Ringworm – Dermatophyte Infections, Mimickers, and Treatment Options

Dermatophyte Infections, Mimickers, and Treatment Options - Ringworm


Ringworm is a common infection of the skin and nails that is caused by fungus. The infection is called “ringworm” because it can cause an itchy, red, circular rash. Ringworm is also called “tinea” or “dermatophytosis.” The different types of ringworm are usually named for the location of the infection on the body.
Areas of the body that can be affected by ringworm include:

  • Feet (tinea pedis, commonly called “athlete’s foot”)
  • Groin, inner thighs, or buttocks (tinea cruris, commonly called “jock itch”)
  • Scalp (tinea capitis)
  • Beard (tinea barbae)
  • Hands (tinea manuum)
  • Toenails or fingernails (tinea unguium, also called “onychomycosis”) Click here for more information about fungal nail infections.
  • Other parts of the body such as arms or legs (tinea corporis)
  • Approximately 40 different species of fungi can cause ringworm; the scientific names for the types of fungi that cause ringworm are Trichophyton, Microsporum, and Epidermophyton.

Dermatophytes are fungi that grow only on keratin. These fungi can infect the skin, hair, and nails, causing superficial diseases. Dermatophytes are distributed by people (anthropophilic organisms), animals (zoophilic organisms), and soil (geophilic organisms), as well as indirectly through fomites. The history, physical examination, and potassium hydroxide (KOH) microscopy can all be used to identify dermatophyte infections. Wood’s lamp inspection, fungal culture, or histologic investigation are sometimes required for diagnosis.

The majority of dermatophyte infections are treated with topical medications. Topical fungicidal allylamines had a greater cure rate and a shorter treatment time than fungistatic azoles. Tinea capitis, tinea barbae, and onychomycosis are best treated with oral treatment. The conventional therapy for tinea capitis is griseofulvin, which is taken orally.

Onychomycosis therapy with ciclopirox nail lacquer has a poor cure rate. Pulse oral therapy with newer imidazoles (itraconazole or fluconazole) or allylamines (terbinafine) for onychomycosis is significantly less costly than continuous treatment but has a somewhat lower mycologic cure rate.

Because of the cost, time, and potential side effects of treatment, the diagnosis of onychomycosis should be verified by KOH microscopy, culture, or histologic evaluation before treatment begins.

Germs are discouraged from colonising the skin’s outer layer due to its dryness, and the shedding of epidermal cells prevents many microbes from establishing residence. However, damage, inflammation, or maceration can cause the skin’s protective processes to fail. Furthermore, by raising local warmth and moisture, occlusion of the skin with nonporous materials might interfere with the skin’s barrier function. Cutaneous infection can arise when the skin’s defensive systems are inhibited or fail.

The most prevalent pathogens in skin infections are Microsporum, Trichophyton, and Epidermophyton species. Nondermatophyte fungus (e.g., Malassezia furfur in tinea [pityriasis] versicolor) and Candida species cause superficial skin diseases less commonly. This article discusses how to diagnose and cure common illnesses.

Ringworm is a fungal illness of the skin that is also known as dermatophytosis, dermatophyte infection, or tinea.

The term “ringworm” is misleading since the infection is caused by a fungus, not a worm. The illness causes a worm-like lesion in the shape of a ring, which is how it received its name.

Tinea corporis (body ringworm) and tinea capitis (head ringworm) are the most common types of ringworm (ringworm of the scalp). Tinea infection in other areas, such as tinea cruris, is sometimes referred to as tinea (ringworm of the groin).

Humans and animals are both susceptible to ringworm infestation. The infection presents as discoloured, scaly patches on the afflicted regions at first. On lighter skin, these patches are often red, but on darker skin, they are brown-gray.
Ringworm may spread from an affected area to other parts of the body, such as the:

  • scalp
  • feet
  • hands
  • nails
  • groin
  • beard

Recognizing the signs and symptoms of ringworm

Symptoms differ depending on the location of the illness. You may encounter the following symptoms if you have a skin infection:

  • itchiness
  • Red, brown, or grey itchy or scaly patches, or plaques are elevated regions of skin that are itchy or scaly.
  • a swollen, itchy area of skin that is spherical and flat
  • blisters or pustules on the patches
  • patches with a ring-like shape and a darker tint on the outer
  • patches with well-defined and elevated edges
  • rings that overlap
  • hair thinning
  • Depending on where area of the body is infected, ringworm can take on a variety of appearances. Ringworm is given several names by doctors based on where it occurs on the body.


