Ringworm

Ringworm: A rash with a raised, wavy border is a common sign of ringworm.

What is ringworm?

If you have ringworm, you may think you have worms in your skin or a disease caused by worms. You have neither. Ringworm is actually a skin infection caused by fungus. No worms involved.

The name “ringworm” probably comes from the rash that many people see. On the skin, the rash often has a ring-shaped pattern and a raised, scaly border that snakes its way around the edge like a worm.

Ringworm is common. You’ve already had it if you had:

Athlete’s foot
Jock itch
Scalp ringworm

Ringworm can appear on just about any part of your body. On the palms, soles, scalp, groin, and nails, the rash lacks the ring-shaped pattern. On the soles and groin, ringworm also has a different name.

Part of the body	Name	Medical name
Skin	Ringworm	Tinea corporis
Feet (soles)	Athlete's foot	Tinea pedis
Hands (palms)	Ringworm	Tinea manuum
Groin area	Jock itch	Tinea cruris
Nails	Ringworm	Tinea unguium or onychomycosis

No matter where ringworm appears on the body, treatment is important. Without treatment, the rash tends to grow slowly and cover a larger area. You can also infect other areas of your body.

Treatment can get rid of the ringworm and stop the itch, which can be intense. Because ringworm is contagious, treatment can also prevent you from spreading it to others.

Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Sobera JO and Elewski BE. “Fungal diseases.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1138-46.
Verma S and Heffernan MP. “Superficial fungal infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1807-16.

Ringworm: Signs and symptoms

Ringworm is an infection caused by fungus. You can get ringworm anywhere on your skin.

On most areas of the skin, it causes ring-shaped patches. What you see, however, changes when ringworm grows on the feet (bottoms and sides), palms, nails, groin, beard area, or scalp.

Skin with ringworm infection

Roundish, flat patches that have a raised, scaly border.
On light-colored skin, the patches tend to be red or pink.
On skin of color, the patches are usually brown or gray.
Patches can grow slowly, increasing in size and appearing on more areas of the body.
The center of a patch tends to clear first.
The patches can be intensely itchy.

Feet with ringworm infection (athlete’s foot)

Itching, burning, and stinging on your soles and between your toes
Dry, scaly skin that usually begins between the toes and can spread to the bottom of the feet, sides, or both
Peeling skin
Blisters, painful cracking skin, bleeding, and thick patches of red and scaly skin
Skin between the toes turns white, becoming soft and mushy
Foul odor
Rash on one or both hands because touching the infected foot can spread the infection to your hands

Hand with ringworm infection

Widespread, dry skin on the palm
Deep cracks on the palms
Infection may spread to the fingernails (see nails below)
Can be mistaken for extremely dry skin or dry, thick skin due to working with hands
Ring-shaped patches on the back of the hand
May get athlete’s foot from touching your feet

Nails with ringworm infection

Can infect 1 or several nails
Begins with thickening of the tissue under the nail (nail bed)
Nails discolor and thicken
Thickened nails may start to lift away from the nail bed
Crumbling nails
Disappearing nails (In time, you see less of the nails.)
Toenails more likely than fingernails to become infected
Often develops in people who have athlete’s foot for a long time

Groin with ringworm infection (jock itch)

First sign: A red (brown or gray in dark skin) rash with swelling and itch in the crease where the leg meets the body
Rash spreads to the groin then slowly reaches the inner thigh (shown here), waist, and buttocks
Infected skin often feels scaly and has a raised border
Skin can flake, peel, and crack
Infected skin can be intensely itchy and painful — but not always

Beard area with ringworm infection

This develops in men who can grow facial hair. Most men get it when they have contact with infected animal, which may explain why farmers and ranchers seem to develop it more often. Signs and symptoms appear on the bearded area of the face and neck, and you may notice:

Intense redness and swelling
Pus-filled bumps
Hair loss (Hair often returns when ringworm is treated.)
Swollen lymph nodes
Raw, open skin
Raised soft, spongy skin that weeps fluid
A skin problem that looks like acne, folliculitis, or another skin condition

Some men feel tired and rundown.

