What causes ringworm of the nails. How is fungal nail infection diagnosed. What are the most effective treatments for nail ringworm. Can ringworm spread to other parts of the body. How long does it take to cure nail fungus.

Understanding Ringworm: More Than Just a Skin Condition

Ringworm, despite its misleading name, is not caused by worms but by fungi. This common skin infection, medically known as tinea, can affect various parts of the body, including the nails. When it invades the fingernails or toenails, it’s specifically referred to as onychomycosis or tinea unguium.

Dermatophytes, a group of fungi that includes species like Trichophyton, Microsporum, and Epidermophyton, are the primary culprits behind ringworm infections. These opportunistic organisms thrive in warm, moist environments, making human skin and nails ideal habitats for their growth.

The Deceptive Nature of Ringworm

Why is ringworm called ringworm if it’s not caused by worms? The name originates from the characteristic ring-like appearance of the rash on the skin. However, when it affects the nails, this circular pattern is not present, often leading to misdiagnosis or delayed treatment.

Ringworm of the Nails: Symptoms and Progression

Fungal nail infections can be stubborn and persistent. Recognizing the early signs is crucial for prompt treatment and preventing spread to other nails or parts of the body.

• Discoloration: Nails may turn yellow, brown, or white
• Thickening: Affected nails often become thicker than normal
• Brittleness: Nails may become brittle, crumbly, or ragged
• Distortion: The nail shape may change or become distorted
• Separation: In severe cases, the nail may separate from the nail bed

How quickly does nail ringworm progress? The infection typically starts at the edge of the nail and slowly spreads towards the cuticle. Without treatment, it can eventually involve the entire nail and even spread to adjacent nails.

Risk Factors and Transmission of Nail Fungus

Understanding the risk factors for nail ringworm can help in prevention and early intervention. Certain conditions and habits can increase susceptibility to fungal nail infections.

1. Prolonged exposure to moisture
2. Poor circulation, especially in the feet
3. A weakened immune system
4. Frequent use of public swimming pools or shared showers
5. Tight-fitting shoes that cause repetitive trauma to nails
6. Diabetes or other conditions affecting blood flow to extremities
7. Sharing personal items like nail clippers or files

Can nail ringworm spread to other parts of the body? Yes, the fungus can spread from infected nails to other areas of skin, particularly in warm, moist environments like between the toes or in skin folds. It’s crucial to practice good hygiene and avoid touching infected nails and then other parts of the body without washing hands thoroughly.

Diagnosing Ringworm of the Nails: Beyond Visual Inspection

While the appearance of infected nails can be a strong indicator, definitive diagnosis often requires more than just visual inspection. Dermatologists and podiatrists use various methods to confirm the presence of fungal infection and determine the specific type of fungus involved.

Diagnostic Techniques for Nail Fungus

• Visual examination: The first step in diagnosis
• Nail clippings: Samples are examined under a microscope
• Fungal culture: Helps identify the specific fungus species
• Polymerase Chain Reaction (PCR): A more advanced, highly accurate test

How accurate are these diagnostic methods? While visual examination can be suggestive, laboratory tests like fungal cultures and PCR provide more definitive results. PCR, in particular, can detect fungal DNA with high sensitivity and specificity, even in cases where other methods might fail.

Treatment Options for Nail Ringworm: From Topical to Systemic

Treating ringworm of the nails can be challenging due to the nail’s structure, which makes it difficult for medications to penetrate. Treatment approaches vary based on the severity of the infection and the nails affected.

Topical Antifungal Treatments

For mild to moderate cases, especially those affecting only a few nails, topical treatments may be sufficient. These include:

• Antifungal nail polishes (e.g., ciclopirox, amorolfine)
• Antifungal creams and ointments
• Medicated nail lacquers

How long should topical treatments be used? Most topical treatments require consistent application for several months, often up to a year, to completely eradicate the fungus and allow healthy nail growth.

Oral Antifungal Medications

For more severe infections or those resistant to topical treatment, oral antifungal medications may be prescribed. Common options include:

• Terbinafine
• Itraconazole
• Fluconazole

What are the potential side effects of oral antifungals? While generally safe, these medications can have side effects ranging from mild gastrointestinal upset to more serious liver complications. Regular monitoring by a healthcare provider is essential during treatment.

