Ringworm on Body (Tinea Corporis)

Ringworm (tinea corporis) is a common fungal infection resulting from dermatophytes.

Ringworm (tinea corporis) is a common fungal infection named for its characteristic symptom of a red, elevated, rapidly growing, round ring-like sore on the skin. The center of the ring may be clear.

Ringworm is caused bydermatophytes, which are microscopic organisms that live on the dead outer layer of skin. There is no actual worm involved. The fungus that causes the ring-shaped rash remains outside the body at all times.

Ringworm can affect anyone at any time. The estimated lifetime risk of developing any superficial fungal infection is significant. The risk of developing ringwon is higher if you: 

• Live in a warm, humid climate
• Have direct contact with active fungal infections on someone else (or a pet)
• Have a weakened immune system (as a consequence of medical problems such as diabetes, leukemia or other cancers, or HIV/AIDS)

Ringworm is very common. Human dermatophytes, which are transmitted by direct contact with other human ringworm sores, cause most ringworm infections. You can also acquire ringworm from soil or through exposure to animals (often a household pet).

Risk factors for developing ringworm on the body include:

• Direct contact with ringworm through an affected animal such as a household pet, or soil;
• Living in a warm, humid climate;
• Having a weakened immune system (such as from HIV/AIDS, cancer, chemotherapy, diabetes, or certain medications);
• Athletes involved in contact sports such as wrestling;
• Sweating in tight clothing;
• Using public showers or locker rooms; and
• Sharing bedding, towels, or clothing or having close contact with a person who is infected.

Ringworm is highly contagious and can be spread from person to person, as well as by clothing or linens used by an affected person, or from household pets. To keep ringworm from spreading:

• Avoid touching suspicious areas;
• Maintain proper hygiene by washing the hands and body frequently and laundering the linens and clothes of an infected family member separately; and
• Avoid contact sports such as wrestling until you have been treating the sores for at least 48 hours.

If your pets have ringworm:

• Take them to a veterinarian for prompt treatment;
• Vacuum areas where the pet spends time;
• Disinfect surfaces and pet bedding; and
• Wash your hands after handling the pet.

Ringworm is named for its characteristic symptom of a red, elevated, rapidly growing, round ring-like sore on the skin. The center of the ring may be clear. The sore itself may be scaly, crusty, or fluid-filled. Itching and pain may accompany the sore. Each lesion (medical term for an abnormality such as a sore) is less than 5 cm across (about 2 inches) and occurs alone or appears as a skin rash in groups of three or four.

• Lesions commonly are found on the trunk, legs, arms, neck, and face (referred to as tinea faciei).
• Other symptoms of ringworm on the body include
  • hair loss,
  • itchy skin, and
  • patches of red, scaly, cracked skin.
• This type of ringworm does not involve the bearded area, scalp, groin (jock itch), hands, or feet (athlete's foot). These other types of ringworm may have slightly different symptoms:
  • Ringworm of the beard (tinea barbae): scaly, itchy, red spots on the cheeks, chin, and upper neck. There may be hair loss.
  • Ringworm of the scalp (tinea capitis): scaly, crusty, itchy, red, circular bald spot that may grow or spread into multiple spots. Hair may become dry and brittle. More common in children.
  • Ringworm of the groin (tinea cruris, "jock itch"): scaly, itchy, red spots on the inner skin of the thighs.
  • Ringworm of the feet (tinea pedis, "athlete's foot"): red, swollen, peeling, itchy skin usually between the toes but sometimes on the soles of the feet. In severe cases, there may be blisters on the skin.

If the ringworm lesion fails to respond to over-the-counter antifungal medications (commonly used for athlete's foot) after one week of applying the medication, call a doctor. The doctor will make sure it is really ringworm and start prescription medication. It is important to have a physician diagnose this condition to treat it properly, as ringworm on the body can resemble other skin conditions such as eczema or psoriasis.

Generally, ringworm infections are not emergencies. But if someone develops fever, increased pain, swelling, drainage, or redness, which could suggest a bacterial secondary infection of the ringworm lesion, go to a hospital's emergency department.

A primary-care provider (PCP) such as a family practitioner, internist, or child's pediatrician can treat ringworm. You may also be referred to a dermatologist, a specialist in skin conditions, for further treatment.

