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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 as a 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.
| Best medication for ringworm | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Lotrimin AF (clotrimazole) | Imidazole antifungal | Topical | Apply a thin layer over the affected area twice a day | Burning, stinging, redness |
| Lamisil AT (terbinafine) | Allylamine antifungal | Topical | Apply a thin layer over the affected area twice a day | Burning, irritation, redness |
| Desenex (miconazole) | Imidazole antifungal | Topical | Apply a thin layer over the affected area twice a day | Irritation, burning, maceration | Lamisil (terbinafine) | Allylamine antifungal | Oral | 250 mg per day for six weeks (longer duration may be required) | Headache, gastrointestinal disturbances, cough, skin rash |
| Gris-PEG (griseofulvin) | Antifungal | Oral | 500 mg daily total administered in one, two, or four doses | Allergic reactions, peripheral neuropathy, nausea |
| SelRx (selenium sulfide) | Cytostatic agent | Topical | One application per day for seven days | Skin irritation, hair loss, hair discoloration |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your healthcare provider based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of ringworm medication?
Ringworm is primarily treated with topical or systemic (oral) antifungal medications. Topical antifungals have few and only minor side effects because they only come in contact with the skin. Systemic antifungals have the potential to cause more side effects.
Topical antifungals
Topical antifungals typically have few side effects that tend to be very mild. For most people, the worst they experience are site reactions such as burning, itching, stinging, or skin irritation on the affected skin. The most serious side effects are allergic skin reactions that can be severe enough to require hospitalization.
Systemic antifungals
Systemic antifungals cause more frequent and more severe side effects than topical antifungals. The most common include abdominal pain, indigestion, diarrhea, and headache. Severe side effects depend on the type of antifungal used. Ketoconazole and griseofulvin, for instance, can damage the liver. Terbinafine can cause a skin reaction similar to lupus, so it should not be given to patients who already have lupus. All systemic antifungals can cause severe and even life-threatening allergic skin reactions.
Selenium sulfide
Selenium sulfide is a safe medication with mild side effects. Its most common side effects are skin irritation and burning, but it can also cause a small amount of hair loss or discoloration.
What is the best home remedy for ringworm?
Ringworm is treated with antifungal medications. For most cases of ringworm, over-the-counter topical antifungals are enough to clear up the infection in a few weeks. Other home remedies used along with antifungal medications can help speed recovery and prevent spreading the infection. However, popular home remedies such as apple cider vinegar, supplements, and natural treatments do not effectively treat the infection.
Keep in mind that ringworm is contagious. It can be spread from person to person with direct skin contact or from surfaces or objects, like towels, clothes, floors, sheets, or hairbrushes. Additionally, a person with tinea can spread the infection to other parts of the body or get re-infected later from surfaces or objects they used when previously infected. A critical component of home treatment, then, is to prevent the infection from spreading.
Use over-the-counter antifungals
Most dermatophyte infections can be treated at home with over-the-counter antifungal creams or ointments, such as clotrimazole, miconazole, or terbinafine. Follow the directions on the label and the infection should clear up in a few weeks.
Wear loose-fitting and dry clothing
Ringworm molds prefer warm and wet environments. Keep the skin dry and cool by wearing loose-fitting clothing that wicks moisture efficiently. If any clothing gets wet, especially socks or underwear, take them off, dry the skin, and put on dry clothes.
Change and wash clothes regularly
Change clothes every day and wash them in hot water to kill the ringworm spores. Wash sheets, pillowcases, and blankets in hot water every day since, after they’ve been slept in, they are covered in mold spores that can cause a new infection.
Wash regularly
Wash your hands after touching the affected area to prevent spreading the infection. Keep the affected area clean by washing it regularly. After washing, dry the skin thoroughly with a clean towel. The towel you use? It needs to be washed in hot water before being used again.
Disinfect objects and surfaces
Any object or surface that you touch or use should be disinfected or washed in hot water. The molds that cause ringworm produce spores that can cause re-infection. These rugged spores can live for a long time – well after the infection has cleared. Do not share objects such as hairbrushes, clothes, towels, or other objects that may come in contact with infected areas. Disinfect or throw out these objects after the infection has cleared to prevent re-infecting yourself. Finally, disinfect surfaces with which you come in contact. Again, not only can these surfaces infect others with ringworm, they can re-infect you.
Frequently asked questions about ringworm
What is the best treatment for ringworm?
Ringworm is treated with topical or oral antifungal medications depending on the extent of the infection. Home remedies such as apple cider vinegar or natural remedies are not effective.
What will happen if ringworm is not treated?
Most ringworm infections will resolve in a few months, but there is a risk that the infection will spread deeper into the skin or the tissues below the skin. Ringworm is one of the only fungal infections that is contagious, so untreated ringworm carries the risk of infecting other parts of the body as well as infecting other people.
What are the side effects of ringworm in humans?
Ringworm typically causes a localized rash that is red and itchy. Some infections, such as scalp ringworm (tinea capitis) or beard ringworm (tinea barbae) can cause lesions, abscesses, or hair loss. Nail ringworm infects the fingernails or toenails and can cause them to turn white, yellow, brown, or black, and become brittle.
What is the most common side effect of griseofulvin?
The most common side effects of griseofulvin are allergic reactions such as rash. Allergic reactions to griseofulvin can be severe and require hospitalization, but this is rare.
How long does ringworm take to go away?
Treatment typically resolves most ringworm infections in two to four weeks. More extensive ringworm infections or difficult infections such as scalp ringworm might take two to three months to resolve. Left untreated, most ringworm infections take several months to clear up.
How do you get rid of ringworm in 24 hours?
No remedy or medication clears up ringworm instantly. It typically takes two to four weeks to clear up a ringworm infection using antifungal medications.
Can antibiotics clear up ringworm?
Antibiotics are designed to treat bacterial infections. Since ringworm is caused by a fungus, antibiotics will not clear up the infection.
Does ringworm have long term effects?
Most ringworm infections clear up without complications. Some ringworm infections, such as tinea capitis or tinea barbae, may cause permanent hair loss in the infected area. Other ringworm infections may cause deeper infections or abscesses that may leave scars. The most serious long-term effect of tinea is a chronic infection.
Does ringworm get bigger?
Not only does ringworm get bigger as the infection progresses, but it can also spread to other parts of the body. Untreated, ringworm typically holds on for several months, but antifungal medications can clear up the infection within a few weeks.
Does vinegar kill ringworm?
Apple cider vinegar is not an effective treatment for ringworm. If used topically with a covering as some people recommend, apple cider vinegar could make the infection worse. An apple cider vinegar foot bath is often suggested as a treatment for nail ringworm. There is no evidence this works.
Will bleach kill ringworm?
Bleach will kill ringworm, but it’s not a good idea to apply bleach to the skin because it can cause chemical burns. The same is true of garlic. However, bleach is very effective at killing ringworm spores, so it’s a good idea to use diluted bleach to clean surfaces, clothes, sheets, towels, and objects to prevent the spread of the infection and reduce the risk of re-infection.
Will rubbing alcohol kill ringworm?
Rubbing alcohol will kill ringworm that is right on the surface of the skin, but the vast majority of a ringworm infection lives below the skin surface. Rubbing alcohol, however, is effective at disinfecting surfaces and objects to prevent the spread of ringworm.