Combination Therapy and Alternative Treatments

In some cases, a combination of topical and oral treatments may be recommended for optimal results. Additionally, some alternative treatments have shown promise:

• Laser therapy: Uses targeted light to eliminate fungus
• Photodynamic therapy: Combines light activation with a photosensitizing agent
• Nail removal: In severe cases, temporary or permanent nail removal may be necessary

Are these alternative treatments as effective as traditional methods? While some patients report success with these alternatives, more research is needed to fully establish their efficacy compared to conventional antifungal treatments.

Prevention Strategies: Keeping Nail Fungus at Bay

Preventing nail ringworm is often easier than treating an established infection. Implementing good hygiene practices and being mindful of risk factors can significantly reduce the likelihood of developing fungal nail infections.

Essential Prevention Tips

1. Keep nails short, clean, and dry
2. Wear breathable footwear and moisture-wicking socks
3. Use antifungal powder in shoes and on feet
4. Avoid walking barefoot in public areas like pools and locker rooms
5. Don’t share personal items like nail clippers or files
6. Regularly disinfect pedicure and manicure tools
7. Treat athlete’s foot promptly to prevent spread to nails

How effective are these prevention strategies? While no method is 100% foolproof, consistently following these practices can significantly reduce the risk of nail fungus. For individuals with recurrent infections, some of these measures may need to become lifelong habits.

The Impact of Nail Ringworm: Beyond Aesthetics

While often considered primarily a cosmetic issue, fungal nail infections can have more significant impacts on an individual’s quality of life and overall health.

Physical and Emotional Consequences

• Pain and discomfort, especially when wearing shoes
• Increased risk of secondary bacterial infections
• Spread of infection to other nails or skin areas
• Self-consciousness and social embarrassment
• Limitations in certain activities or professions

Can nail ringworm lead to more serious health problems? In most healthy individuals, nail fungus remains a localized issue. However, for people with diabetes or compromised immune systems, it can potentially lead to more serious complications, including cellulitis or widespread fungal infections.

Research and Future Directions in Nail Fungus Treatment

The field of dermatology continues to evolve, with ongoing research into more effective and efficient treatments for nail ringworm. Some promising areas of study include:

• Novel antifungal compounds with improved nail penetration
• Nanotechnology-based drug delivery systems
• Gene therapy approaches to enhance natural antifungal defenses
• Combination therapies that target multiple aspects of fungal growth

What breakthroughs can we expect in nail fungus treatment? While it’s difficult to predict specific outcomes, the trend is towards more targeted, personalized treatments that offer faster results with fewer side effects. Advances in molecular biology and drug delivery technologies are likely to play a significant role in future treatment options.

As research progresses, individuals suffering from nail ringworm can look forward to potentially more effective and less time-consuming treatment options. However, the importance of early detection and consistent treatment remains paramount in managing this persistent condition.

Ringworm (Tinea) > Fact Sheets > Yale Medicine

Overview

Tinea, an itchy fungal skin infection, is commonly known as ringworm. The condition gets its nickname from the reddish-ring appearance of the skin rash. It is a type of dermatophytosis, an infection caused by dermatophytes, fungi that affect the skin, fingernails, toenails, and/or hair. There are no worms involved.

Ringworm can appear on different body parts—arms and legs, hands or feet, trunk, scalp, genitals or groin area, and the face, particularly within a man’s beard. There are different types of ringworm—and treatments—depending on the body part affected. For instance, ringworm of the hands and feet is called athlete’s foot; ringworm of the groin or genital areas is called jock itch.

Ringworm is highly contagious and can spread from person to person, pet (especially puppies and kittens) to person, or surface to person. Because the fungus thrives in damp, warm areas, people can contract it while walking barefoot on a locker room floor or using a towel contaminated with the fungus.

There is no national public health surveillance for common fungal infections, such as ringworm, so it is not possible to know exactly how many people contract ringworm each year in the United States. However, it is considered a common condition and can affect anyone at any age.

The good news is that antifungal medication can cure ringworm. The type and length of treatment vary, depending on the location and severity of the infection.

What is ringworm?

Ringworm is a fungal skin infection that causes redness, itching, and burning in the affected area(s). It is highly contagious and easily spreads in moist, hot areas where the fungus thrives.

When a person comes into contact with the fungus that causes ringworm, the part of their body that touched it may become infected. From there, the fungus multiplies and can spread easily, even to other body parts. For instance, a person with athlete’s foot may later develop jock itch if their bare foot touches their underwear while getting dressed.

What causes ringworm?

Different fungi, including trichophyton, microsporum, and epidermophyton, cause ringworm.

What are the symptoms of ringworm?

