EVERYTHING YOU NEED TO KNOW ABOUT RINGWORM INFECTION ON SKIN ; A quick guide

When you hear “Ringworm infection of skin” what strikes you at first? It could be a skin infection, ascribed to a worm, right! But truth to be told, it is not. Ringworm is a skin infection that is not caused by a worm, but a fungus. 

Types of Tinea or ringworm

Ringworm is universally known as “Dermatophyte infection” or in short “Tinea”.

Dermatophyte can affect skin, hair or nail. Depending on which area of body is affected, there is a distinct name for each disease. 

 

Site of body 

Name of infection 

Body 

Tinea corporis 

Feet

Tinea pedis 

Hand

Tinea manuum 

Inner thigh and groin 

Tinea cruris 

Beard

Tinea barbae 

Nail

Tinea unguium, Onychomycosis

Face

Tinea faciel 

Scalp

Tinea capitis 

To know further in detail about each type of ringworm and its manifestation, read our article – RINGWORM SYMPTOMS & TYPES ; Made simple with pictures

Is ring worm rash superficial or deep ?

Outer most layer of skin is known by the name of “stratum corneum”. This is a layer made up of dead cells. Most part of stratum corneum is keratin, which protects skin.

Dermatophyte is a fungus that typically affects superficial dead tissue ( statum corneum) of skin. It also can pass infection to other lifeless structures like nails and hairs. The areas which lack this dead cell layer, for example mucosa that lines inside mouth and tongue are not affected by detmatophyte or ringworm. 

Sometimes ringworm can invade into deeper skin structure through hair follicle or through injured skin. The skin lesions thus formed is called Majocchi granuloma. One example of Majocchi granuloma is fungal foliculitis ( infection of hair follicle ) following shaving hair in legs of women. 

Who develops ringworm?
Factors that increase vulnerability for ringworm infection on skin?

People who have subnormal immunity because of other illness like diabetes, AIDS, immunosuppressive therapy, steroid therapy are vulnerable for ringworm infection on skin.

If we take age into consideration ringworm is more prevalent in children and old individuals. For eg. Tinea capitis or ringworm of scalp is more common in children, in-between age group of 4-14 years. 

Tinea cruris and Tinea pedis occur selectively more in male against female. Other Tinea infections have equal gender predisposition

Wrestlers are subjected to develop Tinea, if they come in contact with an infected wrestler. 

Dermatophytes are found in water of few swimming pools. People who use swimming pool habitually may get ringworm. 

Tinea cruris comes to being on inner thigh and groin area in individuals having excess sweats due to tight clothing and undergarments. 

If a person doesn’t maintain personal hygiene or doesn’t wash hand effectively then s/he may get Tinea. 

Sharing fomites like comb, towel, napkin etc from infected person can bring on Ringworm. 

Pets, for instance cats and dogs also sometimes carry dermatophyte. These are called Zoophilic dermatophytes which can spread along human too. 

Sometimes soil has Geophillic dermatophyte. Stepping out barefoot on soil can get Tinea infection. 

If a person has Tinea pedis ( ringworm of foot ) which afflict sole of foot also, then that person act as carrier of Tinea. They can transmit Ringworm to another person as well. 

Hot and humid climate favours ringworm. Children living in these environmental condition are more vulnerable for Ringworm infection on skin.

Kids who belong to low socioeconomic status and overcrowding are at greater risk of Tinea. 

Inappropriately excessive sweating is called hyperhidrosis. Children having hyperhidrosis are more likely to get ringworm. 

 

How does ringworm rash look like ?

Ringworm is not the only infection of skin. Out of numerous other skin infections, how to identify if it is a ringworm or something else ? Below are few characteristics of ringworm rash. 

1. Onset -

Onset of ringworm rash is slow. Which means, it takes weeks or months to start. 

But if a child gets superimposed bacterial infection on ringworm then it will be an acute on chronic onset. This means that the rash which was previously slow growing will begin to expand acutely. It turns more red and inflamed within few days. 

