium (UN-gwee-um): from the Latin word for nail

What Is Ringworm?

Despite its name, ringworm is not caused by a worm but by mold-like fungi known as dermatophytes (dur-MAH-toh-fites) that thrive in the top layer of the skin, in the scalp, and in nails. Several different but related types of fungi, including those in the Trichophyton and Microsporum species, cause ringworm infection on different parts of the body. All of these infections are known as tinea infections.

Fungal infections take their names from the part of the body where they occur, so tinea corporis is ringworm on the body; tinea unguium is ringworm of the nails; tinea capitis is ringworm of the scalp; tinea cruris is ringworm of the groin (commonly called jock itch); and tinea pedis is ringworm of the feet (also known as athletes foot). The same fungi that infect humans can infect cats and dogs as well, and people can contract the disease from both people and pets.

Damaged skin is more vulnerable to infection, as is skin in warm, moist areas. When the fungus takes hold, it typically causes a ring-like rash of red, flaking skin. The border of the rash may be raised, as if a worm were under the skin. The rashs shape and this raised edge led people to call the infection ringworm. When the nails are infected, they usually become yellow, thickened, and brittle.

Is Ringworm Common?

Ringworm is widespread in many countries, including the United States. Tinea corporis and tinea capitis infections most often occur in children, although they are found in people of all ages. The other types of ringworm, especially jock itch and athletes foot, are more common in adolescents and adults.

How Do People Contract Ringworm?

Ringworm is contagious and spreads through direct contact with an infected person or pet. People also can contract the fungus from soil or from surfaces and things that an infected person has touched, such as toys, a pillow, or the locker room floor. Once someone is infected, that person is contagious until the telltale rash starts to shrink. The fading of the ring indicates that the fungus is no longer present.

How Do People Know They Have Ringworm?

As anyone who has had the infection knows, the symptoms of ringworm are annoying rather than serious. The most common signs are itching

around the infected area, dry skin, and a red, ring-shaped rash. Over time the borders of the rash spread outward and the center clears, leaving a circle of red around normal skin. Sometimes the central patch in the rash is filled with pus*, and the borders may be dry and scaly or moist and crusty.

*pus
is a thick, creamy fluid, usually yellow or greenish in color, that forms at the site of an infection. Pus contains infection-fighting white cells and other substances.

Ringworm on the scalp can cause a temporary bald patch or areas of scaly, flaky skin, occasionally with a red, swollen spot. Infected nails become yellow, thickened, and brittle, and athletes foot often appears as red, cracked, peeling skin between the toes.

How Do Doctors Diagnose Ringworm?

In many infected patients, doctors can identify tinea just by looking at the skin, scalp, or nails. To confirm the diagnosis, the doctor may take a scraping of the suspect area to be examined under a microscope for signs of the fungus. The scraping also can be cultured* to see if any fungi grow from it. Because some types of fungi glow under ultraviolet* (UV) light, the doctor may shine a UV lamp on the rash to see if any part of it lights up. This can help identify the fungus causing the infection.

*cultured
(KUL-churd) means subjected to a test in which a sample of fluid or tissue from the body is placed in a dish containing material that supports the growth of certain organisms. Typically, within days the organisms will grow and can be identified.
*ultraviolet
light is a wavelength of light beyond visible light; on the spectrum of light, it falls between the violet end of visible light and X rays.

How Is Ringworm Treated?

Doctors prescribe antifungal cream, ointment, or shampoo for most cases of infection. More advanced cases also may require oral (by mouth) medicine, including all cases of tinea capitis and tinea unguium.

Patients typically need to use the cream, ointment, or shampoo for at least 2 weeks. However, some patients may need to use medicine for several weeks or months, depending on the extent and location of the infection. Beyond that, it may take even more time for skin to heal completely or for healthy nails and hair to grow back.

Ringworm may be irritating, but it causes almost no complications. Without treatment, the infection can linger for many months, and infected nails may fall off. Sometimes areas that have been attacked by the fungus develop infection from bacteria because the damaged skin is more vulnerable.

Can Ringworm Be Prevented?

The best way to prevent ringworm is to practice good hygiene, like bathing and changing underclothes every day. Keeping the skin clean and dry will discourage the fungus from taking hold. Not sharing personal items such as brushes, towels, and clothing (especially gym shoes) will limit the spread of ringworm between people. In addition, washing an infected persons clothing and bedding frequently can help keep the infection from spreading to others. If a household pet develops ringworm, doctors advise the family to talk to a veterinarian and avoid direct contact with the animal, like cuddling and patting, until the rash heals.

