How do ringworm spread?

When you hear the term “ringworm,” do you imagine a collection of tiny worms slithering around on your skin? Then you may have fallen prey to one of the many misconceptions about this common skin condition. In reality, ringworm is far less creepy than the name suggests.

In this article, we’ll clear up some of the myths that continue to circulate about ringworm.

Myth 1: Ringworm is caused by a worm

Probably the most pervasive ringworm myth, this one stems from the condition’s name. Despite its creepy-crawly name, ringworm (also called tinea) is not caused by any worm. The culprit is actually a group of fungi called dermatophytes, which can cause skin infections. Ringworm gets its name from the distinctive ring-like pattern the red spots often form on the skin.

Myth 2: Ringworm only affects the skin

Although ringworm often does appear on the skin, including the scalp, it can also show up on the fingernails or toenails. Ringworm of the nails doesn’t create a ring-like pattern. Instead, it turns the nails thick, yellow, and brittle.

Myth 3: Everyone with ringworm develops red rings on their skin

Some people who are infected do develop the scaly red ring that gives the condition its name — but not everyone. If you get ringworm infection, you will probably see bumpy red patches around your skin, but they won’t necessarily take the shape of rings. On your scalp, ringworm may look more like a flaky red pimple than a ring.

Myth 4: Only children get ringworm

Children are more likely to get certain types of ringworm, but you can get infected with the fungus at any age.

Myth 5: Ringworm isn’t contagious

In fact, the opposite is true. Ringworm spreads easily from person to person, especially in communal areas like locker rooms and neighborhood pools. Ringworm is so contagious, in fact, that you don’t even have to touch someone to get infected. The fungus can linger in places like locker room floors, as well as on hats, combs, and brushes.

If you share an infected brush or comb, you can develop ringworm of the scalp. The highly contagious nature of the condition is why doctors recommend staying away from anyone who is infected, as well as their personal items.

Ringworm of the body (tin ee uh COR por is) is an infection of the skin caused by a fungus (a plant which is too small to see). Ringworm is not caused by a worm.

The infection starts as a rash with tiny red pimples. The pimples slowly spread and form a round or oval ring, typically ½ to 1 inch (12 to 25 mm) in size. The edges of the area are red, raised or scaly. After the ring has formed, the skin inside the rash may look pink or almost normal. The rash usually appears in only a few places on the skin but it may occur anywhere on the body and may itch. Ringworm rarely causes serious problems.

Ringworm is contagious. It can spread to humans from puppies, kittens and pet rodents. It can also spread from people to people when someone touches the rash or handles something that has touched it.

Diagnosis

The doctor will diagnose ringworm based on the child’s health history and by looking at the rash. A few scales from the infected area may be scraped and sent to the lab for more testing.

Treatment

A single patch of ringworm can be treated with an over-the-counter antifungal cream. The cream will usually contain miconazole, ketoconazole or clotrimazole.

  • Read the medicine’s label or ask your doctor or pharmacist to know if the cream you choose is safe for children.
  • Ask how often it should be applied and for how many days.
  • If there are many patchy areas, the doctor may prescribe a stronger medicine.

Ringworm usually goes away within 4 weeks of treatment.

How to Put on the Antifungal Cream

  1. Wash and dry your hands.
  2. Wash the rash with soap and water in the bathtub, bathroom sink or pan. Do not use the kitchen sink to wash the rash.
  3. Dry the rash completely with a paper towel or clean cloth towel. Do not touch this towel to healthy skin. (A cloth towel must be washed before it is used again.)
  4. Apply a thin layer of cream just past the outside edges of the rash.
  5. Spread the cream, beginning from the outside area first, then move toward the center of the rash (Picture 1).
  6. Do not cover the ringworm with a bandage.
  7. Wash and dry your hands well.

How to Prevent Ringworm

The fungus grows well on warm, dark, moist areas of the body. To prevent ringworm from spreading to others:

  • Keep the skin clean and dry. Dry the skin well after washing or bathing.
  • Wash hands well and right away if a ringworm rash is touched.
  • Wear clean clothes, socks and underwear every day and do not share clothes or personal items (brushes, combs, barrettes) with others (Picture 2).
  • Wash and dry clothing and towels that have come in contact with the rash using the hottest settings allowed on the care labels.
  • Wash the bathtub, bathroom sink or pan well after each use.

