Ringworm Treatment and Medications

Ringworm is a misnomer. It isn’t a worm and it doesn’t always look like a ring. Called tinea, Latin for “worm”), ringworm is a skin infection caused by fungi. More often than not, ringworm is a temporary nuisance, but sometimes, a ringworm infection can stubbornly hold on and spread. From the mildest to the most stubborn infections, antifungal medications are the treatment of choice to clear up the infection.

What is ringworm?

Ringworm, or tinea, is a skin infection caused by one or more species of mold called dermatophytes, a type of fungus. Unlike yeast, which are single-celled organisms, molds form multicellular threads or filaments. Dermatophyte filaments extract nutrients from keratins, proteins that provide structure to the outer skin as well as nails and hair, therefore infection is generally limited to fairly superficial sites such as skin, hair, or nails.

The most common molds that cause ringworm are Trichophyton, Epidermophyton, and Microsporum. However, any ringworm infection can involve more than one type of mold, so the infection is usually further specified based on the location of the infection:

• Tinea corporis (ringworm of the body) is the classic form of ringworm and is usually just called “ringworm.” Tinea corporis can involve any skin area on the chest, arms, back, shoulders, or legs and is identified by the signature red ring formation around the site of the infection.

• Tinea pedis (ringworm of the foot), or “athlete’s foot,” is one of the most common ringworm infections and is usually treated with an over-the-counter antifungal cream.

• Tinea cruris (ringworm of the groin) is a dermatophyte infection of the groin or the perineum (the area between the genitals and the anus). More familiarly-known as “jock itch,” tinea cruris is also very common and usually treated with over-the-counter topical antifungal medications.

• Tinea manuum (ringworm of the hand) is a dermatophyte infection of the back or palms of the hands.

• Tinea faciei (ringworm of the face) is a dermatophyte infection of the face.

• Tinea unguium (ringworm of the nails) infects the fingernails or toenails. This infection is a subset of a broader set of infections known as asonychomycosis. ail ringworm can be difficult to treat and may require several weeks of oral antifungal treatment.

• Tinea barbae (ringworm of the beard) is a dermatophyte infection of the facial beard hair follicles. It is a more difficult tinea infection and usually requires prescription antifungals.

• Tinea capitis (ringworm of the scalp) is the most difficult dermatophyte infection to treat. Also called scalp ringworm or herpes tonsurans, this infection takes hold in the hair, skin, and hair follicles on the head and can cause hair loss, plaques, or pustules (kerions), and swollen lymph nodes. Tinea capitis usually requires four or more weeks of systemic (oral) prescription antifungal treatment.

Tinea is one of the only communicable fungal diseases. Skin contact with an infected person or with surfaces or objects they have come in contact with can spread the infection. Infections are spread by spores that can live for a long time on the skin surface, in dust, in the soil, on hair, or on objects or surfaces that have come in contact with the infected person.

While any person can get tinea, some are more vulnerable than others. Risk factors for a ringworm infection include:

• Living in a warm, humid climate

• Having a compromised immune system

• Practicing bad hygiene

• Sweating excessively

• Frequently using communal locker rooms or showers

• Playing contact sports

• Having a condition such as diabetes mellitus or Cushing’s syndrome

Most tinea infections resolve with over-the-counter topical antifungal medications, but chronic tinea is possible with episodes of infection followed by remission. Serious complications are rare. A serious complication is Majocchi granuloma, a condition in which the dermatophytes spread deeper into the skin or hair follicles.

How is ringworm diagnosed?

Ringworm is usually diagnosed with a physical examination and a thorough history, though some tests may be used to confirm the diagnosis. Many ringworm infections, such as athlete’s foot, jock itch, or tinea corporis, are self-diagnosed and successfully treated at home with antifungal creams.

The symptoms of ringworm are an itchy, red rash that may also be scaly based on the location of the infection. The rash is usually circular in a tinea corporis infection, but the center of the circle is clear, making the infection look like a ring. Tinea infections in other areas of the body are more diffuse and shapeless. Nail ringworm is identifiable because it turns the nails white, yellow, or brown and makes them brittle, pitted, or scaly.

Most tinea cases are treated by family physicians, but more extensive infections will require a specialist like a dermatologist. The healthcare provider will make a diagnosis based on the physical appearance of the infection. The healthcare provider may examine the skin microscopically using a small, hand-held device called a dermatoscope. In some cases, a skin scraping will be examined under a microscope to confirm the diagnosis.

Ringworm treatment options

Ringworm is treated with medications. Lifestyle modifications will help to both clear the infection and prevent future infections.

Medications

For limited or localized infections, topical antifungal medications are enough to resolve the infection in a few weeks. For extensive or obstinate infections, oral (“systemic”) antifungals will be used for four to eight weeks. The prognosis with treatment is very good. Treatment will clear most tinea infections in two to four weeks. Left untreated, however, tinea infections will take months to resolve.

Lifestyle changes

Drug treatment, however, does not completely rid the body of the dermatophyte spores, which can live indefinitely on the skin. Subsequent ringworm outbreaks are always possible.

To both treat and prevent re-infection, lifestyle changes are advised:

• Wearing loose-fitting clothing

• Not scratching the affected area

• Washing the body and the hair regularly to prevent the infection from spreading to other parts of the body

• Drying the skin completely when it is wet

Ringworm medications

Ringworm will be treated primarily with topical or oral antifungals depending on the nature and site of the infection. For localized infections, treatment will usually begin with topical antifungals. Systemic (oral) antifungals will be reserved for more extensive or stubborn infections. Tinea capitis (scalp ringworm) is a particularly difficult fungal infection and will often be treated by systemic antifungals as a first-line treatment.

Topical antifungals

Topical over-the-counter antifungals can effectively treat ringworm in most cases. These include clotrimazole (Lotrimin), terbinafine (Lamisil), and miconazole (Desenex). However, a doctor may prescribe prescription antifungals. Antifungal medications kill the fungus by interfering with the fungus’ ability to form cell walls. Topical antifungals are available in cream, ointment, lotion, foam, spray, or shampoo.

Systemic antifungals

Oral and rarely injected antifungals are far more effective against ringworm than topical antifungals but have more side effects. For this reason, they’re used only when topical antifungals don’t work or if the infection is extensive. Therapy with systemic antifungals may take several weeks to dislodge an obstinate infection. Systemic antifungals are prescription-only and include terbinafine (Lamisil tablets), griseofulvin, itraconazole (Sporanox), and fluconazole (Diflucan). Like the topical antifungals, these drugs (except griseofulvin) kill the fungus cells.

Selenium sulfide

Patients with scalp ringworm, a particularly difficult infection, will often be prescribed a selenium sulfide shampoo in addition to systemic antifungals. Selenium sulfide is a “cytostatic” agent (not an antifungal), meaning it stops skin or fungal cells from growing.

Other medications

In extensive or particularly obstinate ringworm infections, a healthcare professional may prescribe topical steroids to relieve itching and discomfort. Using over-the-counter steroid creams for minor ringworm infections, however, is discouraged.

What is the best medication for ringworm?

There is no best medication for ringworm. Tinea infections can be mild or severe. Most tinea infections can be easily resolved in a week or two with topical clotrimazole or terbinafine, but some infections, such as scalp ringworm (tinea capitis), may require systemic antifungal treatment for several weeks.

Save big on your prescriptions

with the free SingleCare app.

4.8 average rating

Text a link to get the app

Send

Best medication for ringworm