Athletes foot can flourish when the skin on the feet, especially between the toes, stays moist. Removing shoes and socks to allow moisture from sweat to dry, carefully drying feet after showering, and changing socks daily can help ward off the fungus. Wearing slip-on sandals instead of going barefoot in public places such as locker rooms and gym showers can reduce the risk of picking up tinea from surfaces an infected person has touched.

See also

Fungal Infections

Resources

Organization

U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894. The National Library of Medicine has a website packed with information on diseases such as ringworm, consumer resources, dictionaries and encyclopedias of medical terms, and directories of doctors and helpful organizations.

Telephone 888-346-3656 http://www.nlm.nih.gov

Website

KidsHealth.org. KidsHealth is a website created by the medical experts of the Nemours Foundation and is devoted to issues of childrens health. It contains articles on a variety of health topics, including ringworm.

http://www.KidsHealth.org

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ringworm

ring·worm / ˈringˌwərm/ • n. a contagious itching skin disease occurring in small circular patches, caused by any of a number of fungi and affecting chiefly the scalp or the feet. The commonest form is athlete's foot. Also called tinea.

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ringworm

ringworm Fungus infection of the skin, scalp or nails. The commonest type of ringworm is athlete's foot (tinea pedis). It is treated with antifungal preparations.

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ringworm

ringworm (ring-werm) n. see tinea.

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ringworm

ringwormaffirm, berm, confirm, firm, germ, herm, midterm, perm, sperm, squirm, term, therm, worm •pachyderm • echinoderm •wheatgerm • endosperm •gymnosperm • isogeotherm •ragworm • flatworm • threadworm •tapeworm •eelworm, mealworm •silkworm • ringworm • inchworm •blindworm • lobworm • roundworm •slow-worm • screw worm •woodworm •bookworm, hookworm •bloodworm • lugworm • lungworm •earthworm

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Ringworm

Ringworm

Introduction

Disease History, Characteristics, and Transmission

Scope and Distribution

Treatment and Prevention

Impacts and Issues

BIBLIOGRAPHY

Introduction

Ringworm, also known medically as Tinea and dermatophytosis, is a group of contagious, very common cutaneous (skin) infections, which can also involve the scalp, hair, or nails. It is caused by various moldlike fungi called dermatophytes, which live on dead tissues of the body. Because many different fungi species cause ringworm, an infection with one species will not make a person immune to infection from other species.

Moist areas of the body such as the groin, between the toes, and in the armpits are generally infected the most frequently. The infected area often looks inflamed and feels itchy. These symptoms are caused by sensitivity to the fungus or by a secondary bacterial infection. Ringworm, in its most serious forms, causes an acute infection with blisters on the feet or lesions on the scalp.

Disease History, Characteristics, and Transmission

The most common symptom of ringworm is flat, nearly round lesions. They may be dry and scaly, or moist and crusty. Eventually, they turn red and become extended, itchy bumps with edges that blister and secrete fluid. As the infection continues, the color sometimes becomes nearly clear in the center and redder on the outside. This pattern causes the patch to look ringlike in appearance, which gives ringworm its common name.

The incubation period is generally not known. However, ringworm of the scalp (tinea capitis) usually appears 10–14 days after contact and ringworm of the body (tinea corporis) usually appears in 4–10 days.

Ringworm infection is most often spread during human-skin-to-human-skin contact. It becomes contagious to another person even before the infection is evident on the first person. Ringworm is sometimes spread when humans touch infected cats and dogs; when humans care for other domestic animals such as cows and pigs; and when humans touch contaminated clothes, towels, hairbrushes, combs, headgear (such as hats), or other infected objects.

The most contagious form—ringworm of the scalp—is seen primarily in children. Symptoms include growing pimples, itching of scalp, and breaking off of hair. The scalp may temporarily become bald in patches.

Ringworm can also occur on the arms, legs, and trunk. It causes raised, round patches on the skin. The inner parts heal first, while the outer parts further spread the infection. When ringworm infection reaches other areas of the body, such as the armpit and groin, the shape often changes to resemble butterfly wings or it may be completely irregular in shape. The condition is called tinea cruris, or jock itch, when it affects the groin area.

The fingernails and toenails may also be infected. This condition is called tinea unguium. When this happens, the nails become yellowish, thickened, and deformed. They may crumble and fall off. When the infection spreads to the feet, ringworm is often called athlete's foot (tinea pedis). When ringworm affects facial hair it is called tinea barbae; when it affects the face, tinea faciei;andwhenit affects hands and palms, tinea manuum.

WORDS TO KNOW

CUTANEOUS: Pertaining to the skin.

