Ringworm: Causes, Types, Symptoms and Treatment

Ringworm is a fungal skin infection which is also known as Dermatophytes. These are called as Dermatophytes because they normally are not the components of skin but these can reside within the keratinized structures of the skin. Dermatophyte infection occur worldwide, mainly in warm and humid climates. Tinea is the Latin word for worms and can be used to describe various types of dermatophytes with the name of the body part affected for eg. Tinea Capitis ( head.). However in some books, the term ringworm is used interchangeably as Tinea Corporis( infection of body/trunk).

Types of Dermatophytes

• Trichophyton- Skin, Hair, Nails( Pencil shaped macroconidia is seen on microscopy)
• Microsporum- Skin, Hair (Spindle shaped macroconidia is seen on microscopy)
• Epidermophyton- Skin, Nails (Club shaped macroconidia is seen on microscopy)

Like mentioned above, Tinea infections can be named on the basis of the location of infection-

• Tinea Capitis- Scalp
• Tinea Barbae- Beard
• Tinea Faciei- Face
• Tinea Cruris/ Tinea Ingunalis- Groin ( also called as Dhobi/Jock Itch)
• Tinea Pedis- Feet ( also called as athlete foot)
• Tinea Corporis/ Tinea Circinata- Classical ring like fungal infection on the trunk
• Tinea Unguium/ Thumbnail fungus - Nail bed (Onchomycosis)

Tinea Corporis

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Causes of Ringworm infection

• Warm and humid environments.
• Transmitted by contact and fomites , such as combs, wet floors that are contaminated by infected individuals.
• Contact with infected animals like cats and dogs
• Contact with contaminated soil.
• Barefoot walking in pubic areas like swimming pools, athletic facilities.

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Risk Factors of Ringworm infection

Environmental factors-

• Warm and humid climates
• Contact with infected person, fomites or public showers
• Contact with infected animals.

Patient Factors-

• Occlusive clothing
• Obesity
• Peripheral artery disease
• Concurrent dermatophyte infection

Immune deficiency-

• Diabetes mellitus
• HIV infection
• Patient on systemic glucocorticoid therapy

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Symptoms of Ringworm infection

• Tinea Capitis- Occurs most commonly in 3-7 years old children and presents as well-demarcated scaly eryhtematous patches with broken hair shafts( Black dots) above the skin which can result in alopecia. Tender Lymphadenopathy can be appreciated.
• Tinea Corporis- Presents as well demarcated annular scaly lesions with central clearing and raised borders. The lesions are itchy and spreads centrifugally.
• Tinea Cruris- Seen mostly in men. It is an erythematous and pustular rash which is usually itchy.
• Tinea pedis- Usually develops in the webspaces of the toes and leads to peeling, maceration which is followed by development of scaly itchy rash along the plantar and lateral surfaces of the feet. Hyperkeratosis of the feet can occur and it can create path for the streptococci and staphylococci to gain entrance which causes lower-extremity cellulitis.
• Onchomycosis- More common in older adults and people with diabetes and PAD. It presents as thick brittle nails and should be differentiated from psoriasis which has associated skin conditions too.

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Diagnosis of Ringworm infection

• Mostly the dermatophyte infections can be diagnosed clinically but when in doubt the diagnosis can be confirmed by KOH mount method and examine under microscope directly. The scrapings should be taken from the edge of a lesion with scalpel blade.

Dermatophytosis KOH Mount

Treatment of Ringworm infection

• Tinea are treated with Topical antifungals (azoles)- Itraconazoles/Terbinafine are preferred.
• Tinea Capitis is specifically treated using oral Griseofulvin. Household contacts should use selenium sulfide or ketoconazole shampoo.
• In Tinea pedis patient, treatment will be the same and patient should be asked to keep the feet dry and dispose of old footwear.

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