Ringworm is a very common type of infection caused by a group of fungi on the scalp, hair, body, nail, underpants, feet and virtually any part of the body where there’s skin, hair and nails. The words ‘tinea infection’ are used medically for this condition such that it is called ‘tinea capitis’ for scalp infection, ‘tinea corporis,’ if found on the body; ‘tinea cruris’ for underpants infection, inner thighs and buttocks; ‘tinea unguium’ for nail infection and it goes on like that, depending on the part of the body affected. The fungi are normally carried by an insect that feeds on clothes and books. It thrives best in moist environments and releases these fungi on the skin. This infection is known to spread quickly from person to person, especially where there is physical contact. We can also call it a parasitic infection of the skin. The fungi live on the skin like a parasite.
Is it caused by worms?
No, it is not caused by worms. It would be out of place to think it is a worm, hence treating it with medication for worms. It only derives its name from the shape it takes on the skin, typically looking like there’s a round (ring-like) worm (raised edges) under the skin. It is not a worm and you should not expect to find a worm under the skin.
Ringworm is caused by fungi; there are different types in this ‘tinea’ category. These types are also called dermatophytes (skin plants). Fungi are microorganisms that can also cause infection in humans, just like viruses and bacteria that we are familiar with.
What are the symptoms of ringworm?
Symptoms that someone with ringworm would present with include usually a ring-like formation on any area of the skin or scalp that is infected. This can be very wide and extensive. For example, ‘tinea corporis’ (on body) could cover the whole chest or abdomen. It could also be very small, which may or may not be in multiple places, hair loss (especially on the scalp); whitish, reddish or pale discoloration of the affected area; discomfort; moderate to severe itching and some psychological effects on the patient, e.g. low self-esteem among peers. Someone with ringworm would never be proud to show it off to others. Even when clothes cover it and no one is seeing it, they can still feel uncomfortable when with someone else. It can affect a child’s performance in school, especially in peer group work and assignments, and can be worse in adolescents.
Is ringworm contagious?
Yes. It is contagious, meaning it can easily spread from person to person, hence direct contact with infected persons or their belongings like combs and towels should be prevented.
How is ringworm diagnosed?
When someone presents with ringworm in the clinic, the doctor will know this infection by its typical shape but will request a test to confirm diagnosis or another to confirm specifically the type of fungus it is. These tests may require scraping a part of the affected skin and looking at it under a special light after staining with a chemical. A characteristic shape of the fungus will be seen in the laboratory, then diagnosis is considered confirmed. Blood tests can be ordered in cases where added bacterial infection is suspected.
How prevalent is ringworm among Nigerians?
A study conducted in 2014 among schoolchildren (nine to 12) in the western part of Nigeria by Olaide Olutoyin et al showed 35 per cent prevalence of ringworm, with males slightly more than females. It was discovered also that infection of the head (tinea capitis) was the commonest, while that of the hand (tinea mannum) was the least common among these subjects. Typically, tinea of the head is commonest in children and that of the feet is commonest in adults in every race and culture.
What signs should one look for in detecting ringworm?
Signs are what you or the doctor will see in an infected person. For ringworm infection, once you see the typical ring shape with whitish, reddish or pale centre on any part of the skin, you can suspect a ringworm infection but only the doctor can reach a conclusion on what it is. You should also notice the gradual spread of the said ring formation (becoming wider).
Can ringworm be cured?
Yes, it can be treated. Although it could be very stubborn, especially in pleasant situations or continuous reinfection, but it can be cured. It has a very high chance of recurrence if not handled properly.
How is ringworm treated?
It is treated by the use of antifungal medications. I should say that there are many in the market but your doctor will choose the specific one for this type of fungi and will also guide you on how to use it better to prevent reoccurrence. It is paramount to avoid self-medication. When infected, get diagnosed and treatment will follow. Ringworm could be a very resistant and recurring infection, hence should be handled well. When you are prescribed a medication, you must take it religiously even when it seems to have disappeared until the time you are told to stop the medications. If you don’t do as prescribed, it may come back. Seeing a dermatologist or skin specialist may be a way out for some infections. Even though the average Nigerian would go to other people first and use all sorts before seeing a doctor, it is still advisable to get diagnosed. On a normal day, even without infection on the skin, the skin should be moisturised and the use of hypoallergenic soaps is advised.
Who is most at risk of getting ringworm?
Considering the manner by which this infection spreads, those at risk or who can get infected easily would be children and adults, especially in overcrowded houses or communities like in the slums; those who keep pets, have roommates with ringworm or have poor personal hygiene; people of low socio-economic status; children in boarding houses, camps, in institutionalised homes like correctional homes and prisons; children that attend crèche; people who do communal bathing; some people in occupations like swimming, karate, wrestling, boxing and those in mining; people who have the habit of sharing personal wear, combs, hair brushes and towels with people; internally displaced persons; destitute and homeless people; and those who have atopy (excessive reactions of skin and possibly airways to allergens).
How can one prevent ringworm?
It can be prevented basically by ensuring optimum personal hygiene, including regular bathing and hair grooming; avoiding contact with infected individuals; avoiding sharing of wears, combs, hair brushes, towels, and other personal belongings; reporting to the hospital if you see what looks like ringworm on you or taking the affected person to the hospital; use of hypoallergenic soaps and soaps that are gentle on the skin that can preserve the normal microorganisms that live on the skin (some organisms that live on the skin are actually protective); adequate moisturisation of the skin; regular hand-washing; and ensuring dryness in between toes (this can be done by deliberately wiping off moisture from in between the toes).
What happens to someone who does not get the needed treatment?
Someone who does not get needed treatment will have it spread to other parts of the body and even to other people around. There can also be bacterial infection in that same place. We call it superimposed infection. Like I mentioned earlier, it can have psychological effects on the infected person.
In conclusion, ringworm is a preventable communicable disease, not usually serious though. It is caused by fungi infection that quickly spreads from person to person with high risk for recurrence and resistance. It can be diagnosed, treated and cured.