How to treat ringworm?

In a Nutshell

  • Common fungal infection of skin that may affect different parts of the body such as scalp, feet, groin etc.
  • Diagnosed by physical examination, but sometimes your doctor may advice microscopic evaluation of skin scrapings or culture & biopsy
  • Topical or oral antifungal medications can be used to treat the infection

Brief Context:

Ringworm infection (also known as dermatophytosis) is a common skin infection caused by fungi. It is characterized by appearance of a circular rash (like a ring, hence the name) that is red, itchy, and discomforting. Other symptoms include loss of hair from the site of infection, scaling of skin, appearance of sores or blisters etc.

The infection can affect anyone, and any part of the body can be affected. Ringworm infection is also known as tinea and is further classified on the site of infection.

- Feet (athlete’s foot or tinea pedis)

- Groin (jock itch or tinea cruris)

- Scalp (tinea capitis)

- Beard (tinea barbae)

The diagnosis is usually made on physical examination, but in some cases your doctor may advise additional tests to confirm such as culture test to see fungal growth in controlled laboratory environment or microscopic evaluation of skin scrapings.

Basic Treatment Regimen

Treatment regimen involves management of active infection with antifungals (topical, oral or both) as unfortunately, you cannot treat the infection with home remedies alone.

Topical antifungals

For localized infection (for example ringworm infection of scalp, beard, or feet), topical antifungals can be used. When used regularly along with optimal supportive care, most infections clear out in 2 weeks. You can apply these twice a day or as suggested by your doctor. Some common topical antifungals are:

- Clotrimazole

- Miconazole

- Ketoconazole

- Econazole

- Naftifine

- Terbinafine

Systemic antifungals

For more widespread or concealed infections (such as ringworm of toenails or scalp), systemic antifungals are advised. Generally, doctors recommend a course of 3 -months but duration may vary according to site and severity of infection and response to therapy.

Most frequently prescribed systemic antifungal drugs are:

- Terbinafine

- Itraconazole

- Fluconazole

Supportive Care:

- Use symptomatic or supportive treatment to alleviate symptoms such as removal of infected nail or hair or use of cold compresses to alleviate itching and discomfort in jock’s itch/ athlete’s foot

- Treat all ringworm infections at the same time

Preventive measures

- Ringworm infection is highly contagious and spreads from person to person via shared articles of clothing or items of personal use such as towels, combs, brushes. It also spreads from skin to skin contact or contact with contaminated pool, locker room or changing room surfaces.

- Avoid tight clothing in hot humid environment that promotes sweating or irritation of skin

- Make sure to complete the course of antifungal even if you are free from symptoms.

- Change your clothing (especially intimates) every day

- Dispose off infected articles of clothing properly as fungi tend to stay active on non-living surfaces for a long period of time

Nuances/ Safety

Most cases of ringworm infection resolve with antifungal treatment. Speak to your doctor if:

- Your symptoms are not improving with the treatment

- You are pregnant or breast-feeding as some antifungal drugs may pose a threat to your baby

- You have compromised immune system (such as if you have received a transplant and are on immunosuppressant therapy)

Strength of Evidence:B
The recommendations made in this article are based on consensus treatment as advised by healthcare providers and best practices by American Dermatology Association and the National Health Services.

Our Ruling

Ringworm infection is fairly common and can infect any individual. The key to management is early identification and proper management with an antifungal agent (topical, oral, or systemic) depending on the site and severity of infection). Since recurrence rate is very high, it is advised to avoid sharing personal articles such as comb, brushes or intimates/ clothing. Avoid wearing tight clothing or ill-fitting shoes during hit humid weather as fungi grows in warm and moist environment.

Our Sources:

  1. https://www.cdc.gov/fungal/diseases/ringworm/treatment.html
  2. https://www.aad.org/public/diseases/a-z/ringworm-treatment
  3. https://www.aad.org/public/diseases/a-z/ringworm-self-care
  4. https://www.medicinenet.com/ringworm/article.htm
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