Scalp ringworm

A scaly bald patch
Widespread baldness with thick, crusty patches on the scalp
Black dots in the bald area
Open sores oozing pus
Raised soft, spongy, inflamed area
Swollen lymph nodes
Intense itch

If you notice any of these signs or symptoms, you should see a dermatologist. You could have ringworm or another type of skin infection. Treatment can cure a skin infection.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

References
Gupta AK and Lynch LE. “Fungal and yeast infections.” In: Kelly AP and Taylor S. Dermatology for Skin of Color. (first edition). The McGraw-Hill Companies, Inc. China, 2009:427-8.
Habif TP, Campbell, JL, et al. “Fungal infections.” In: Dermatology DDxDeck. Mosby Elsevier, China, 2006: Cards# 72, 75, 76, 77, 78, 80, and 81.
Sobera JO and Elewski BE. “Fungal diseases.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1138-46.
Verma S and Heffernan MP. “Superficial fungal infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1807-16.

Ringworm: Who gets and causes

Who gets ringworm

Head-to-head contact can spread scalp ringworm. Children get scalp ringworm, which is rare in adults. The other types of ringworm are more common in adults.
People around the world develop ringworm, and anyone can get it.

Your risk of getting ringworm increases if you:

Live in a tropical area
Spend time in hot, humid weather
Sweat heavily
Wrestle, play football, or participate in another contact sport
Live in close contact with others, such as in military housing
Share towels, clothes, razors, and other things without disinfecting (razors) or washing (clothes and towels) them
Are obese
Have diabetes
Wear clothing that chafes your skin
Use a locker room or pool and don’t wash and dry your feet well before putting on shoes and socks

Having HIV does not increase your risk of getting ringworm. If you are HIV-positive and get ringworm, however, the ringworm can be more severe and difficult to get rid of.

Athletes tend to get ringworm because they often have sweaty bodies and may have close physical contact with other athletes. Two types of ringworm, athlete’s foot and jock itch, are especially common in athletes.

You don’t have to be an athlete, however, to get ringworm. Anyone who has damp or sweaty feet can get athlete’s foot. Sweating a lot in the groin area can lead to jock itch.

What causes ringworm?

Certain types of fungi (plural of fungus) cause ringworm. These fungi thrive where it’s warm and humid. Ringworm is common in tropical areas and during hot, humid summers. It flourishes in warm, moist locker rooms and indoor pools.

You can also get ringworm when the weather is cool because ringworm is extremely contagious.

It's possible to get ringworm from:

Having skin-to-skin contact with someone who has it
Petting an animal like a dog, cat, or farm animal infected with ringworm
Touching soil infected with ringworm
Using an infected object like a phone, comb, or towel

The fungi that cause ringworm can live on any infected object, including clothing, brushes, and sports equipment for a long time.
Image from Thinkstock

References
Gupta AK and Lynch LE. “Fungal and yeast infections.” In: Kelly AP and Taylor S. Dermatology for Skin of Color. (first edition). The McGraw-Hill Companies, Inc. China, 2009:427-8.
Martin ES and Elewski BE. “Tinea capitis in adult women masquerading as bacterial pyoderma.” J Am Acad Dermatol 2003; 49:S177-9.
Sobera JO and Elewski BE. “Fungal diseases.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1138-46.
Verma S and Heffernan MP. “Superficial fungal infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1807-16.

Ringworm: Diagnosis, treatment, and outcome

How do dermatologists diagnose ringworm?

It’s important to apply (or take) antifungal medicine for as long as prescribed. Stopping early may fail to clear the infection. This can make ringworm

A dermatologist can often tell if you have ringworm by looking at the infected area.

Your dermatologist may also examine other areas of your body. It’s common to have athlete’s foot and ringworm on one or both hands. Sometimes, the infection spreads to one or more nails.