Other Advice

  • Wear shoes in locker rooms and public showers.
  • Shower right away after all contact sports like wrestling and football.
  • Keep fingernails short and clean.
  • Wash hands after playing with pets. Check pets for ringworm and get them treated if necessary.
  • Your child can return to daycare or school after treatment has begun.

When to Call the Doctor

Call your child’s doctor if the rash:

  • Gets worse and shows signs of infection (pus, swelling or discharge)
  • Does not seem to be healing after 2 weeks
  • Has not healed completely after 4 weeks

Ringworm (Tinea Corporis) (PDF)

HH-I-143 1/91, Revised 10/17 Copyright 1991, Nationwide Children’s Hospital

How Ringworm Spreads, and How to Deal With It

Despite its name, ringworm isn’t caused by a worm — but rather by a fungus. “The rash happens to come as a ring,” says Amy Kassouf, MD, a dermatologist with the Cleveland Clinic in Ohio. The name ringworm describes the characteristic circular shape, which can be red and scaly in appearance.

Ringworm occurs at various places on the body and is scientifically known as tinea, followed by a word denoting the area where the rash is visible; tinea capitus is a scalp infection, for example. In fact, ringworm that occurs in one person on one area can be transmitted to someone else and show up on a completely different body part, depending on how the fungus was transmitted.

The infection can spread via skin-to-skin contact, clothing, or surfaces where the fungus lives, such as in showers or locker rooms. It’s more common among people with compromised immune systems and can spread more easily among families (because of skin contact) or athletes (because of the locker room environment).

“Kids may have it on the scalp, and their mom will have it on her neck,” says Robin P. Gehris, MD, chief of pediatric dermatology at the University of Pittsburgh Medical Center’s Children’s Hospital of Pittsburgh. “When infants have tinea capitus and the mom snuggles with the infant, the mom can get it by direct inoculation to places like her neck and chest,” she explains.

Ringworm Treatment

While ringworm is irritating, it doesn’t come with severe complications.

In most cases, the rash is treated in the same way: with a topical antifungal treatment, such as Lotrimin (clotrimazole) or Lamisil (terbinafine). The one exception to the simple treatment rule is for a scalp infection, which occurs more commonly in children and is noticeable because a ring of hair loss will often occur in the infected area. Ringworm that reaches the scalp entails much more intensive treatment — typically six weeks of an oral antifungal medication rather than a topical cream.

While it’s necessary, the longer treatment course is unwelcome news to most patients, says Dr. Gehris. But topical creams won’t work on the scalp because the surface treatments don’t penetrate deeply enough. “Treating it yourself with over-the-counter antifungal creams, is not going to be effective because it’s on the scalp,” says Gehris.

Ringworm Transmission From Animals to People

Unlike some other infections, ringworm doesn’t only spread between people, but can also come from contact with an infected animal.

“I had a colleague who got it from holding a koala bear in Australia,” says Dr. Kassouf.

While most cases won’t come from such exotic sources, infection is a concern with household pets, who certainly rub up against human companions enough to spread ringworm to people within the house.

RELATED: 10 Diseases Your Pets Could Give You

“Fungus is everywhere,” says Beth Goldstein, MD, a dermatologist in private practice in the Chapel Hill area and an adjunct at the University of North Carolina. “Small animals, like kittens and puppies, can get infected.”

Is It Ringworm or Something Else?

Because ringworm typically has a distinctive circular appearance, you may think you know what you have and treat it yourself with over-the-counter (OTC) remedies.

“Classically it looks like a red scaly patch where the center becomes clear,” says Dr. Goldstein.

But it can also look like eczema or other skin problems, so if your self-diagnosed rash doesn’t respond to OTC treatments, a visit to the doctor is a good idea.

The most important steps for you to take when you see an unexplained rash, says Adam Goldstein, MD, PhD, professor of family medicine at the University of North Carolina School of Medicine in Chapel Hill, are these: “Getting it diagnosed quickly, getting it treated so you’re not spreading it, and figuring out where you got it from.”

