Ringworm

• Ringworm


  Fungal skin conditions, not caused by a worm
• Dermatophyte infections


  • Superficial skin infections predominantly caused by dermatophytes
  • Invade the stratum corneum of the skin, hair and nails but don't generally infiltrate living tissues
  • The fungus grows and proliferates in the non-living cornified layer of keratinised tissue of the epidermis
• Types of tinea (ringworm) infections

  • Tinea corporis (body)
  • Tinea cruris (groin, Dhobie or jock itch)
  • Tinea pedis (foot, athlete's foot)
  • Tinea capitis (head, scalp ringworm)
• Dermatophytic fungi are more prevalent in tropical and subtropical areas because fungal organisms prefer high temperatures and high humidity
• Tinea pedis (athlete's foot) is the most common fungal infection, affecting about 15% of the UK population
• Risk factors for body and groin ringworm

  • Hot, humid climates or working in high-temperature environments
  • Wearing tight-fitting clothing
  • Obesity
  • Hyperhidrosis
  • Immunocompromised states
  • Lower socioeconomic status and house crowding
• Transmission of ringworm


  • Direct contact with an infected person (anthropophilic spread)
  • Direct contact with an infected animal (zoophilic spread)
  • Indirect contact with fomites (objects or materials which carry infection)
  • Contact with the soil (geophilic infections, rare)
• Management of body and groin ringworm

  1. Terbinafine 1% cream - apply thinly to affected area once or twice a day for up to 12 weeks

  2. Clotrimazole 1% cream - apply to affected area 2-3 times a day for at least 4 weeks

  3. Miconazole 2% cream - apply to affected area twice a day for 10 days after all skin lesions are healed

  4. Daktacort hydrocortisone - suitable for children over 10 years for candidal intertrigo and athlete's foot

  5. Econazole 1% cream - apply to affected area twice a day until all skin lesions are healed
• Practical measures for body and groin ringworm

  1. Wear loose-fitting clothes made of cotton or moisture-wicking material

  2. Maintain good hygiene by washing affected skin areas daily and drying thoroughly

  3. Avoid scratching affected skin

  4. Do not share towels, and wash them frequently

  5. Wash clothes and bed linen frequently to eradicate fungal spores

  6. No need to exclude children from school or nursery
• Management of scalp ringworm

  1. Oral antifungal treatments after culture - terbinafine (4 weeks) or griseofulvin (6-8 weeks)

  2. Contraceptive needed for women (during plus 1 month post) and men (during plus 6 months post)

  3. Topical antifungal agent during initial oral treatment to reduce transmission risk

  4. Ketoconazole shampoo at least twice weekly for 24 weeks or imidazole cream (in children <5 years) daily for 1 week
• Practical measures for scalp ringworm

  1. Soften any surface crusts and gently tease away

  2. Discard or disinfect objects that can transmit fungal spores

  3. Do not share towels, and ensure they are washed frequently

  4. Inspect the scalps of other children and household contacts regularly

  5. Assess and treat suspected household pets