- "Ringworm" redirects here. For the band, see Ringworm (band); Not to be confused with Roundworm, Pinworm, or Hookworm.
|Classification and external resources|
Ringworm on a human leg.
Dermatophytosis is a clinical condition caused by fungal infection of the skin in humans, pets such as cats, and domesticated animals such as sheep and cattle. The term "ringworm", commonly used to refer to such infections, is a misnomer, since the condition is caused by fungi of several different species and not by parasitic worms. The fungi that cause parasitic infection (dermatophytes) feed on keratin, the material found in the outer layer of skin, hair, and nails. These fungi thrive on skin that is warm and moist, but may also survive directly on the outsides of hair shafts or in their interiors. In pets, the fungus responsible for the disease survives in skin and on the outer surface of hairs.
It has been estimated that currently up to twenty percent of the population may be infected by ringworm or one of the other dermatophytoses. It is especially common among people who play sports, wrestling in particular. Wrestlers with ringworm may be withheld from competition until their skin condition is deemed non-infectious by the proper authorities.
A number of different species of fungi are involved. Dermatophytes of the genera Trichophyton and Microsporum are the most common causative agents. These fungi attack various parts of the body and lead to the conditions listed below. Note that the Latin names are for the conditions (disease patterns), not the agents that cause them. The disease patterns below identify the type of fungus that causes them only in the cases listed:
- Tinea pedis (athlete's foot) affects the feet
- Tinea unguium affects the fingernails and toenails
- Tinea corporis affects the arms, legs, and trunk
- Tinea cruris (jock itch) affects the groin area
- Tinea manuum affects the hands and palm area
- Tinea capitis affects the scalp
- Tinea barbae affects facial hair
- Tinea faciei (face fungus) affects the face
- Other superficial mycoses (not classic ringworm, since not caused by dermatophytes)
Signs and symptoms
Infections on the body may give rise to typical enlarging raised red rings of ringworm, infection on the skin of the feet may cause athlete's foot and in the groin jock itch. Involvement of the nails is termed onychomycosis, and they may thicken, discolour, and finally crumble and fall off.
They are common in most adult people, with up to 20 percent of the population having one of these infections at any given moment.
Dermatophytosis tends to get worse during summer, with symptoms alleviating during the winter. Animals such as dogs and cats can also be affected by ringworm and the disease can be transmitted between animals and humans (zoonotic disease).
Advice often given includes:
- Avoid sharing clothing, sports equipment, towels, or sheets.
- Washing clothes in hot water with fungicidal soap after suspected exposure to ringworm.
- Avoid walking barefoot; instead wear appropriate protective shoes in locker rooms and sandals at the beach.
- After being exposed to places where the potential of being infected is great, one should wash with an antibacterial and anti-fungal soap or one that contains tea tree oil, which contains terpinen-4-ol.
- Avoid touching pets with bald spots as they are often carriers of the fungus.
Antifungal treatments include topical agents such as miconazole, terbinafine, clotrimazole, ketoconazole, or tolnaftate applied twice daily until symptoms resolve — usually within one or two weeks. Topical treatments should then be continued for a further 7 days after resolution of visible symptoms to prevent recurrence. The total duration of treatment is therefore generally two weeks, but may be as long as three.
In more severe cases or where there is scalp ringworm, systemic treatment with oral medications may be given.
To prevent spreading the infection, lesions should not be touched, and good hygiene maintained with washing of hands and the body.
Misdiagnosis and treatment of ringworm with a topical steroid, a standard treatment of the superficially similar pityriasis rosea, can result in tinea incognito, a condition where ringworm fungus will grow without typical features like a distinctive raised border.
Dermatophytosis has been prevalent since before 1906, at which time ringworm was treated with compounds of mercury or sometimes sulfur or iodine. Hairy areas of skin were considered too difficult to treat, so the scalp was treated with x-rays and followed up with antiparasitic medication.
In veterinary medicine
Typical lesion is a round, whitish crust. Multiple lesions may coalesce in "map-like" appearance.
Clinical dermatophytosis is also diagnosed in sheep, dog, cat, horse. Causative agents, besides Trichophyton verrucosum, are T. mentagrophytes, T. equinum, Microsporum gypseum, M. canis, and M. nanum.
Ringworm in pets may often be asymptomatic, resulting in a carrier condition which either infects other pets. In some cases, the disease only appears when the domestic animal develops an immunosuppressive condition. Circular bare patches on the skin suggest the diagnosis but no lesion is truly specific to the fungus (similar patches may result from allergies, sarcoptic mange, and other conditions). Three species of fungi cause 95% of dermatophytosis in pets: these are Microsporum canis, Microsporum gypseum, and Trichophyton mentagrophytes.
Veterinarians have several tests to identify ringworm infection and identify the fungal species that cause it:
Woods Test: This is a black light (ultraviolet light) with a magnifying lens. Only 50% of Microsporum canis will show up as an apple-green fluorescence on hair shafts, under the black light. The other fungi do not show. The fluorescent material is not the fungus itself (which does not fluoresce) but rather an excretory product of the fungus which sticks to hairs. Infected skin does not fluoresce.