Tinea corporis, or body ringworm, is the most prevalent use of the term “ringworm.” Patches with the typical circular ring shape on your torso or limbs are common manifestations of this kind.


Tinea capitis, or ringworm of the scalp, begins as isolated scaling on the scalp and progresses to itchy, scaly bald areas. It is especially prevalent in children. Hair around the afflicted region may break or fall out, resulting in bald patches.


Tinea barbae, or ringworm of the beard, affects the cheeks, chin, and upper neck, causing bald patches. This might resemble acne, folliculitis, or another skin problem. Fatigue and enlarged lymph nodes are common side effects for some persons.


Ringworm of the hand, or tinea manuum, is usually caused by touching another affected area, such as your groin or foot. Infection of the hand may look like very dry skin with deep cracks on the palm.
If the infection spreads, you may see ring-shaped patches on the back of your hand.


Jock itch, known as tinea cruris, refers to ringworm infection of the skin around the groin, inner thighs, and buttocks. It’s most common in men and adolescent boys.
This usually starts as an itchy red, brown, or gray rash where your leg and body meet. The itching may intensify after exercise and may not improve after using anti-itch cream.


Athlete’s foot, also known as tinea pedis, is a ringworm infection of the foot. People who go barefoot in public settings where the virus might spread, such as locker rooms, showers, and swimming pools, are usually affected.
This begins as dry, scaly skin between your toes, spreading to your sole and heel. Among the signs and symptoms are:
a stinging, burning, or irritating feelingblisteringpeelinga bad odor


Onychomycosis, commonly known as tinea unguium, is a nail ringworm infection. Because footwear frequently creates a damp, warm environment that fungus enjoy, it affects toenails more than fingernails.

The nails of those who are affected may thicken or darken. It’s possible that they’ll start to fracture or pull away from your nail bed.

Causes of ringworm

About 40 different species of fungus can cause ringworm. They are typically of the Trichophyton, Microsporum, and Epidermophyton types.
These fungi can live on your skin and other surfaces, particularly damp areas. They may also live for an extended period of time as spores in soil.
The fungi can spread to humans in four ways:

  • Human to human communication. If you come into touch with someone who has ringworm or exchange personal objects like combs or towels, you may contract the illness. The infection is usually transferred among youngsters and via the sharing of fungus-infected things.
  • Human to animal. Ringworm can be contracted by contacting an infected animal or by touching anything that the animal has come into contact with. Cats and dogs are major carriers of the fungus, but other animals, such as agricultural animals, can also transmit it.
  • To a person, an object. If you come into touch with an infected device or surface, such as a phone or the floor of a public shower, you might get the illness. These fungus flourish in wet conditions.
  • Human to soil. Ringworm may be contracted by humans and animals after coming into close contact with fungus-infested soil.

Risk factors for ringworm

Ringworm may affect everyone, but you’re more likely to develop it if you:

  • reside in a hot, humid climate or surroundings
  • Wrestling or football are two examples of contact sports.
  • Take use of public showers or locker facilities.
  • come into close proximity to animals
  • chafe your skin by wearing tight shoes or clothing
  • suffer from diabetes
  • who are obese or overweight
  • sweating profusely
  • afflicted with a compromised immune system

Getting a ringworm diagnosis is a difficult task.

Your doctor will diagnose ringworm by inspecting your skin and maybe seeing the afflicted region under a black light. Under black light, depending on the species of fungus, it may fluoresce (glow).

Your doctor may order the following tests to confirm a ringworm diagnosis:

  • If you’re getting either a skin biopsy or fungal culture, your doctor will take a sample of your skin or discharge from a blister and send it to a lab to test for the presence of fungus.
  • If you’re getting a KOH exam, your doctor will scrape off a small area of affected skin onto a slide and place drops of a liquid called potassium hydroxide (KOH) on it. The KOH breaks apart typical skin cells, making the fungal elements easier to see under a microscope.

Treatment for ringworm

The treatment for ringworm depends on its location on the body and how serious the infection is. Some forms of ringworm can be treated with non-prescription (“over-the-counter”) medications, but other forms of ringworm need treatment with prescription antifungal medication.

To treat ringworm, your doctor may prescribe both drugs and lifestyle changes.


Depending on the severity of your ringworm infection, your doctor may prescribe a variety of treatments.
Topical drugs, such as antifungals, are often used to treat jock itch, athlete’s foot, and body ringworm.

  • creams
  • ointments
  • gels
  • sprays
  • Oral medicines may be used to treat certain severe instances.

Oral prescription-strength medicines, such as griseofulvin (Gris-PEG) or terbinafine, may be required for ringworm of the scalp or nails.