Before giving you the diagnosis, your dermatologist may send a bit of the infected skin, hair, or nail to a laboratory.

Taking a sample is easy. If you might have ringworm on your skin, your dermatologist will scrape off a bit of the infected skin. When it looks like you have ringworm on your scalp or beard area, your dermatologist may remove some hair. To find out if you have ringworm on a nail, your dermatologist will clip off a bit of nail and remove some debris from under the nail.

By looking at the sample under a microscope, a doctor can see if it contains any of the fungi that cause ringworm.

How do dermatologists treat ringworm?

If you have ringworm, your dermatologist will treat it with antifungal medicine. This medicine comes in many different forms like creams, ointments, and pills. What you use will depend on the area of the body that needs treatment.

Skin: An antifungal ointment or cream often clears ringworm on the skin. Most of these medicines you apply twice a day for 2 to 4 weeks. Many of these approved medicines are safe and effective for children.

If the ringworm covers a large area of skin, you may need to take a prescription antifungal medicine.

When the ringworm starts to clear, you’ll likely see the scale clear before the redness.

Athlete’s foot: An antifungal cream or spray that you buy without a prescription may clear athlete’s foot. A mild case usually clears in 2 weeks.

If the athlete’s foot is more severe or fails to clear in 2 weeks, a dermatologist can prescribe stronger medicine.

Jock itch: To treat this type of ringworm, your dermatologist may recommend an antifungal cream, spray, or powder that you can buy without a prescription. You typically apply the antifungal twice a day for 10 to 14 days.

To treat the itch, it often helps to apply a wet, cool washcloth to the area for 20 to 30 minutes. You may need to apply cool compresses 2 to 6 times a day.

When washing the infected area or applying a cool compress, be sure to use a clean washcloth every time and use it only on the jock itch. Before using the washcloth again, you’ll want to wash it in hot, sudsy water to kill the fungus. Ringworm can survive on objects for a long time.

If the jock itch fails to clear with at-home treatment, be sure to tell your dermatologist. You may need stronger medicine.

Washing your hands after treating ringworm helps stop the disease from spreading to other areas of your body.

Scalp: On the scalp, ringworm requires prescription medicine.

Children who have scalp ringworm often receive a medicine called griseofulvin (griz-e-oh-full-vin). Your dermatologist may prescribe the tablets, capsules, or liquid. Sometimes, another prescription medicine is prescribed.

It is important to take an antifungal medicine exactly as prescribed — and for as long as prescribed. The ringworm may fail to clear if you stop taking it sooner than prescribed. This can make it more difficult to get rid of the ringworm.

Clearing scalp ringworm also often requires using an antifungal shampoo. In fact, everyone with whom the infected person lives needs to use an antifungal shampoo. Scalp ringworm is extremely contagious. When everyone uses antifungal shampoo, this helps prevent family members from infecting each other.

To clear ringworm, you must treat it everywhere on your body at the same time.

Hands: You may be able to clear a mild case with an antifungal cream. Often stronger antifungal medicine like terbinafine (ter-bin-ah-fine) or itraconazole (it-rah-con-ah-zole) is necessary.

If the ringworm has spread to a fingernail, you will need to take an antifungal medicine to get rid of the infection.

Nails: You need prescription medicine to clear ringworm from the nails. Because nails grow slowly, ringworm will take time to clear. It’s important to keep all follow-up appointments with your dermatologist.

You may also need to follow preventive measures to avoid reinfection.

Beard: Ringworm in the beard area requires prescription antifungal medicine and a tailor-made treatment plan. Your dermatologist may need to remove unhealthy tissue to help the area heal. You’ll also need to shave the infected hair.

What is the outcome for someone who has ringworm?

Antifungal medicine can clear ringworm from every area of the body. In some areas like the nails and hands, clearing takes time. It’s important to follow your dermatologist’s treatment plan and keep all follow-up appointments.