How to Prevent the Spread of Ringworm

Some basic steps families can take to avoid the spread of ringworm include being careful about what you share: Teach kids not to wear each other’s hats, and make sure each family member uses their own comb and brush. Other basic hygiene practices, like not sharing razors, can help prevent the spread of ringworm. And athletes and gymgoers should be sure to wipe down or avoid sharing athletic equipment.

One of the most at-risk groups for ringworm are wrestlers, who come in contact with each other and with moist mats that harbor the fungus and facilitate its spread. In some cases, wrestlers may want to use antifungal treatments as part of a regular cleaning routine. Check with your doctor about this.

“In a high-risk sport like wrestling, consider showering right after with something that might be somewhat antifungal, such as Head & Shoulders or Selsun Blue shampoos as body wash,” says Gehris.

Unfortunately, she adds, “Sometimes you do everything right and you still get it.”

Ringworm (Scalp)

DEFINITION

  • Round patches of hair loss that slowly increase in size
  • A black-dot, stubbled appearance of the scalp from hair shafts that are broken off at the surface
  • The scalp may have scaling
  • Mild itching of the scalp
  • Ringworm of the face may also be present
  • Usually occurs in children age 2 to 10 years
  • This diagnosis requires a positive microscope test (potassium hydroxide ) or fungus culture.

A fungus infects the hairs and causes them to break. Ringworm is not caused by a worm. Over 90% of cases are due to Trichophyton tonsurans, which is transmitted from other children who are infected. Combs, brushes, hats, barrettes, seat backs, pillows, and bath towels can transmit the fungus. Less than 10% of the cases are caused by infected animals. The animal type causes more scalp irritation, redness, and scaling. If your child has the animal type of fungus, he is not contagious to other children.

Ringworm of the scalp is not dangerous. Without treatment, however, the hair loss and scaling may spread to other parts of the scalp. Some children develop a kerion, which is a boggy, tender swelling of the scalp that can drain pus. Kerions are an allergic reaction to the fungus and may require additional treatment with an oral steroid. Hair regrowth is normal after treatment but will take 6 to 12 months. In the meantime, your child can wear a hat or scarf to hide the bald areas.

TREATMENT

Oral Antifungal Medicine. The main treatment for ringworm of the scalp is griseofulvin taken orally for 8 weeks. Griseofulvin is best absorbed if taken with fatty foods such as milk or ice cream. Antifungal creams or ointments are not effective in killing the fungus that causes ringworm of the scalp.

Antifungal Shampoo. The use of an antifungal shampoo makes your child less contagious and allows him to return to day care or school. Purchase a nonprescription shampoo containing selenium sulfide (e.g., Selsun). Lather up and leave it on for 10 minutes before rinsing. Use the antifungal shampoo twice a week for the next 8 weeks. On other days, use a regular shampoo.

Contagiousness. Ringworm is mildly contagious. In the days before antifungal medications, about 5% of school contacts usually became infected. However, 25% of siblings (close contacts) developed ringworm. Once your child has been started on griseofulvin and received one washing with the special shampoo, he can return to school. Caution your child not to share combs or caps with other children. Check the scalps of your child’s siblings. If you see any scaling or patches of hair loss, refer that child to their doctor’s office.

Common Mistakes. It is psychologically harmful and unnecessary to shave the hair, give a close haircut, or to force your child to wear a protective skull cap.

Follow-up Appointment. In 4 weeks return for lab tests of your child’s hair to be certain we have achieved a cure. If not, the griseofulvin will need to be given for longer than 8 weeks.

CALL OUR OFFICE

During regular hours if

  • The ringworm looks infected with pus or a yellow crust.
  • The scalp becomes swollen or boggy.
  • The ringworm continues to spread after 2 weeks of treatment.
  • You have questions or concerns.

Instructions for Pediatric Patients, 2nd Edition, ©1999 by WB Saunders Company.
Written by Barton D. Schmitt, MD, pediatrician and author of Your Child’s Health, Bantam Books, a book for parents.

Ringworm, Multicolored (Tinea Versicolor)

  • The name means “multicolored ringworm.”
  • The condition occurs in adolescents and adults.
  • Numerous spots and patches appear on the neck, upper back, and shoulders.
  • The spots are covered by a fine scale.
  • The spots vary in size.
  • In summer, the spots are light and don’t tan like normal skin.
  • In winter as normal skin fades, the spots look darker (often pink or brown) than normal Caucasian skin.

