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Ringworm – Symptoms and Treatments

A “fungus” (plural “fungi”) is a germ related to yeast and mold. Many fungi can live on human skin. Doctors use the word “tinea” to describe a variety of infections with fungi. There are many different species of fungi that cause skin and scalp infections in humans. Each species tends to cause infections in one or two particular areas of the body. “Ringworm” is the common term for tinea of the scalp (tinea capitis) or skin (tinea corporis). There is no real “worm” in ringworm, but the sound of it bothers many people. “Athlete’s foot” is the common term for tinea infections of the feet (tinea pedis). Teenagers, especially athletes, can also get tinea infections in the groin, or “jock itch” (tinea cruris). A somewhat different kind of tinea infection, called “tinea versicolor,” can cause discoloration of the skin on the chest and back.

All of these fungal infections have several things in common: they cause redness and scaling of the skin, and most of them itch (tinea versicolor usually doesn’t). How much each of these symptoms affects each child depends on the child’s age and the location of the fungus. Tinea of the scalp, for example, is often not very itchy, while athlete’s foot and “jock itch” can be almost unbearable. The child’s immune system is actually the cause of most of the symptoms, as it sends white blood cells and special chemicals to the skin to destroy the fungus.

 What is the Biggest Concern with Ringworm?

For most people with tinea infections, the itching and scaling of the skin are the biggest concerns. Many people worry that ringworm infections, especially if they happen on the face, will cause scars (they don’t). Sometimes children who scratch too hard at a tinea infection can break the skin and allow bacteria to enter. This can cause a bacterial infection called “impetigo” or a deeper skin infection called “cellulitis.” Tinea infections can also recur easily, because the germs that cause them are so common. Ringworm infections of the scalp, in particular, often spread rapidly through pre-school and daycare centers.

Ringworm Treatment

With some exceptions, it is easy to treat tinea infections, but it does take time and patience. Tinea infections on the skin, like ringworm of the skin, athlete’s foot, and jock itch, get better with topical medicine such as tolnaftate (Tinactin®, and others), or clotrimazole (Lotrimin® and others). These medicines come as sprays, liquids, powders, gels, and creams. Your doctor will recommend the right preparation for your child. Please apply the medicine twice daily (or as directed by your doctor). Most doctors recommend treating the affected skin areas for up to three days after the visible signs of the infection are gone. This will help to prevent a recurrence. During treatment it is important for your child or teen to avoid the kinds of activities that help the fungus to grow. Fungi like dark, warm, moist places, and they tend to thrive on surfaces that stay wet most of the time, such as locker room or shower room floors. While it is fine for your child to continue athletic activity if s/he has a fungal infection, please be sure that s/he understands the importance of washing well in soapy water and drying thoroughly with a clean towel immediately. For athlete’s foot, s/he should wear a clean pair of white cotton socks each day, to avoid re-infection. Have your athlete apply the medication immediately after showering and drying off. It also makes sense to take care to put on underwear carefully, avoiding contact with the infected feet. This may help to keep the fungus from spreading from the foot to the groin.

Ringworm of the scalp (tinea capitis) is harder to treat, because the fungus gets into the roots of the hair. This means that topical treatments such as shampoos and lotions will not help. Your doctor will recommend an oral anti-fungal drug such as griseofulvin (Fulvicin®) and others. You should give these to your child every morning with some fatty food, such as eggs or butter. These foods help your child to absorb the medicine better. Because the medicine must travel in your child’s blood stream and then enter the hair roots, treatment takes six full weeks to work properly. These medications can cause some rare but important side effects on your child’s blood and liver. Your doctor may recommend a blood test during the treatment. Because of these side effects, it is especially important to be sure to give every dose on time, and to finish the entire supply of medicine. Otherwise, the medicine can not finish killing the fungus, and you might have to give it again, or for a longer period, which would expose your child to more risk. You may also want to use an anti-fungal or a dandruff shampoo (such as Selsun Blue® or Head & Shoulders® to help loosen the itching and scaling on the scalp.

Tinea versicolor is also more difficult to treat than ringworm or other skin infections with fungi. If your child or teen has tinea versicolor, your doctor may prescribe an oral anti-fungal drug such as itraconazole (Nizoral®) or fluconazole (Diflucan®). These drugs are generally safe, but please be sure to follow your doctor’s directions carefully. Tinea versicolor can take weeks or even months to clear up, even on medication. Some doctors recommend applying a dandruff shampoo for ten minutes before a shower twice a day.

When should I be worried?

Tinea infections are rarely serious by themselves, though they can be very irritating. Here are some things to look out for that might suggest the condition is getting worse, or that another kind of infection has set in:

  • Spreading of the areas of rash, redness, or scaling after three or more days on treatment
  • New rash appearing in different parts of the body with a different appearance
  • Areas of broken skin from scratching that have swelling, redness, or pain around them, or that are draining pus.
  • Scalp swelling and oozing with ringworm of the scalp (tinea capitis)
  • Fever

If any of these occur, please be sure to call your doctor’s office right away.

Other points of concern

Ringworm of the scalp (tinea capitis) can cause some other problems besides the itching and scaling. The particular fungi that cause the scalp infection also cause the child’s immune system to react powerfully. This can cause a condition called a “kerion,” which is a large area of swelling in one or more locations on the scalp. The swelling can be impressive, covering an area the size of a water glass. Most of the time the kerion will ooze or drain a honey-colored, cloudy, or bloody liquid. They often itch intensely. Despite their terrible appearance, kerions are not bacterial infections. They are areas of intense inflammation. Your doctor may prescribe a short course of oral steroid medication if your child develops a kerion.

Ringworm of the scalp can also cause the lymph nodes (blood filters) in the neck to swell and sometimes to be painful. In fact, in some cases, the child or parent notice these “swollen glands” before they notice the infection itself. Just as with a kerion, these glands are inflamed, but not infected. They will gradually get better as the fungus goes away.

Any kind of fungal infection can cause a so-called “id” reaction. An “id” reaction looks like red, slightly raised bumps or wheals that are all over the child’s body – not just where the original fungal infection was. The “id” reaction happens when chemicals from the fungus travel in the child’s blood stream and set off the immune system in the skin all around the body. An “id” reaction is not the same thing as a spreading of the actual infection. Most of the time the “id” reaction will clear up as the fungus gets better, but it can last longer than the original fungal infection.

Other Conditions that Might Be Present with Ringworm

Most simple fungal infections are easy to diagnose and treat. There are a few other skin conditions, however, that can look a lot like a fungal infection. Often, these conditions only become obvious when treatment for fungus has failed. These conditions include “granuloma annulare,” which can look a lot like ringworm of the skin, and “pityriasis rosea,” which can look like ringworm of the skin or like tinea versicolor. Some forms of eczema and psoriasis can look like athlete’s foot or ringworm of the skin. Seborrheic dermatitis, or seborrhea, can sometimes appear like ringworm of the scalp.