Over-the-counter (OTC) drugs and antifungal skin lotions may also be recommended by your doctor. Clotrimazole, miconazole, terbinafine, and other comparable chemicals may be included in these products.

Adapting your way of life

In addition to prescription and over-the-counter medications, your doctor may advise you to treat the infection at home by doing the following:

  • To aid in the disinfection of your environment, wash your bedding and clothing on a regular basis.
  • After showering, properly dry your skin.
  • In the impacted locations, loose clothes is recommended.
  • Tinea pedis can lead to tinea cruris recurrence if not treated, thus treat all afflicted areas.

You should contact your healthcare provider if:

  • Your infection gets worse or doesn’t go away after using non-prescription medications.
  • You or your child has ringworm on the scalp. Ringworm on the scalp needs to be treated with prescription antifungal medication.

Home treatments for ringworm

Before researchers established antifungal medications, people utilized folk cures for ringworm for many years.

The majority of evidence supporting the use of these therapies is anecdotal. There is no scientific evidence to back up their usage over over-the-counter antifungals.

The following therapies are available:

  • Apple cider vinegar. Some people apply cotton balls soaked in apple cider vinegar over affected areas of skin three times a day to treat ringworm.
  • Coconut oil. People apply coconut oil to their skin to reduce the incidence of ringworm infections. If you want to try this remedy, apply coconut oil one to three times a day.
  • Turmeric. You can mix turmeric, a common spice, with water to make an antifungal paste. Apply the paste directly to your skin and allow it to dry.

A caution about home remedies

Home remedies shouldn’t be used in place of known antifungal treatments. Instead, discuss any you might like to try alongside proven treatments with your doctor.

Eczema vs. ringworm

Ringworm is similar to a skin disease known as nummular eczema. Nummular eczema is also known as discoid eczema or nummular dermatitis by doctors.

Both illnesses generate round or coin-shaped lesions on your skin, which are similar in appearance. Itchy and scaly sores are common.

Ringworm patients often have fewer ring-like areas than those with nummular eczema. Also, unlike ringworm, nummular eczema normally does not have a clearing (normal-appearing skin) in the middle.

Ringworm may also have pustules associated with it, while nummular eczema typically doesn’t.

Sometimes the two conditions look so much alike that the only way to tell the difference is to speak with your doctor. A doctor can take samples of the skin cells and send them to a laboratory for testing.

Doctors treat nummular eczema in different ways from ringworm. They use topical steroids, which if used for ringworm infections, can mask as well as worsen the infection. Antifungal ointments won’t help nummular eczema.

Psoriasis vs. ringworm

Another skin disorder that might resemble ringworm is psoriasis. Plaque psoriasis is a skin condition caused by immunological dysregulation that results in inflammatory plaques.

Plaque psoriasis manifests as pink plaques with thick white scales on lighter skin. It shows as purple spots with grey scales on darker skin.

Small isolated plaques might resemble ringworm in appearance. Ringworm and psoriasis can both produce discolored areas of skin, itching, and scaling.

Ringworm on the chest or limbs, on the other hand, frequently appears round with a clearing in the center. It’s also likely to be confined to a single location or a small number of lesions.

Ringworm during pregnancy

If you get ringworm during pregnancy, there are medications you can use to treat it that aren’t known to cause any problems to a baby.
Examples of these drugs, which are fine to use when applied topically, include:

  • ciclopirox (Loprox)
  • clotrimazole (Lotrimin)
  • naftifine (Naftin)
  • oxiconazole (Oxistat)
  • terbinafine
  • However, it’s always best to talk with your doctor before using any medications while pregnant.

Most medications can’t be properly studied in pregnant people due to the ethical implications of these studies. So it’s nearly impossible to say with full certainty that a medication, whether topical or oral, will be safe to use.

Doctors don’t usually recommend taking oral medications to treat fungal infections during pregnancy. Some oral medications that have the potential to cause known, unwanted side effects include oral ketoconazole and oral miconazole.

Regardless of the medication of choice, if you’re pregnant and have ringworm, it’s best to ask your doctor first before using any kind of medication or home remedy to treat your condition.

You should also talk with your doctor before using any medications if you are breastfeeding.


In 2 to 4 weeks, skin treatments may eradicate ringworm from your torso and limbs.
If you have severe dermatophytosis that isn’t responding to over-the-counter or home remedies, or if you believe you have a tinea infection of the scalp or hair follicles, your doctor may prescribe antifungal tablets to treat the illness.
The majority of patients react well to therapy.

Tags: infections, skin care

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