Images from Thinkstock

References
Sobera JO and Elewski BE. “Fungal diseases.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1138-46.
Verma S and Heffernan MP. “Superficial fungal infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1807-16.

Ringworm: 12 tips for getting the best results from treatment

Keep the area clean and dry: Using a different towel to dry off the area infected by ringworm can improve treatment results.
When treating a ringworm infection, it’s important to use an anti-fungal medicine. To get the best results and prevent the infection from spreading to other areas of your body, dermatologists recommend the following:

Treat the area for as long as recommended. Anti-fungal medicine may work quickly. You may see clearing or no longer feel symptoms in a few days.
If this happens, you should still treat the area for as long as your dermatologist recommends. If you’re treating with a medicine that you bought without a prescription, treat for as long as stated in the directions.
By treating ringworm for as long as recommended, you help ensure that the ringworm does not re-appear a few weeks after you stop treating it.
After touching the area with ringworm, wash your hands before touching another area of your body. Touching or scratching the area with ringworm and then touching another area can spread ringworm from one part of your body to another. Washing your hands well can help prevent this.
Keep the infected area clean and dry. The fungus that causes ringworm thrives in warm, moist areas, so you want keep the area clean and dry.
When cleaning the area with ringworm, wash the affected area(s) and dry it (them) with a clean towel. Use another clean towel to dry the other parts of your body.
Before using these towels again, wash them in hot, sudsy water.
To keep the area dry, avoid wearing clothes, socks, and shoes that make you sweat.
Treat all ringworm at the same time. If you have athlete’s foot and ringworm on your hands, it’s important to treat both your feet and hands. If you treat only one area, you’ll still have a ringworm infection. The infection can quickly spread to other areas again.
Because ringworm is very contagious, you can also spread ringworm to other people.
Change your clothes, including underwear and socks, every day. Wash the clothes before wearing them again. This includes clothes you wear to work out.
Shower after working out. Fungi thrive in moist, warm areas. You want to wash away perspiration and keep the area dry.
Avoid sharing towels and other personal items. You can easily spread ringworm to others by sharing towels, hats, combs, and other personal items. The fungi can survive on objects for a long time.
Wear shower thongs or waterproof shoes in locker rooms, showers that others use, and pool areas. If you have athlete’s foot, this helps prevent spreading it to others. It also gives you some protection if someone else has ringworm.
Disinfect or throw out infected items. The fungi that cause ringworm can survive for a long time.
To avoid re-infecting yourself with infected items, you should wash clothes, towels, and bedding that you use while you have ringworm. Be sure to wash everything in hot, soapy water.
If you have athlete’s foot, you’ll want to toss all shoes and other footwear that you wore before you started treatment. If you cannot bear to toss shoes, you can disinfect them using an ultraviolet (UV) shoe sanitizer or ozone cabinet, which you can buy online.
Disinfecting items is also important because if you continue to use an infected item, treatment may not work.
If you suspect your pet has ringworm, take the animal to your vet. It’s possible to catch ringworm from an animal. Dogs, cats, and other animals can pass ringworm to humans. Just as there are effective treatments for people, there are effective ringworm treatments for pets.
If your pet is diagnosed with ringworm, you’ll want to take some preventive measures for a few weeks. You’ll find these at:
Healthy Pets Healthy People: Ringworm (Centers for Disease Control)
If treatment fails to clear the rash, tell your dermatologist. Virtually every case of ringworm can be successfully treated.
Keep all follow-up appointments with your dermatologist. Ringworm often clears with the first treatment a dermatologist prescribes. Sometimes, ringworm can be stubborn or patients unknowingly do something that prevents the treatment from working. For these reasons, it best to keep follow-up appointments.

Image from Thinkstock

References
Sobera JO and Elewski BE. “Fungal diseases.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008:1138-46.
Centers for Disease Control. Healthy Pets Healthy People: Ringworm. Last accessed April 19, 2016.

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