Microscopic test: The vet takes hairs from around the infected area and places them in a staining solution to view under the microscope. Fungal spores may be viewed directly on hair shafts. This technique identifies a fungal infection in about 40%–70% of the infections but cannot identify the species of dermatophyte.
Culture Test: This is the most effective but also the most time-consuming way to determine if there is ringworm on a pet. In this test, the veterinarian collects hairs from the pet, or else collects fungal spores from the pet's hair with a toothbrush, or other instrument, and inoculates fungal media for culture. These cultures can be brushed with transparent tape and then read by the vet using a microscope, or can be sent to a pathological lab. The three common types of fungi which commonly cause pet ringworm can be identified by their characteristic spores. These are different-appearing macroconidia in the two common species of Microspora, and typical microconidia in Trichophyton infections.
Identifying the species of fungi involved in pet infections can be helpful in controlling the source of infection. Microsporum canis, despite its name, occurs more commonly in domestic cats, and 98% of cat infections are with this organism. It can also infect dogs and humans, however. Trichophyton mentagrophytes has a major reservoir in rodents, but can also infect pet rabbits, dogs and horses. Microsporum gypseum is a soil organism and is often contracted from gardens and other such places. Besides humans, it may infect rodents, dogs, cats, horses, cattle, and swine.
Because of the usually longer hair shafts in pets (as compared to those of humans), the area of infection and possibly all of the longer hair of the pet must be clipped in order to decrease the load of fungal spores clinging to the pet's hair shafts. However, close shaving is usually not done because nicking the skin facilitates further skin infection.
Washing of household hard surfaces with 1:10 household hypochlorite bleach solution (too irritating to be used directly on hair and skin) is effective in killing spores.
Pet hair must be rigorously removed from all household surfaces, and then the vacuum cleaner bag (and often the vacuum cleaner itself) discarded when this has been done repeatedly. Removal of all hair is important, since spores may survive 12 months or even as long as two years on hair clinging to surfaces.
In bovines, an infestation is difficult to cure, as systemic treatment is out of economic range.
Local treatment (with iodine compounds) is time-consuming, as it needs scraping of crusty lesions. Moreover, it must be carefully conducted using gloves, because of a possible infestation of the worker.
Old car oil has been used by farmers with some success.
- Decorby, MaryAnn, Director of the British Columbia Wrestling Association. "www.amateurwrestler.com: The Truth About Ring Worm". Retrieved 11 August 2009.
- Klemm, Lori (2 April 2008). "Keeping footloose on trips". The Herald News.
- Fort Dodge Animal Health: Milestones from Wyeth.com. Retrieved April 28, 2008.
- Ringworm In Your Dog Cat Or Other Pet: Prevention by Ron Hines DVM PhD 5/4/06. Retrieved April 28, 2008.
- Hammer, K. A.; Carson, C. F.; Riley, T. V. (2003). "Antifungal activity of the components of Melaleuca alternifolia (tea tree) oil". Journal of Applied Microbiology 95 (4): 853–860. doi:10.1046/j.1365-2672.2003.02059.x. PMID 12969301.
- Fontenelle RO, Morais SM, Brito EH, et al. (May 2007). "Chemical composition, toxicological aspects and antifungal activity of essential oil from Lippia sidoides Cham". J. Antimicrob. Chemother. 59 (5): 934–40. doi:10.1093/jac/dkm066. PMID 17376793.
- Kyle AA, Dahl MV (2004). "Topical therapy for fungal infections". Am J Clin Dermatol 5 (6): 443–51. PMID 15663341.
- McClellan KJ, Wiseman LR, Markham A (July 1999). "Terbinafine. An update of its use in superficial mycoses". Drugs 58 (1): 179–202. PMID 10439936.
- Tinea~treatment at eMedicine
- Tinea Corporis~treatment at eMedicine
- "Antifungal agents for common paediatric infections". Can J Infect Dis Med Microbiol 19 (1): 15–8. January 2008. PMC 2610275. PMID 19145261.
- Gupta AK, Cooper EA (2008). "Update in antifungal therapy of dermatophytosis". Mycopathologia 166 (5–6): 353–67. doi:10.1007/s11046-008-9109-0. PMID 18478357.
- Ringworm on Body Treatment at eMedicineHealth
- Sequeira, J.H. (1906). "The Varieties of Ringworm and Their Treatment" (PDF). British Medical Journal 2 (2378): 193.
- Scott, David W. (2007). Colour Atlas of Animal Dermatology. Blackwell. ISBN 978-0-8138-0516-0.
- "Ringworm in Dogs Diagnosis". Dogclassonline.com. Retrieved 2011-01-10.
- "General ringworm information". Ringworm.com.au. Retrieved 2011-01-10.
-  Detailed veterinary discussion of animal treatment
- "Veterinary treatment site page". Marvistavet.com. Retrieved 2011-01-10.
- "Persistance of spores". Ringworm.com.au. Retrieved 2011-01-10.
- The Mycosis Study Group website, with photos, education, fungal treatment regimens
- Tinea photo library at Dermnet
- Slideshow: See Pictures and Learn About Ringworm