Ringworm is a skin infection caused by a fungus. It is not caused by worms, and there are no worms involved, despite the name! Treatment with an antifungal cream usually works well.
What is ringworm?
Ringworm is a fungal skin infection caused by parasites that live on dead skin tissue.(It is not due to a worm as its name implies!) There are many types of fungal germs (fungi) and some can infect the skin, nails, and hair. Fungal infections are also known as 'jock itch' or 'tinea' or 'tinea infections', 'dermatophyte infections' or 'dermatophytosis'. This leaflet just deals with ringworm of the skin (sometimes called tinea corporis). See also the separate leaflets called Fungal Scalp Infection (Scalp Ringworm), Athlete's Foot (Tinea Pedis), Fungal Groin Infection (Tinea Cruris) and Fungal Nail Infections (Tinea Unguium).
How do you get ringworm?
Generally speaking, ringworm and other fungal skin infections are contagious, but not especially so. You can touch someone's skin if they've got ringworm or some other fungal infection and, as long as you wash your hands afterwards, it's unlikely you'll catch it.
Occasionally you can catch ringworm by the following means:
- From person to person by touching a person who has the infection.
- From touching items which have been in contact with an infected person. For example, towels, clothes, bed linen or chairs which have been used by somebody who has ringworm.
- From animals. Some animals, such as dogs, cats, guinea pigs and cattle, have fungal infections on their skin. They can pass on the infection, especially to children. (Animals can be treated too if you suspect a pet is the cause. See your vet.) Farm animals can also be a source. Touching a farm gate where infected animals pass through may be enough to infect your skin.
- From soil. Rarely, fungi can be present in soil, and you can get the infection from contact with soil.
What does ringworm look like?
By Corina G., Public domain, via Wikimedia Commons
The most common symptom of ringworm is the emergence of a small area of infected skin that tends to spread outwards. In most cases, ringworm develops into a rounded, red, inflamed patch of skin. The outer edge is more inflamed and scaly than the paler centre. So, it often looks like a ring that becomes gradually larger - hence the name ringworm. Sometimes only one patch of infection occurs. Sometimes several patches of ringworm occur over different parts of the body, particularly if you catch the infection from handling an infected animal.
The rash may be irritating, itchy and inflamed. If it's not itchy and annoying, it's very unlikely the ringworm is fungal.
Sometimes fungal skin infections and symptoms of ringworm look similar to other skin rashes, such as psoriasis. If you have a ring of slightly bumpy skin, but it isn't itchy at all, it could be something called granuloma annulare: a harmless skin condition that requires no treatment.
Antifungal creams for ringworm
You can buy an antifungal cream from pharmacies over the counter (OTC), or get one on prescription. There are various types and brands - for example, terbinafine, clotrimazole, econazole, ketoconazole and miconazole. These are good at clearing fungal skin infections such as ringworm. There is no evidence that any one cream is better than any other one.
Apply the cream to the affected areas for as long as advised. This varies between the different creams, so read the instructions carefully. Briefly:
- Clotrimazole: apply 2-3 times a day for at least four weeks.
- Miconazole: apply twice a day and continue for 10 days after the skin is back to normal.
- Econazole: apply twice a day until the skin is back to normal.
- Ketoconazole: apply once or twice a day and continue for a few days after the skin is back to normal. Cannot be used for children.
- Terbinafine: apply once or twice a day for one to two weeks. Cannot be used for children.
For ringworm skin that is particularly inflamed, your doctor may prescribe an antifungal cream combined with a mild steroid cream. This would normally be used for no more than seven days. You may need to continue with an antifungal cream alone for a time afterwards. The steroid reduces inflammation and may ease itch and redness quickly. However, the steroid does not kill the fungus and so a steroid cream alone should not be used: in fact, it will probably make the fungal infection worse.
Antifungal tablets for ringworm
Not all ringworm treatments are suitable for everyone. People who may not be able take antifungal tablets include:
- Women who are pregnant or breastfeeding.
- People with certain liver diseases.
- People at risk of heart failure.
- People with long-standing lung disease.
- Elderly people.
- People taking other medication which may interact with antifungal tablets.
Do you need to see a doctor for ringworm?
Generally, no. A pharmacist can diagnose ringworm, so see them first and they will tell you whether or not you need to see a GP.
However, you should see your GP if the ringworm has not improved after using the antifungal medicine prescribed by the pharmacist, or if you have a weakened immune system from other medications or treatments.
General advice and tips for ringworm
Keep the affected area clean and dry.
To prevent passing on the infection, do not share clothes or towels. Wash towels, sheets and clothes frequently. Clean your shower or bath well after use. Try not to scratch the rash, as this may spread the fungus to other areas of your body.
You do not need to stay off work or school once ringworm treatment has started.
Further reading and references
Fungal skin infection - body and groin; NICE CKS, September 2014 (UK access only)
Fungal skin infections; DermNet NZ
Andrews MD, Burns M; Common tinea infections in children. Am Fam Physician. 2008 May 1577(10):1415-20.
Rotta I, Ziegelmann PK, Otuki MF, et al; Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments. JAMA Dermatol. 2013 Mar149(3):341-9. doi: 10.1001/jamadermatol.2013.1721.
Malhotra S, Malhotra SK, Aggarwal Y; Tinea faciei caused by Trichophyton mentagrophytes in a 20-day-old neonate. Indian Dermatol Online J. 2015 Dec6(Suppl 1):S43-6. doi: 10.4103/2229-5178.171045.