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.

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.

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.

Who gets ringworm

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.

How do dermatologists diagnose 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.

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.

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.