All about Ringworm

Ringworm contains a series of fungal infections that affect the superficial layers of the skin in different parts of the body.

The term ringworm derives from the Latin tinea, which means worm, woodworm, louse, because in the Middle Ages the disease was attributed to the larvae of moths or “moths” that infest fabrics and wood.

In popular jargon “tignoso” is an adjective that, throughout Italy, indicates a very stingy person, so much so as to accumulate even the skin crusts typical of ringworm, in fact.

In the Roman dialect the term is also attributed to those who are particularly stubborn, as if to recall the resistance of the various cutaneous mycoses enclosed under this name. These, in fact, can take up to two or three weeks of treatment with antifungal drugs to be eradicated.

What is ringworm

The term ringworm indicates a series of infections by pathogenic filamentous fungi (dermatophytes of various species, hence the medical term of dermophytosis) that affect the superficial layers of the skin.

The “scabs” are what remains of the “meal” of these mushrooms, which feed on the keratin of the stratum corneum of the epidermis and reproduce through spores, initially causing boils that gradually widen (the lesion is called tinea), while in the center the skin appears healthy.

In this way, the skin surface of patients will appear irregular and covered with erythematous patches and small crusts, as if it had healed as a result of an injury; Depending on the case, this sort of scar may appear different in shape, color, areas in which it appears and extension.

The rashes of ringworm can in fact occur in various parts of the body, always on the superficial layer of the skin, taking different scientific names:

• the face, neck and beard (tinea faciei and tinea barbae);
• The trunk (tinea corporis);
• The groin(tinea cruris));
• nails (tinea unguium);
• The scalp (tinea capitis);
• The Hands (tinea manum);
• the feet (the “athlete’s foot“, tinea pedis).

Each form of disease corresponds to different clinical manifestations; Each of them, in turn, requires the prescription of a different and specific drug for the problem and the area to be treated.

How is it transmitted?

Especially through direct contact with people or animals (more rarely transmission occurs through the soil) that have the fungus or using brushes, razors, linen, hats or other clothing on which skin flakes are found. Athlete’s foot mainly afflicts those who practice sports and walk barefoot on floors (for example by the pool), showers, platforms, mats, tatami mats, saunas etc.

Since this form of contagious ringworm can be taken very easily, here are some practical tips to avoid it without resorting to any medication or taking medicine, starting with good personal hygiene practices.

It is easy to understand that the first cure for ringworm is prevention: you must always use personal towels and bathrobes, with particular attention to surfaces and tools commonly used in sports facilities, spas, locker rooms and in any community place, from school to office and beach.

It is better not to share slippers either, as well as never walking barefoot on floors, carpets and carpets of hotel rooms, edges of swimming pools, common showers and other areas of this kind.

It is also important to pay the utmost attention to the hygiene of the foot, drying it well after washing (even between the fingers) and possibly using talcum powder or antifungal powder if you tend to hypersweating, preferring shoes with good breathability and leaving them in the sun and outdoors after using them. It is also advisable to take care to change socks or anklets often and to always wash them in hot water. Clothing can also cause fungal infections to thrive: especially synthetic fibers, which promote heat and humidity.

If you have pets, be careful because cats, dogs, rabbits and hamsters can transmit some forms of ringworm: if the puppy of the house scratches or has loss of hair in patches it is good to report it immediately to the veterinarian.

It is not uncommon, in fact, that the cat or dog spreads ringworm to more than one family member before the problem is realized. Also for this, dogs and cats (as well as other pets) should be subjected to frequent checks by professional veterinarians.

In addition to contact with infected animals or staying in a contaminated environment, this type of infection can proliferate in many other ways, which requires maximum attention. For this, even in the family, it is better that towels, napkins, linen, combs and brushes, manicure tools and so on are not shared. In case there is a family member who has contracted mycosis, it is necessary to wash clothing and bedding at high temperature, to eliminate spores.

The diet rich in fruits and vegetables and the consumption of probiotic yogurt helps to maintain high immune defenses, and therefore also helps against the risk of fungal infections.

The ringworm of the head

“We speak of ringworm of the head (tinea capitis) to indicate various pilar dermatophytias of the scalp, ie infections caused by fungi (fungi of the genus Microsporum and Trichophyton) on the surface of the skin of the head,” explains Chiara Galloni, dermatologist at the Santagostino Medical Center in Milan and member of the Italian Society of Medical, Surgical, Aesthetic Dermatology and Sexually Transmitted Diseases (SIDeMaST).

«In Italy the most frequent is the tinea capitis microsporica (microsporic ringworm), with round patches or spots, usually isolated, with a diameter of one to ten centimeters, erythematous and with grayish scales, sharp contours and without inflammation; rarer is instead the trichophytic ringworm with not very large patches and jagged, multiple margins, similar to those of alopecia, desquamated and sprinkled with hairs. They mainly affect children and adolescents, and usually disappear with puberty» explains the specialist; However, contagion is possible, as well as in young people, also in adults and the elderly, who, therefore, should not exclude this risk a priori.

There is also ringworm favosa, basically circular in shape, which in addition to the scalp attacks the nails.

In men, beard ringworm is more common, while in women head ringworm tends to strike especially after menopause: mushrooms are kept away from the fatty acids of the sebum produced by the skin, whose synthesis decreases with the loss of sex hormones of the female fertile period.

