Ringworm is very common, especially among children, and may be spread by skin-to-skin contact, as well as via contact with contaminated items such as hairbrushes. Ringworm spreads readily, as those infected are contagious even before they show symptoms of the disease. Humans can contract ringworm from animals; cats and dogs are often carriers. It should be noted that any contact sports such as wrestling has a risk of contracting the fungal infection through skin-to-skin contact.

Types

A number of species of fungi called dermatophytes cause ringworm. Members of the genera Trichophyton and Microsporum are the most common causative agents. These fungi attack various parts of the body and lead to the following conditions:

Tinea corporis affects the arms, legs, and trunk
Tinea capitis affects the scalp
Tinea cruris (jock itch) affects the groin area
Tinea pedis (athlete's foot) affects the feet
Tinea unguium affects the fingernails and toenails
Tinea versicolor

Symptoms and diagnosis

The most well known sign of ringworm is the appearance of one or more red raised itchy patches with defined edges. These patches are often lighter in the center, taking on the appearance of a ring. If the infected area involves the scalp or beard area, then bald patches may become evident. If the nails are affected, they may thicken, discolor, and finally crumble.

Doctors can diagnose ringworm on sight, or they may take a skin scraping. This is examined under a microscope, or put on an agar plate in a microbiology laboratory and allowed to grow. Some of the fungi fluoresce under a black light examination.

Topical antifungal drugs containing miconazole and clotrimazole, available by perscription or over the counter, are used to clear up the infection.

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Scalp ringworm - adapted from the Family Practice News, February 1, 1996
From Pediatrics for Parents, 6/1/95

Tinea capitis (ringworm of the scalp) is only second to pedunculosis capitis (head lice) in causing parental feelings of inadequacy. Although called "ringworm," tinea is caused by the fungus Trichophyton tonsurans.

The rash to tinea, be it of the scalp or someplace else on your child's body, is round to oval in shape, is often scaly, and may have a slightly raised ring surrounding it. The central area is smooth and may look like normal skin. if in the scalp, your child may lose hair in the area of the ring. The rash is not itchy, and your child may not even know it's there.

Ringworm is spread from person to person. When treating tinea, particularly tinea capitis, it's important for the child's close family members, playmates, and schoolmates to be checked. One study of inner city children, only three percent of the children had symptomatic ringworin, but another 14% were prolonged asymptomatic carriers. And nearly one third of the children had at least one positive culture during the 16 months of the study. Yet these children had no symptoms.

The children most likely to be asymptomatic carriers were siblings or close playmates of children with tinea capitis. This may mean that the children who showed symptoms kept picking it up from the siblings or friends.

There are a number of different treatments for tinea capitis. Selenium sulfide shampoo is the first treatment. There is a prescription version that contains 2.5% selenium sulfide. However, the over-the-counter version (Selsun Blue and others), which is only 1% selenium sulfide, works almost as well and is much cheaper.

Either shampoo should be used daily for eight weeks. Because of the risk of recatching tinea capitis from asymptomatic carriers, it is wise to treat these potential carriers also. An alternative strategy is to treat only the affected child the first time. If the child has recurrent episodes, then potential asymptomatic carriers should be treated also. If the shampoo doesn't work, then pills may be needed.

Other steps you should take to help prevent the spread of scalp ringworm is to discourage your children from sharing combs, brushes, hats, etc. Bed clothing, pillow cases and sheets, and towels should be washed to kill any spores.

Once the ring disappears, your child's hair will grow back, all will appear normal, and this episode will become a distant memory.

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