By Dr. Loretta Lanphier, ND, CN, HHP, CH

To the uninitiated, the skin condition called ringworm sounds like an infection involving parasitic worms that somehow burrow into your skin. While this is a misconception, this malady is associated with parasites, but they are from the plant kingdom and not the animal kingdom. Ringworm is an important health issue because, among other reasons, it affects many children in this country, so let’s see if we can better understand the ins and outs of it.

What is Ringworm?

Ringworm is a contagious fungal infection that can attack many different parts of the body. In one form or another, most people will have at least one bout with ringworm at some point in their lives. The skin lesions that result from ringworm infections tend to move outward in circular patterns that resemble rings. Thus, the somewhat misleading name “ringworm.” There are “rings,” but there are definitely no “worms” associated with this condition.

Ringworm, mainly of the scalp and less commonly of the body, is very common amongst young children under the age of 10. In fact, it afflicts more than one million youngsters every year in the United States, with a higher incidence in African Americans than in Caucasian American kids.  Ringworm of all types is found more often in males than in females, and tends to spread more easily in warm, moist public areas such as locker rooms or health clubs, and in places where there are large numbers of people in close quarters such as schools and day care centers.

The most common types of ringworm are: tinea (“fungus”) corporis (“body”) or ringworm of the body, tinea pedis (“foot”), or ringworm of the foot (also known as “athlete’s foot”), tinea cruris (“crotch”) or ringworm of the genital area (also known as  “jock itch”), tinea capitis (“scalp”) or ringworm of the scalp, and tinea unguium (“nails”) or ringworm of the nails.

While it can be unsightly and cause discomfort, most of the time ringworm is not a critical or dangerous condition. However, in people with compromised immune systems any infection, including ringworm, can potentially lead to more serious complications.

What Causes Ringworm?

Fungal infections such as ringworm are caused by tiny, microscopic parasites that invade the outermost layer of the skin and feed on these cells as their “host.”  The mold-like fungi that cause ringworm are officially known as dermatophytes, and in medical literature, ringworm is referred to as a dermatophyte infection.

Ringworm is highly contagious, and can be spread in a number of ways. The most common include:

  • Human to human:  Having direct contact with the skin of a person infected with ringworm can expose you to the fungi as well. This often happens to groups of children who have personal contact while playing together or sharing close quarters in school or daycare. Those under the age of 10 are most susceptible to the infections. Transmission of ringworm can also occur in adults, especially in crowded and/or unsanitary environments. Ringworm is also more likely to proliferate under hot, humid conditions where the environment is damp and close. Health clubs and locker rooms are typically very favorable conditions for the growth of ringworm. When you perspire excessively, some of the natural protective oils on the skin that normally help protect against fungal infections is washed away. Studies have also shown that tightly braiding the hair or using hair gels can also increase risk for contracting ringworm, especially in areas where the conditions are such that the growth of the fungus is encouraged.
  • Animal to human:It is also possible to be exposed to ringworm while handling animals such as cats, dogs, goats, horses, pigs, rabbits, and ferrets, among others. Dogs and cats can carry three different types of fungi that can cause ringworm in humans. This can be contracted by grooming or petting the animals, although it is relatively rare. Those most susceptible to getting ringworm from animals are the very young, the very old, and anyone with a compromised immune system. If you notice patches of hair loss or crusty bumps on your pet’s skin, it could be a sign of ringworm and you should have them examined by your veterinarian as soon as possible.
  • Objects to human:Along side human-to-human contact, this is the most likely way that a ringworm infection will be spread. Ringworm of the scalp is the most common type that affects children, and is usually responsible for large groups of children coming down with ringworm simultaneously. You should teach your children, and make it a practice yourself, to never share personal items such as combs, brushes, towels, hats, other clothing, or bedding. This is a sure way to pick up ringworm from an infected person. Ringworm can even be caught from touching infected door handles, bathroom fixtures, and toys or playground equipment.
  • Soil to human:This is probably the rarest type of exposure, but some fungi that cause ringworm can also live in soil, and prolonged exposure to it may result in an infection in humans. Sometimes pets will pick it up from digging in soil as well.
  • All of these factors are even more significant if you have an immune system disorder such as diabetes or HIV/AIDS. Folks with weakened immune systems are more likely to contract ringworm in the first place, and will often experience worse symptoms that are more persistent and difficult to resolve than folks who are otherwise healthy.