The incubation of ringworm of the head lasts about a couple of weeks; The first symptom is gradual hair loss, patchy, then there may be itching and burning due to the inflammatory reaction. The hair becomes dull and brittle, sometimes there is also a flaking similar to dandruff as well as baldness of the affected area.

It is important to contact the dermatologist for diagnosis, because ringworm of the head can be confused with other pathologies that affect the scalp, such as alopecia areata, seborrheic dermatitis, psoriasis or trichotillomania, a psychological disorder that pushes to pull and tear hair compulsively.

“The specialist, in addition to the visit, can complete the diagnosis with the examination in the light of Wood, a mycological analysis, and possibly also with a histological examination,” adds the dermatologist.

Head ringworm is mostly taken from an infected person, more rarely from a pet. “Among children it spreads to the nursery or kindergarten, also through the exchange of combs, clothing, brushes, pillows, scarves. But you can also take it by leaning against the back of the school bus seat,” emphasizes the dermatologist.

Infections on the scalp are the most “tignose”, with a longer course and, unlike others, require oral therapy more than local, although ad hoc shampoos (based on selenium or ketoconazole) can be helpful and useful to avoid the spread of spores, but they are not enough.

«Therapy must be timely: it is based on the use of an antifungal antibiotic (such as griseofulvin) by mouth plus local treatment with topical antifungals, for a period of about a month, or with other drugs in case of more prolonged treatments (riazole and terbinafine)». It is recommended, however, to always contact medical specialists and health personnel for the treatment of ringworm of the head, avoiding the use of alternative treatments that, sometimes, could not only prove to be ineffective but also worsen the situation.

Beard ringworm

Among men, beards are back in fashion: attention, even in this area of the face a fungal infection is possible (caused by the fungi Trichophyton mentagrophytes and Trichophyton verrucosum), with a consequent process of formation of lesions generally superficial, but sometimes deeper and similar to folliculitis, with inflammation and hair loss.

In the past, beard ringworm was quite widespread because it was transmitted by barbers who did not yet have disposable razors available, and in fact the infection was also called “barber’s itch”, since those affected tended to scratch the contaminated part in an attempt to find relief.

The treatments include topical drugs for local use and oral systemic antifungals (itraconazole, terbinafine, griseofulvin) and, in case of itching and burning, also corticosteroids.

Inguinal ringworm

“The incidence of inguinal ringworm (or inguinal epidermofizia) increases during puberty. The routes of contagion are always the same, direct or through clothing and towels; transmission can also be favored by sweat and frequent irritation in skin folds, especially in case of overweight, and also by changes in pH in the groin area» explains Chiara Galloni.

“It is caused by various types of fungi (Epidermophyton floccosum, Trichophyton rubrum, T. mentagrophytes) and manifests itself with erythematous and scaly lenticular patches that tend to extend and unite in a single brown-yellow smooth patch, with irregular and reddened contours, sometimes with small vesicles that then give rise to scabs, on the upper thigh at the groin level, on one or both legs,” adds the dermatologist.

“Ringworm can reach the perineum and pubis. Again, the diagnosis of the dermatologist is essential for the effectiveness of therapies, because it is possible that it is confused with other infections (candidal intertrigo, psoriasis of the folds, bacterial intertrigo, etc.) and specific examinations may be necessary, such as microscopic analysis of desquamation material and culture analysis.

Therapy? «Local antifungal drugs (azoles, allylamines, morpholines, polyenes) for 15-20 days and, possibly, systemic (terbinafine or triazole if there is an association with Candida or bacteria)».

Athlete’s foot

«The “athlete’s foot” gives desquamative phenomena more often in the space between the second and third toes and between the third and fourth. The skin is red, the person feels itching and sometimes burning. It usually starts at one foot, then eventually affects the other as well. It mainly affects boys after the age of ten, male. Practicing sports is an important risk factor,” emphasizes the dermatologist.

“There are various evolutions of the disease, with extension to the other spaces between the toes or to the sole of the foot with erythematous-desquamative patches, which tend to hyperkeratosis and then go up on the sides (athlete’s foot “moccasin”), or, again, always on the sole and sides of the foot with small vesicles that turn into pustules and therefore into abrasions”.

The causes that predispose to athlete’s foot are varied: «Reduced immune defenses, prolonged use of certain drugs, pregnancy, high sweating (hyperhidrosis), abuse of rubber shoes, poor foot hygiene, maceration of the tissues due to overheating of the foot during sports followed by frequent washing and, perhaps, little attention in drying before putting on socks and shoes, keeping the skin moist for a long time».

Athlete’s foot can be confused with candidal or bacterial intertrigo, psoriasis, dyshidrosis, contact dermatitis, which can sometimes also live with ringworm, but each of these pathologies manifests itself with a peculiar and different shape from the others.

Prevention is fundamental:

• dry the skin well after washing;
• prefer cotton, wool or bamboo socks;
• avoid synthetic tights or knee-highs;
• prefer breathable shoes;
• Avoid applying creams in the spaces between the fingers because they facilitate the weakening of the skin.

«So pay attention to sneakers, décolleté or safety footwear, which must be used for the time strictly necessary. The therapy is local with creams based on imidazole and allyllamines, and includes proper foot hygiene, with sterilization of shoes and socks to accelerate healing» concludes the dermatologist.