A B C D E F G H I J K L M N O P R S T U V W

RINGWORM - TINEA - ATHLETES FOOT

What is Ringworm ?

Tinea is caused by an infection of the skin by one of a number of fungi (or mould). The features of the infections depend upon the area affected body, hand, feet, scalp or nails and the type of fungus involved. The amount of inflammation varies. On the body, the infection causes typical ringworm - a circular area with a red, slightly raised and scaly edge. Some fungi cause a lot of inflammation in the skin and the involved areas become red or sore. Others cause minimal or no inflammation and all that is seen is a roughness and scaling of the affected skin. When the scalp is infected, one or more bald areas develop. These are scaly and may show a number of broken hairs. If the fungus causes a lot of inflammation, the area becomes red and swollen, and pus may develop. In tinea pedis (athlete's foot), the area between the toes is usually first affected with soreness and moistness. When it spreads on to the sole of the foot, small blisters or even pustules may develop with a background of redness and scaling. Affected nails may become detached from the nail bed or become thick or discoloured.

How does Ringworm occur ?

The infection is caught by contact with animals, humans or soil on which the fungi are present. Fungi that are caught from other humans tend to be highly infectious. Infections from animals and soil are not generally passed on to other people.

Why does Ringworm occur ?

The fungi that cause ringworm are very common. Most people come into contact with the fungi at some time in their lives. Why some people develop an infection and others do not is not well understood. This probably reflects individual differences in the body's infection defence system. It also depends on factors such as the oil produced in the skin, which tends to stop the growth of fungi. Infections are more common in patients with diabetes and in other disorders or treatments which interfere with the body's immune system, including anti-cancer drugs. Sweating, skin moistness and friction also makes infections more likely to occur. These factors are particularly important in infection of the toes and groin.

Treatment Involved for Ringworm

Fungal infection of the skin can be treated by creams or tablets. The exact treatment will depend upon the site and the severity of the infection. A number of creams are very effective in clearing fungal infections. Such creams are generally based on the imidazole drugs which affect the growth of the fungus. They are usually used twice daily for about a month. Treatment should continue even after the rash has settled, as the skin may still harbour fungus. Some creams combine the antifungal agent with 1% hydrocortisone. This safely reduces the inflammation and the symptoms of the infection. Steroid (cortisone-like) creams used alone, however, can cause the infection to spread or worsen. They should be avoided. Antifungal nail paints are now available for the treatment of nail ringworm. The most common tablet used in fungal infections is griseofulvin, which is safe and effective. For most fungal infections of the skin, treatment should be continued for at least 6 weeks. It is important to follow the doctor's directions, as even when the obvious signs of the infection have subsided, the fungus may still be present. In nail infections, the drug may need to be continued for up to two years. Even after this there is a considerable relapse rate. Several newer antifungal agents are now available which are more effective than griseofulvin. They are particularly good for treating ringworm of the skin. A new antifungal agent called terbinafine has been developed which kills the fungi rather than suppressing their growth. It is effective in a cream formulation in skin infections and is also successful when taken as a tablet for treatment of nail infections.

During Treatment for Ringworm

With treatment, the skin eruption will rapidly fade. The course of treatment should be completed even if the infection seems to have cleared. Itching and redness tend to clear quickly, but the scaling may persist. When the scalp is involved, the hair will take some time to grow back. Nails respond slowly to treatment with griseofulvin. It may take a year for your fingernails and 2 years for toenails to clear. Terbinafine will effectively clear nail fungus after a 3 month course of the drug, but the nail will still look abnormal for up to 2 years, until, new nail replaces that previously affected. Some experience nausea with griseofulvin and terbinafine tablets. Few people have problems with antifungal creams.

After Treatment for Ringworm

Tinea involving the groins and feet tends to recur. Taking care to dry between the toes does help. Sometimes an antifungal dusting powder can help to reduce the relapse rate in these areas.

If Ringworm is Left Untreated

The inflammatory forms of tinea are self-limiting. Given time, the body mounts a defence to the infection and clears the skin. In the non-inflammatory forms of tinea, there is no attempt by the body to eradicate the infection. It can persist for months or years and spread over other areas of the body. Nail tinea may remain localized or may spread to other nails and adjacent skin. In infections acquired from other people, the fungus is infectious and can be passed on to others. This is particularly true of the scalp ringworm.

Effects on Family of Ringworm

People carrying infections have a responsibility to others using the same showers or baths to treat their infection as quickly and thoroughly as possible. They should always use their own towels and flannels. Unaffected people may minimize their risks by thorough drying of feet and use of antifungal dusting powder.