What Are the Symptoms of Ringworm?

Signs of ringworm vary depending on the type of infection and the location on the body. Let’s break it down by the most common forms of ringworm.

Ringworm of the Body

Tinea corporis affects mostly the trunk, arms, legs, and face of its victims. It is characterized by circular rashes that are red and inflamed around the outer edges, but the skin in the center of the circle appears normal and healthy. The rash spreads outward in growing circular patterns, and may appear on more than one part of the body at the same time. It can also cause sores that are either wet and crusty or dry and flaky. Some people experience raised lesions, while others will mainly find the ringworm appears as round flat patches of itchy skin.

Persons with ringworm of the body should be sure to wear loose fitting clothing and be especially aware of folds of skin that may be susceptible to perspiration or irritation. Ringworm may spread easily to these areas or be hard to get rid of if it already exists there. Be sure to keep them clean and dry.

Athlete’s Foot

Tinea pedis is most commonly a problem between the toes, but it can also be found on the soles and sides of the feet in some patients. Typical symptoms include:

  • Burning, itching, and stinging between the toes (most often the last two toes)
  • Burning, itching and stinging on the sides and/or soles of the feet
  • Dry, cracked and peeling skin in affected areas
  • Itchy blisters in affected areas

Be especially careful when you are in a public shower, pool, or locker room, as most athlete’s foot is spread in warm, moist areas such as this. It is a good idea to wear shower shoes in any environment such as this, even in a motel room or anywhere that is used by multiple individuals.

Advanced cases of athlete’s foot may lead to a secondary bacterial infection that can cause deterioration of the skin resulting in “soggy” skin and erosion, most often between the toes. The fungi that causes the ringworm also has an antibacterial effect that inadvertently kills off some bacteria, but strengthens hardier varieties that can make both infections difficult to get rid of.

Jock Itch

Tinea cruris is ringworm that infects the tissues of the groin, genitals, buttocks, and inner thighs. The signs include raised red sores with well-defined edges that can be burn and be very itchy. The best way to avoid getting jock itch is to be careful about using any towel that has been used by someone else, or even “clean” towels in public places such as a health club. If they have not been laundered properly, they can be a vehicle for the spread of ringworm. It is also a good idea to never dry one part of your body, and then reuse the towel again on the same part. For example, drying from head to toe and then returning to dry your genitals again can spread ringworm from one part of your own body to another.

Ringworm of the Scalp

Tinea corporis is very common amongst school-aged kids, and may appear as red, itchy bald patches on the scalp. In some children, the patches may also have a grayish color or, if your child has dark hair, they may exhibit black dots as well. The hair in affected areas tends to become brittle and can easily fall out or be pulled out.

Infections that are severe or left untreated can escalate into a condition called kerion, a painful inflammation of the scalp that can lead to permanent scarring and hair loss. The lesions may form as swollen rings that can become filled with pus and result in a yellow, crusty appearance to the scalp.

Ringworm of the Nails

Tinea unguium is most often found in the toenails, but in rare cases may affect the fingernails. This fungal infection of the nails typically is the result of athlete’s foot spreading to the nails and attacking them as well. The toenails usually will thicken and turn dark, and may crumble and eventually pull away from the nail beds.

What Treatments Are Available for Ringworm?

There are a variety of topical antifungal remedies available both by prescription and over-the-counter. Most of them work fairly well, and they are relatively harmless. However, more serious cases are sometimes prescribed oral medications, and you should be very careful about taking these, especially for children. One particularly dangerous one is called itraconazole, and it has been linked to liver failure and even death in some patients. It is also not recommended for anyone with heart disease.

Obviously, the best thing to do is use common sense and avoid behaviors that may expose you to ringworm. However, if you do come down with a case, some more natural options to mainstream medicines are:

  • Tea tree oil:  Application of this natural antiseptic, antifungal agent, and disinfectant can lessen the pain and itching of ringworm, as well as encourage faster healing.
  • Vinegar soaks:  Vinegar has so many beneficial uses. Dilute some with water, and apply to affected areas. It will help with itching and burning.

Be sure to wash any bedding, clothing, or personal items that have been exposed to the ringworm fungi with hot, soapy water. Dry them on as hot a temperature as possible as well. Sometimes it can be hard to eliminate this fungal pest, but you want to be sure to do everything you can to make sure you don’t experience and encore appearance of the illness down the road.

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