Cause

This superficial infection is caused by a yeast-like fungus call Malassezia furfur. It is more common in warm, humid climates.

Expected Course

The problem tends to wax and wane for many years. Since complications do not occur, tinea versicolor is solely a cosmetic problem. Itching is uncommon.

Home Care

Selsun Blue Shampoo. Selsun Blue (selenium sulfide) is a nonprescription medicated shampoo that can cure this condition. Apply this shampoo once each day for 14 days. Apply it to the affected skin areas as well as 2-3 inches onto the adjacent normal skin. Rub it in and let it dry. Be careful to keep it away from the eyes and genitals, since it is irritating to these tissues. After 30 minutes, take a shower. In 2 weeks the scaling should be stopped, and the rash temporarily cured. Normal skin color will not return for 6 to 12 months.

Prevention of Recurrences. Tinea versicolor tends to recur. Prevent this by applying Selsun Blue shampoo to the formerly involved areas once each month for several years. Leave it on for 1-2 hours, then shower. This precaution is especially important in the summer months, because this fungus thrives in warm weather.

Contagiousness. Tinea versicolor is not contagious. This fungus is a normal inhabitant of the hair follicles in many people. Only a few develop the overgrowth of the fungus and a rash.

CALL OUR OFFICE During regular hours if:

  • The rash is not improved with this treatment after 2 weeks.
  • You feel your child is getting worse.
  • You have other questions or concerns.

Department of Health

Ringworm

Last Reviewed: October 2011

What is ringworm?

Ringworm is a skin infection caused by a fungus that can affect the scalp, skin, fingers, toe nails or foot.

Who gets ringworm?

Anyone can get ringworm. Children may be more susceptible to certain types of ringworm than adults.

How are ringworm infections spread?

Transmission of these fungal agents can occur by direct skin-to-skin contact with infected people or pets, or indirectly by contact with items such as barber clippers, hair from infected people, shower stalls or floors.

What are the symptoms of ringworm infections?

Ringworm of the scalp usually begins as a small pimple which becomes larger in size and leaves scaly patches of temporary baldness. Infected hairs become brittle and break off easily. Occasionally, yellowish cuplike crusty areas are seen. With ringworm of the nails, the affected nails become thicker, discolored and brittle, or they become chalky and disintegrate. Ringworm of the body appears as flat, spreading ring-shaped areas. The edge is reddish and may be either dry and scaly or moist and crusted. As it spreads, the center area clears and appears normal. Ringworm of the foot appears as a scaling or cracking of the skin, especially between the toes.

How soon do symptoms appear?

The incubation period is unknown for most of these agents, however ringworm of the scalp is usually seen 10 to 14 days after contact and ringworm of the body is seen 4 to 10 days after initial contact.

Does infection with ringworm make a person immune?

Since so many species of fungus can cause ringworm, infection with one species will not make a person immune to future infections.

What is the treatment for ringworm infections?

Your doctor may prescribe a fungicidal material to swallow as tablets or powders that can be applied directly to the affected areas. Griseofulvin is commonly prescribed for treating fungus infections.

What can be done to prevent the spread of ringworm?

Towels, hats and clothing of the infected individual should not be shared with others. Young children who are infected should minimize close contact with other children until effectively treated. When multiple cases occur, seek advice from your local health department.

Water-related Diseases

Ringworm or Tinea is a typically mild disease of the skin, scalp or nails caused by a fungus. Personal hygiene, supported by availability of adequate quantities of water are important preventive measures.

The disease and how it affects people

Ringworm is a contagious skin disease, in which the scalp (tinea capitis), nails (tinea unguium), feet (tinea pedis or “athlete’s foot”), or body (tinea corporis) can be affected. Despite its name, ringworm is caused by a fungus.

On the scalp, ringworm begins in the form of a pimple or sore, which then spreads into a ring shape. Hair becomes brittle, breaking easily and falling out, leaving bald spots on the scalp. On the body, ringworm may first appear as red or pink, flat or slightly raised, patches on the skin.