If you experience an infection associated with ringworm, you may be seen by an emergency-medicine specialist in a hospital's emergency department.

Diagnosis of ringworm is usually made by clinical exam. To confirm the diagnosis, a doctor may scrape the lesion's active border with a scalpel blade. After placing the scrapings onto a glass slide, the doctor will check the sample under a microscope. This may be done only if the diagnosis is not obvious to the treating physician.

Although ringworm infection may go away without treatment, some ringworm may require antifungal medications applied as a cream to the lesions (topical treatment).

• Apply topical antifungal medications to the lesion itself and 1 inch beyond its border twice daily for a minimum of two weeks, and at least one week after it goes away. Keep the infected area clean and dry. Over-the-counter medications available at the drugstore include
  • miconazole 2% (Monistat-Derm, Lotrimin AF Powder, Lotrimin AF Powder Spray, Lotrimin AF Liquid Spray, and Micatin);
  • clotrimazole 1% (Lotrimin AF Cream and Mycelex);
  • butenafine 1% (Lotrimin Ultra, and Mentax); and
  • terbinafine 1% (Lamisil AT).
• Although diaper rash, yeast infections, and ringworm are all caused by types of fungus, the medications used for those infections (nystatin) are not effective for ringworm.
• Ringworm on the scalp may be treated with shampoo with selenium sulfide (1%-2.5%), zinc pyrithione (1%-2%), or ketoconazole such as Head & Shoulders Intensive Treatment, Selsun Blue, and Nizoral.
• Apple cider vinegar has been touted as a home remedy for ringworm because of its natural antifungal properties. It may be effective for mild cases, however, it can take longer to be effective than medications. It may also sting when applied to the skin. Consult a doctor for information before using vinegar or any other natural remedy.

• If only one or two lesions exist, topical antifungal therapy is sufficient. One may be given a prescription for any of the following topical medications:
  • Imidazoles
    • Clotrimazole (Lotrimin)
    • Miconazole (Monistat-Derm)
    • Ketoconazole (Nizoral)
    • Econazole (Spectazole)
    • Oxiconazole (Oxistat)
    • Sulconazole (Exelderm)
    • Sertaconazole (Ertaczo)
  • Allylamines
    • Naftifine (Naftin)
    • Terbinafine (Lamisil)
  • Naphthiomates
    • Tolnaftate (Tinactin)
  • Substituted pyridines
    • Ciclopirox (Loprox)
• Although a topical corticosteroid is sometimes used to help relieve the itching, this should be avoided as much as possible. Steroids are never used as the only treatment in ringworm infections, as their use may worsen the infection and make the fungus more likely to spread into the hair follicles. Combination products may mix an antifungal medication with a steroid. These are usually more expensive and should also be avoided.
• Antifungal medication may be given as a pill for extensive infections, infections that are not cleared with a topical medicine, or infections in people with weakened immune systems. Examples of oral medications for ringworm include itraconazole (Sporanox), terbinafine (Lamisil), fluconazole (Diflucan), and griseofulvin (Grisactin). Although griseofulvin is the least expensive oral medicine, it has more side effects and does not work on as many types of ringworm as the newer medications.
• Bacterial superinfections of skin that have a ringworm lesion usually require antibiotics.
• Seriously infected or deep abscesses may require surgical drainage.

After leaving the doctor's office, it is important to follow the prevention guidelines, to complete a full course of therapy, and to follow proper hygiene.

To avoid ringworm infection, there are several steps you can take:

• Avoid contact with suspicious lesions on others.
• Wear loose-fitting clothes.
• After showering, dry off completely.
• Examine all family members for signs of tinea, as reinfection may occur.
• Don't share bedding, towels, or clothing with a person who is infected with ringworm.
• Athletes involved in contact sports should shower after they have completed their match or workout.
• Examine pets for ringworm, and if suspected, take them to a veterinarian for prompt treatment, vacuum areas where the pet spends time, disinfect surfaces and pet bedding, and wash the hands after handling a pet.

In general, ringworm infections can be cured with the proper treatment, and patients will get better within 4 weeks. Possible complications include bacterial superinfection or an invasive dermatophyte infection, in which the fungus spreads down into the hair follicles.