What is ringworm?
Ringworm, or tinea, is a skin infection caused by fungi called dermatophytes. Despite the name, it has nothing to do with worms. It is called ringworm because it often forms a round, red, itchy patch with a clearer centre and a raised, scaly edge. It is very common in India because fungi thrive in heat, humidity and sweat.
It is named by the part affected: tinea corporis on the body, tinea cruris in the groin (jock itch), tinea pedis between the toes (athlete's foot), tinea capitis on the scalp, and tinea unguium in the nails. Each type needs a slightly different treatment approach.
How it spreads
Ringworm spreads through direct skin contact with an infected person or animal, and by sharing towels, clothes, bedsheets, combs and footwear. It is common in families where one member is infected, and in hostels, gyms and crowded homes. Pets, especially cats, dogs and cattle, can also carry the fungus and pass it to people who handle them.
Risk factors include heavy sweating, tight synthetic clothing, wet undergarments, obesity, diabetes and weak immunity. Walking barefoot in shared bathrooms and wearing closed shoes for long hours also increase the risk. The monsoon, with its damp clothes that do not dry fully, is a common time for flare-ups.
Symptoms of ringworm
The main symptom is itching, which can be intense, especially in the groin and folds of skin. Patches often spread outward and new patches can appear elsewhere. Scalp ringworm in children may cause scaly bald patches or tender swellings. Scratching can spread the fungus to other parts of the body.
- Round or ring-shaped red, scaly patches
- Itching, often worse with sweating
- Patches in skin folds: groin, under breasts, waist, armpits
- Cracked, peeling skin between toes
- Thick, discoloured, crumbly nails
The problem with steroid mix creams
Many creams sold in India combine a steroid with an antifungal and antibiotic. Steroids reduce itching and redness at first, so the infection seems better, but they weaken the skin's defences and let the fungus spread deeper and wider. This has led to a large number of stubborn, widespread ringworm cases that are hard to treat.
Steroid creams can also thin the skin and cause stretch marks. Do not use any steroid-containing cream on a rash unless a doctor has prescribed it for a clear reason. If you have been using one, tell your doctor, who will guide you on stopping it and starting proper antifungal treatment.
Diagnosis and treatment
A doctor can often diagnose ringworm by looking at the rash. If unsure, a skin scraping can be tested with a KOH mount under the microscope, or sent for fungal culture. This is useful for nail and scalp infections and for cases that have not responded to treatment.
Small patches are treated with antifungal creams such as clotrimazole, terbinafine or luliconazole, applied to the patch and a little skin around it. Follow the label or your pharmacist's advice and continue for some time after the rash has cleared, because stopping early lets it come back. Widespread, scalp or nail infections need antifungal tablets, taken only on a doctor's prescription and sometimes with blood tests to check the liver.
Special groups
Pregnant and breastfeeding women should ask a doctor before using any antifungal tablet. Children with scalp ringworm need tablets rather than creams alone, prescribed by a doctor. People with diabetes should keep their sugar well controlled, as high sugar makes fungal infections more likely and harder to clear. People with liver disease need careful medicine choices.
Prevention and when to see a doctor
Keep skin clean and dry, especially skin folds and between the toes. Bathe after sweating and dry thoroughly before dressing. Wear loose cotton clothes and change undergarments and socks daily. Do not share towels, combs or clothes. Wash clothes and bedsheets of the affected person separately, and dry them in sunlight. Treat all affected family members at the same time.
See a doctor if the rash is spreading, not improving after a couple of weeks of cream, affects the scalp or nails, or keeps returning. Pets with patchy hair loss should be checked by a vet. Your doctor or pharmacist can help you choose a suitable, steroid-free treatment.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Antifungal creams such as clotrimazole, terbinafine or luliconazoleKill the fungus on the skin in small, limited patches.Follow the label or your pharmacist's advice and keep applying for a while after the rash clears.
- Antifungal dusting powdersHelp keep skin folds and feet dry and reduce recurrence.Use alongside, not instead of, prescribed treatment.
- Antifungal tablets such as terbinafine or itraconazoleTreat widespread, scalp or nail infections.Only on a doctor's prescription; tell the doctor about liver disease, pregnancy and other medicines.
- Antihistamines such as cetirizineEase itching while antifungal treatment works.Some cause drowsiness; follow the label or your pharmacist's advice.
See a doctor urgently if
- Rash spreading quickly or covering large areas of the body
- Pus, swelling, pain or fever around the rash
- Scalp patches with hair loss or a boggy, painful swelling
- No improvement after two weeks of correct cream use
- Ringworm in someone with diabetes or weak immunity that keeps returning
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.