2. Shape -

As the name suggests Ringworm is ring shaped i.e round/oval to begin with.

This happens when lesion is small. Once the lesion spreads over body its shape gradually transmutes from annular to geographic pattern. 

3. Margin -

Margin of ringworm is most characteristic of it. It is prototypically scaly and raised. ‘Margin’ is that part of lesion where fungus is most active.

That’s why many a times this margin is red and inflamed too. Very actively progressing margin has *vesicles and **papules as well. 

4. Centre -

Centre of a ringworm is often normal looking and flat. It is also the least active part of this fungal infection. 

Central clearing is typical of ringworm. 

5. Advancement -

Ringworm advances in all possible directions but at different rates. 

That’s why the fungal lesion that erupts as ring like shape attains a geographic map like pattern as it spreads. 

6. Itching -

Active fungal lesion of Tinea is itchy. Pruritus or itch is also found in other infective and non-infective skin diseases, which mimic ringworm. Wherefore, this is a challenge for diagnosis

7. Hyperpigmentation -

Subsequent to healing, ringworm sometimes leaves behind a dark pigmented area ( hyperpigmented area ).

8. Permanent scar -

Tinea capitis or scalp ringworm at times develop as painful purulent patch over scalp, which is called kerion. Even after lesion heals, hair doesn’t grow back in that particular area leading to irreversible patch of alopecia (loss of hair)

What is Tinea incognito ?

Tinea incognito is a type of Tinea that grows after use of local steroid ointment on a misdiagnosed Tinea infection.

Many over-the-counter ointment options available in market include steroid. If a person instead of consulting a doctor, consults a quack or simply takes an ointment from pharmacy on his/her own on a ringworm infection on skin then it begets problem.

Steroid notoriously downgrades skin defence mechanism. As Tinea is a fungal infection, it spreads more after steroid treatment. Initially active redness and inflammation may reduce transiently, but later it becomes intense. 

After steroid use ringworm deviates from its true characteristics and looks completely different and is difficult to diagnose. Hence it is called “Tinea incognito”. The word incognito means ‘concealing one’s true identity’.

IMPORTANT NOTE

So the bottom line is “Steroid should never be used in Tinea.”

What are the conditions that resemble Tinea or Ringworm ?

For a layman it is really hard to diagnose Tinea or ringworm. Reason being there are many other skin lesions that mimic Tinea. As listed below.

  • Psoriasis
  • Eczema
  • Candida 
  • Bacterial skin infection 
  • Seborrheic dermatitis

It may happen that child is co-infected with another bacteria too, along with ringworm. So consult a health care specialist before diagnosing and starting treatment on your own. This will possibly do more harm than good. 

How is Diagnosis of Ringworm made ?

Your health care provider many a times may diagnose ringworm clinically by just looking at it. Your doctor might suggest KOH wet mount from scrapping of the lesion or even fungus culture to further authenticate the diagnosis. 

 

Additionally, ‘wood light examination’ aids in diagnosis in few cases too. 

How long does it take to treat Tinea ?

Tinea starts insidiously. It is a type of chronic infection. Thus treatment also takes time. Physician may recommend you topical agents like anti fungal cream and powder and shampoo, if the infection is small scale. 

In case of widespread infection, oral anti fungal agent will be required. Treatment might take weeks to 2-3 months or sometimes even more. Have patience and follow your doctor’s directions till complete treatment. 

Once treatment is started, scales will resolute first. Then pruritus and other signs will come down. Hyperpigmentation may take many months to fade away. 

IMPORTANT NOTE : 

 

The dose and duration of treatment if not followed strictly may cause recurring infection. Later which will develop resistance to all medications. 

Conclusion

Ringworm infection on skin is completely treatable. So take timely advice and get it treated for your kid. Take caution not to spread it to other family members. 

I hope this article came up with this topic that is extremely useful and must know for parents. Share it other parents and let them be aware of ringworm infection.

 

Caution

All the informations provided here are for educational and awareness purpose only. Kindly do not use these as alternative to medical consultation.

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