Ringworm: symptoms and treatment tinea corporis

Tinea corporis or ringworm is a superficial fungal disease of the smooth hairless skin, with a typical ring-shaped appearance. Hence the name ‘ringworm’. Ringworm is a body fungus. Infection with the fungus can occur through direct contact with infected skin or with dander. The GP can often make the diagnosis by sight. Additional examination by means of microscopic examination of skin flakes can confirm the diagnosis. There is a tendency for spontaneous healing, but treatment is required because of the contagiousness. Treatment with antifungal ointment is usually sufficient. The prospects for ringworm treatment are generally very good. After two to three weeks the fungus will disappear. Complications such as a secondary bacterial infection rarely occur. You can prevent ringworm by keeping the skin clean and dry. Mold thrives in warm, moist areas.

• Tinea corporis or ringworm
• Causes and infection ringworm

• Especially in children
• Ideal conditions for fungi
• Ringworm is contagious

• Risk factors for ringworm
• Complaints and symptoms of ringworm
• Diagnosis and research

• Physical and diagnostic examination
• Differential diagnosis

• Tinea corporis treatment

• Antifungal drug
• Medicines

• Prognosis
• Complications
• Prevention

Ringworm / Source: ProjectManhattan, Wikimedia Commons (CC BY-SA-3.0)

Tinea corporis or ringworm

Tinea corporis or ringworm is a dermatomycosis or fungal disease of the smooth hairless skin, with a typical ring-shaped appearance to which the name of the condition also refers, as well as the synonyms herpes tonsurans and tinea cirunatus . The word ‘worm’ in the name refers to the fact that it was previously thought that ringworm was caused by invasive worms. Ringworm is a superficial skin infection caused by dermatophytes, which are fungi that cause parasitic infections on the skin.

Causes and infection ringworm

Especially in children

Tinea corporis is a common skin condition in children. However, it can occur in people of all ages. It is caused by a species of fungus that is able to infect human skin and affects the outer layer of the epidermis, the stratum corneum. Pathogenic fungi here in this country often concern M.canis , T.rubrum , T.mentagrophutes and epidermophyton floccosum . These culprits account for approximately 90% of all skin fungal infections diagnosed annually in the Netherlands.

Ideal conditions for fungi

Mold thrives in warm, moist areas. The following conditions increase the risk of a fungal infection:

• prolonged and frequent sweating;
• minor skin injuries;
• poor hygiene.

Always use a clean towel / Source: Mama_mia/Shutterstock.com

Ringworm is contagious

Infection with the fungus can occur through direct contact with infected skin or with dander. Someone with ringworm can infect others as long as there are fungal spots on the skin and no treatment is given. Tinea corporis can also be easily spread to other people through shared use of headgear, combs, hairbrushes, barrettes, hair clippers, clothing, cuddly toys, bath towels and bedding. Contamination is also possible via the upholstery of bus, cinema or theater seats. Furthermore, contamination can occur through contact with the skin of infected animals.

Risk factors for ringworm

You can contract ringworm in different places and circumstances. The biggest risk factor is coming into contact with a person who has ringworm. Warm, moist areas are favorable conditions for mold growth. That is why public showers and changing rooms are places where you can easily contract mold. However, any contact with an infected person or a contaminated surface can lead to ringworm infection. The following conditions also increase the risk of infection:

• Minor skin or nail injuries, as a defect in the skin barrier can provide a portal of entry for the fungus;
• Walking around with wet skin for a longer period of time, for example due to sweating;
• Having close contact with other people, for example during contact sports;
• Do not wash your hair or body often;
• Having a weak immune system like diabetics.

Pityriasis rosea on lower leg / Source: Aceofhearts1968, Wikimedia Commons (Public domain)

Complaints and symptoms of ringworm

The spots are superficial and show local redness and flaking. The lesions normally spread in a circular manner, with often little activity in the center. The edges, on the other hand, are distinctly red and often show flaking. In some cases, blisters and pustules the size of a pinhead also occur in these edges. The lesions may be accompanied by mild itching. The individual spots can merge into each other, creating confluent spots that can cover large body surfaces. When the smooth skin shows infiltration, this may be accompanied by pain. The rash may appear on arms and legs, the face, or other exposed parts of the body.

Diagnosis and research

Physical and diagnostic examination

The GP can often make the diagnosis by sight. It turns out that in more than 67% of cases, the GP feels confident about the diagnosis.¹ Additional research by means of microscopic examination of skin flakes from the affected skin area can confirm the diagnosis.

Differential diagnosis

Ringworm can be confused with other skin diseases such as:

• psoriasis;
• pityriasis rosea;
• nummular eczema;
• subacute cutaneous lupus erythematosus;

Reddish-brown bumps due to granuloma annulare / Source: Mierlo, Wikimedia Commons (CC0)

• granuloma annulare;
• granuloma facial;
• atopic eczema;
• cutaneous candidiasis (fungal infection of the skin);
• erythema annulare centrifugum;
• erythema multiforme;
• erythrasma;
• impetigo (impetigo);
• lymphatic skin infiltration;
• parapsoriasis;
• pediatric syphilis;
• pityriasis versicolor;
• reticular erythematous mucinosis.

GP prescribes prescription for ringworm / Source: Istock.com/Wavebreakmedia

Tinea corporis treatment

Antifungal drug

There is a tendency for spontaneous healing, but treatment is required because of the contagiousness. Usually a local antimyotic (an antifungal drug, not to be confused with ‘antibiotic’) is sufficient. The edge of the lesion, including a margin of not yet visibly affected skin around it, must also be treated. Furthermore, it is important to continue treatment for two weeks after clinical healing to prevent recurrence. If treatment is too short, there is a chance that the fungus will survive and cause symptoms again. The contagiousness is over after the first week of treatment. An imidazole preparation is the drug of choice: miconazole or ketoconazole. Resistance to such preparations is rare. The contagiousness is over after the first week of treatment.

Medicines

In case of extensive tinea corporis or multiple recurrences, oral treatment is indicated, for which griseofulvin, intraconazole and terbinafine are suitable, of which the latter is the most effective.²

Prognosis

Ringworm can be cured with appropriate treatment. Ringworm usually disappears after two to three weeks with adequate treatment. Sometimes a recurrence occurs.

Complications

Complications are rare and may include a secondary bacterial infection of the skin or a widespread fungal infection. This is extremely rare and mainly occurs in people with a suppressed immune system.

Always use a clean towel and don’t share it / Source: Pexels, Pixabay

Prevention

Avoid sweaty and humid conditions. Men are advised to wear boxer shorts and for women it is best to avoid pantyhose and so on. Wear light and absorbent clothing, preferably made of cotton or linen. You can also take steps to prevent the spread of ringworm infections. Never share clothing, towels, hairbrushes, combs, hair accessories, sporting goods, or other personal care products with others. Always wear flip-flops or shoes in gyms, locker rooms, and swimming pools. After touching a pet, it is recommended to wash your hands.

Note:

1. JS de Kanter: Ringworm/tinea corporis , in: Minor ailments in general practice , fifth completely revised edition, second edition, Elsevier Healthcare, Amsterdam, 2010, p.154.
2. Ibid, p.156.

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