Dermatology
Ringworm (Tinea)
​Overview:
  • Ringworm is a common fungal infection caused by dermatophytes; it spreads dermally into a ring-shaped slightly raised scaly-crusted sore.
  • Dermatophytes occur in warm and humid climates; therefore, ringworm is more frequent in tropical regions.  
  • Ringworm is remarkable due to its distinguishable and wide-spread effect on the skin.
  • Ringworm rarely spreads subcutaneously to cause serious infection.
  • Personal hygiene, supported by clean places, clothes, and tools are important preventive measures. 
What is ringworm?
Ringworm is a common fungal infection caused by dermatophytes (microscopic organisms that live upon the stratum corneum). Dermatophytes cause a skin rash that appears as a ring-shaped slightly raised scaly crusted sore. 

Other names:
Tinea
Cause
Ringworm is caused by particular types of dermatophytes that thrive in warm and humid climates; therefore, ringworm is more frequent in tropical regions and in summer. Dermatophytes spread inside warm and moist locker rooms and indoor swimming pools. Ringworm is highly contagious even in cold weather. Infection may also be caused by: 
  • Direct contact with an infected person.
  • Direct contact with items contaminated by the fungus, for example, towels, clothing, bedclothes or chairs handled by people with the infection. 
  • Contact with some infected pets (dogs and cats), especially by children.
  • Infected farm animals (cattle) that pass through gates may be contagious enough upon direct contact.  
  • Contact with soil where the fungus rarely exists.
Risk factors:
  • Living in warm climates.
  • Domestic contact with an infected person or pet.
  • Sharing clothes, bed or towels with an infected person. 
  • Sports that require physical contact, such as judo and karate.
  • Perspiration while wearing tight clothes. 
  • Bathing in public restrooms, locker rooms, or reservoirs, as found in sports clubs and playgrounds. 
  • Weak immune system due to diseases like diabetes, AIDS, or leukemia.
Symptoms:
Ringworm is remarkable in the body due to its distinguishable and wide-spread effect on the skin; it occurs in the form of ring-shaped patches. However, ringworm varies in shape according to infection location: feet, hand palms, nails, thighs, beard or scalp. 
Dermal symptoms:
  • Ringworm may first appear as round flat slightly raised scaly crusted patches.
  • On fair skin, patches tend to appear as red or pink in color. 
  • On dark skin, patches usually appear as brown or gray in color.
  • Patches may slowly grow bigger and spread through more parts of the body.
  • Patches may also cause severe itching.
Symptoms of tinea pedis or (Athlete's foot):
  • Itching and burning on the soles and in between toes
  • Dryness and scaling that usually begins in between the toes and may spread on the soles and/or the side of the foot
  • Blisters, painful cracked skin, bleeding and thick red and scaly sores 
  • White smooth skin in between toes. 
  • Unpleasant odor
  • Rash in one or both hands, because infection can spread to the hands by touching the infected feet
Symptoms of tinea manuum (hands):
  • Dryness on the palm of the hand
  • Deep scaling on the palm of the hand
  • Infection may spread to fingernails
  • Occurs in the form of a ring on the back of the hand
Symptoms of tinea unguium (nails):
  • May affect one or more nails
  • Begins with thickness in subcutaneous tissues
  • Change in color and thickness of the nails
  • Pitted and grooved nails
  • Disappearance of the nails
  • Toenails are more susceptible to infection than fingernails
  • Often occurs in persons with long-term tinea pedis.
Symptoms of tinea barbae (beard):
Tinea Barbae is most frequently passed to adult men from infected animals, so agricultural workers and cattle breeders are the most commonly infected persons. Signs and symptoms appear on the mustache and beard area in the face and neck: 
  • Redness and severe swelling
  • Pustules that may ooze pus
  • Hair loss (hair often grows back after treatment)
  • Swollen lymph glands
Symptoms of tinea capitis (scalp):
  • Hair loss in the infected area and scaly patches on the scalp
  • Black spots in the bald area
  • Ulcers full of pus
  • Swollen lymph glands
  • Severe itching
When to see a doctor?
  • If there is fever, excessive pain, swelling, drainage, or redness, this may indicate a secondary bacterial infection.  
  • If the rash doesn't improve within one week of beginning self-treatment with an over-the-counter antifungal product, it may be necessary to be treated according to a prescription.
Complications:
Rarely, a fungal infection may spread subcutaneously to cause serious infection. However, persons with a weak immune system due to diabetes or AIDS may face difficulties in getting rid of the infection. 

Diagnosis:
It is significant for a doctor to diagnose such a condition to treat it properly. Tinea corporis (body ringworm) can be mistaken for other dermal infections such as eczema or psoriasis. When the diagnosis is difficult, tinea corporis is confirmed by scraping a portion of the affected skin and examining it under a microscope. This is because the histopathological features of tinea corporis are distinguishable, and the microorganisms causing it are found on the skin surface. 

Treatment:
  • Antifungal medications including creams, ointments and pills depending on the infected area.  
  • Antifungal pills prescribed by a doctor in case the ringworm has spread in more than one area.  
  • If the infection causes abscesses, it may require surgery for draining purposes.
  • Special attention to cleaning and drying moist infected areas.  
Prevention:
  • Maintain personal hygiene by washing hands frequently.
  • Keep shared areas clean, especially in schools, child care centers, gyms and locker rooms. 
  • If you participate in contact sports, shower right after practice or a match. 
  • Keep your sports uniform and shoes clean.
  • Stay cool and dry. Don't wear thick clothing for long periods of time in warm, humid weather. Avoid excessive sweating. 
  • Dry the body well after bathing and before dressing, because the fungus thrives in moist, dark areas. 
  • Avoid infected animals. The infection often looks like a patch of skin where fur is missing.
  • Don't share personal items. Don't let others use your clothing, towels, hairbrushes, sports gear or other personal items. And don't borrow such things. 
Tips for infected persons:
  • Avoid touching infected areas.
  • Treat the affected area and complete the course of treatment prescribed by the doctor to ensure your ringworm does not reappear a few weeks after stopping treatment.
  • Keep the affected area clean and dry. 
  • If you have athlete's foot (tinea pedis), you will need to throw away all the shoes you have been wearing before starting treatment. If you cannot bear to throw the shoes, they must be disinfected before using them again. 
  • Keep clean via regular and thorough bathing. The clothing and linen of infected persons should be frequently and separately laundered. 
  • Avoid contact sports such as boxing. 
  • When owning or raising pets or cattle, you should periodically check them at the veterinarian for ringworm, especially in regions with hot or very humid climate. 
  • If pets have ringworm, they should be taken to the veterinarian for quick treatment. Places where infected pets spend time should be cleaned thoroughly. Surfaces and pet beds should be disinfected. Wash hands immediately after handling a pet.
FAQ:
  • Is body ringworm an emergency?
In general, a ringworm infection is not an emergency. However, if there is fever, excessive pain, swelling, drainage, or redness, this may indicate a secondary bacterial infection; then you must go to the nearest ER department.
  • Can body ringworm affect newborns?
Body ringworm may, but rarely, affect newborns.

Myths & Truths:
Ringworm affects only athletes.
Truth: Ringworm can infect any person, regardless of their gender, age, or fitness level. It also affects pets (dogs, cats and cattle). Sometimes it is spread by contact with soil. 


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Last Update : 05 January 2021 12:29 PM
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