The circular sores may be dry or scaly crusted or moist. As the sores become larger, the central area clears, leaving a ring of infected tissue around the clear area. Infection in the nails usually begins at the site of an injured nail and may spread to the other nails. Infected nails become thick, pitted, grooved and abnormal in shape and colour.

Ringworm of the feet and body are more frequent in men than women. Adults are more likely than children to get ringworm of the feet, which occurs more frequently in hot weather.

The cause

Ringworm is caused by various types of fungi known as the dermatophytes. It is spread by direct contact with an infected person or animal (dogs, cats, guinea-pigs, cattle), contact with soil or by indirect contact with items contaminated by the fungus, for example clothing, towels, bedclothes, chairs, and toilet articles handled by people with the infection. The link with water is via poor personal domestic hygiene and shortage of water for cleaning and washing.

Distribution

The various types of ringworm are found worldwide.

Scope of the Problem

Although specific figures are not available, ringworm is a frequent problem in most countries, particularly where personal and domestic hygiene are poor.

Interventions

Key components of prevention are:

  • An adequate supply of water for personal washing and hygiene.
  • Regular and thorough bathing with soap and water, with special attention to drying moist areas.
  • Health education about how its spreading can be prevented.

Where ringworm occurs:

  • The clothing and linen of infected persons should be frequently laundered in hot water to rid them of the fungus.
  • Rashes can be treated with topical anti-fungal lotions or creams. In severe or persistent cases oral anti-fungal medication may be required.

Prepared for World Water Day 2001. Reviewed by staff and experts from the cluster on Communicable Diseases (CDS) and the Water, Sanitation and Health unit (WSH), World Health Organization (WHO).

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What Is Ringworm?

It sounds like the name of a creep-crawly bug. But ringworm isn’t an animal — it’s a contagious infection on the skin, scalp, or nails that’s caused by a type of germ called a fungus.

It’s called ringworm because of how the rash looks — it’s shaped like a ring that is red and swollen on the edge and healthy-looking in the center. Ringworm affects people of all ages, but is especially common in kids.

How Do People Get Ringworm?

Ringworm is contagious, which means it can easily spread from person to person. It can spread when they’re in close contact or when they share things like combs, brushes, towels, clothing, and sports gear.

The fungus needs a warm, dark, and humid place to grow. So public showers, pools, and locker rooms are common places where kids might pick up ringworm infections. It can also spread from pets and other animals, like dogs, cats, or rodents.

What Are the Signs & Symptoms of Ringworm?

Ringworm can be a little annoying — or really uncomfortable. On the skin, it usually starts out as a small red area the size of a pea. As it grows, it spreads out in a circle or ring, or even several rings. The edges of the rings are raised and red, and the rash may itch, sting, or burn.

On the scalp it begins as a small bump or scaly patch that looks like dandruff. The bump or patch gets bigger, and the hair in the infected area can break off. This can leave scaly patches of baldness, but the hair will grow back.

What Will the Doctor Do?

A doctor can usually figure out if you have ringworm by looking at the rash on your skin or scalp. Your doctor may swab or scrape off a skin sample or clip off a piece of hair or nail to test for fungus. But don’t worry, this won’t hurt!

Treatment is usually simple. For mild cases on the skin, your doctor may have you apply a powder, cream, or spray that contains medicine that kills the fungus. This should make the rash go away in a week or two. Sometimes you’ll need to use the medicine for up to a month or more to get rid of the ringworm completely. You’ll also need to keep your skin clean and dry.

If the infection doesn’t clear up, your doctor might prescribe a stronger medicine. This one will be the kind you swallow.

For ringworm of the scalp or fungus in the nails, you’ll need to take medicine by mouth. You may also need to use a special shampoo to stop the fungus from spreading to other people.

Ringworm Prevention

You can do your part to avoid ringworm. Be sure to:

  • Take a shower or bath every day (especially after playing sports and sweating) and dry off completely.
  • Wear clean clothing.
  • Change your clothes every day.
  • Use clean towels and don’t share towels or clothes.
  • Wash your hands well with soap and water after playing with pets.

Reviewed by: Michelle P. Tellado, MD Date reviewed: September 2019

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