DERMATOPHYTE: A dermatophyte is a parasitic fungus which feeds off keratin, a protein which is abundant in skin, nails and hair and therefore often causes infection of these body parts

TOPICAL: Any medication that is applied directly to particular part of the body's surface is termed topical; for example, a topical ointment.

IN CONTEXT: CULTURAL CONNECTIONS

Ringworm-causing fungi affect various parts of the body and give rise to alternative names and conditions. In the scalp ring worm is known as tinea capitis, on the body, ringworm is known as tinea corporis). In the groin region ringworm is known as tinea cruris, more commonly called “jock itch,” and on the feet ringworm is known as tinea pedis, more commonly known as athlete's foot.

Over one million children (about 0.3% of the 2006 population) are infected with scalp ringworm annually in the United States. It is a highly contagious, and the number of children infected each year is increasing. Ringworm of the scalp represents over 90% of all skin fungal infections in U.S. children aged ten years or younger. About 7% of the U.S. population suffers from ringworm of the scalp. It is most frequently caught in overcrowded conditions such as medical facilities, nursing homes, and educational institutions. Elderly people and people with weak immune systems are at increased risk for acquiring ringworm because of their susceptibility to infections.

Jock itch and athlete's foot are important economically because they are targets of several commercial products and generate millions of dollars in advertising revenues spent to market the over-the-counter products designed to fight the fungal infections.

Scope and Distribution

Ringworm can occur almost anywhere in the world. Because the fungi that cause tinea cruris and tinea pedis thrive in moist and humid areas, they occur most frequently in the tropical and subtropical areas of the world.

Treatment and Prevention

Doctors often identify ringworm visually. If not recognizable, it is often diagnosed by scraping off or plucking some material from the infected area. The sample is examined under a microscope to confirm the presence of fungal growth. Ringworm of the scalp is diagnosed with an ultraviolet light under which the fungus appears to be a bright, yellowish green color.

Ringworm treatment includes topical antifungal medications. Common antifungal creams, lotions, or powders that contain miconazole, econazole, or clotrimazole are often used either by prescription or over-the-counter.

Infected children are sometimes isolated from others, especially other children, to prevent further spreading of the infection. Griseofulvin is commonly used to treat animals and humans. It usually eliminates the infection, but side effects can be pronounced. Undecylenic acid is sometimes used as a fungicide. Antibiotics may be necessary to cure bacterial infections.

According to the Mayo Clinic, although ringworm is unpleasant, it is not serious except for people with weak immune systems. Ringworm usually resolves itself without a visit to the doctor within four weeks. Bed linens and pajamas should be washed daily. A person should seek medical treatment if the infection becomes severe or persistent. Antifungal drugs, including fluconazole, itraconazole, ketoconazole, and terbinafine, are sometimes taken by mouth for persistent infections.

The National Institutes of Health recommends a variety of measures to prevent ringworm including:

  • Shampoo hair regularly, especially after it is cut.
  • Wear shoes in shower stalls, gym locker rooms, pools, and other moist areas.
  • Keep skin and feet clean and dry.
  • Do not share personal care items or items of apparel, such as towels, hairbrushes, shoes, or hats.
  • Avoid touching pets or other domestic animals that have bald spots.

Impacts and Issues

Anyone can get ringworm. Children are more susceptible to certain types of ringworm fungi, while other types occur equally in all age groups. Children become more susceptible to ringworm when they are malnourished, live in a warm climate, practice poor hygiene, come into contact other children or pets with ringworm, or have weak immune systems due to medicines or disease. Complications of ringworm include spreading the infection to other areas than the initial site; bacterial skin infections; skin irritations, such as contact dermatitis; and side effects from drugs used for treatment.

See AlsoMycotic Disease.

BIBLIOGRAPHY

Books

Brock, David. Infectious Fungi. Philadelphia: Chelsea House Publishers, 2006.

Yosipovitch, Gil, et al., eds. Itch: Basic Mechanisms and Therapy. Oxford: Taylor & Francis, 2004.

Periodicals

Weinstein, A. “Topical Treatment of Common Superficial Tinea Infections.” American Family Physician. 65 (May 15, 2002): 2095–2102.

Web Sites

Mayo Clinic. “Ringworm of the Body.” October 4, 2006. <http://www.mayoclinic.com/health/ringworm/DS00489/DSECTION=1> (accessed March 22, 2007).

MedlinePlus. “Ringworm.” June 16, 2005. <http://www.nlm.nih.gov/medlineplus/ency/article/001439.htm> (accessed March 28, 2007).

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