Although people with ringworm may have fingernail or toenail infections, the hallmark symptom of the condition is a rash with the following characteristics:

• It contains rounded, red spots (which may appear gray or brown on darker skin)
• It is scaly and/or contains pus-filled bumps
• It grows in size slowly
• It causes itchiness and a burning sensation
• It may cause temporary hair loss, if present on the scalp or beard

What are the risk factors for ringworm?

People may be at risk for ringworm infection if they:

• Have contact with a person or animal with ringworm
• Touch or wear clothing/towels used by a person with ringworm
• Use or touch combs, brushes, or other hair accessories touched by a person with ringworm of the scalp
• Remain in damp or sweaty clothing for long periods of time
• Stand or walk barefoot in a locker room, through a pool area, or in a shared shower where the fungus is present
• Spend time in hot, humid weather
• Wear tight-fitting clothing
• Have diabetes or weakened immune systems

Disinfectants or bleach can be used to kill ringworm on surfaces. Washing clothes, towels, and sheets in hot water with detergent should kill ringworm, as well as stop its spread.

How is ringworm diagnosed?

Doctors can diagnose ringworm after hearing a patient’s medical history, performing a physical exam, and, sometimes, via diagnostic tests.

If you suspect you have ringworm, tell your doctor when you first noticed the rash and what symptoms you have experienced. It’s helpful to share details about activities that may have exposed you to ringworm, such as using public pools, sharing a friend’s workout towel, or caring for a child with ringworm.

During a physical exam, your doctor may diagnose ringworm simply by inspecting your rash. In some cases, the doctor may scrape some cells from the site of the rash or the area beneath an affected fingernail or toenail. The cells will later be examined under a microscope by your doctor or a pathologist to check for a fungal infection.

In rare cases, the doctor will use skin scrapings for a fungal culture, during which the cells are grown in a laboratory setting to identify the type of fungus present on the skin.

How is ringworm treated?

Over-the-counter (OTC) antifungal treatments are often all that is needed to eliminate many forms of ringworm, including jock itch and athlete’s foot. These products come in cream, lotion, gel, spray, and powder forms. The fungal infection should disappear within two to four weeks. It’s important to use the medication for the entire length of time listed on the product, even if the condition seems to have disappeared.

If OTC treatments don’t cure ringworm within the time listed on the package, your doctor may prescribe one of the following medications, depending on the body part affected:

• Econazole
• Ketoconazole
• Ciclopirox
• Naftifine

It’s important to note that ringworm on the scalp, beard, or nails doesn’t respond to OTC treatment; this type of infection needs to be treated with prescription medication that must be taken orally each day for one to three months.

What is the outlook for people with ringworm?

OTC medications can generally treat certain kinds of ringworm within several weeks; however, ringworm infections of the scalp, beard, or nails require oral medication that can take up to three months to treat.

The fungus that causes ringworm is highly contagious. Making lifestyle changes, such as wearing flip-flops on pool decks instead of walking barefoot, changing socks and underwear at least once each day, wearing socks with shoes, keeping your skin clean and dry, and washing your hands with soap after playing with or touching pets, may help lower the risk of getting ringworm again.

This article was medically reviewed by Yale Medicine dermatologist Amanda Zubek, MD, PhD.

Ringworm | Boston Children’s Hospital

Listen

Ringworm is a skin condition characterized by a ring-shaped red, scaly rash, or patches with clearing centers. “Ringworm” is a misleading term that refers to the circular appearance of the fungal lesion. There are no worms involved.

• Different fungi, depending on their location on the child’s body, can cause ringworm.
• The most common types of ringworm include athlete’s foot, jock itch, and ringworm of the scalp, nails, and body.
• Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely. Treatment may need to be repeated.

There is an increased risk of contracting ringworm if your child:

• is malnourished
• has poor hygiene
• lives in a warm climate
• has contact with other children or pets that have ringworm
• is immunocompromised by disease or medication

What are the most common types of ringworm?

The most common types of ringworm include:

Athlete’s foot (tinea pedis or foot ringworm)

• This common condition mostly affects teen and adult males.
• It less frequently affects children before puberty.
• Contributing causes include sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather conditions.
• Symptoms of athlete’s foot may include:
  • whitening of the skin between the toes
  • scaling of the feet
  • itchy rash on the feet
  • blisters on the feet

Jock itch (tinea cruris or groin ringworm)

• This condition is also more common in males and occurs more often during warm weather conditions.
• It is very rare in females.
• Symptoms of jock itch may include:
  • red, ring-like patches in the groin area
  • itching in the groin area
  • pain in the groin area
  • does not usually involve the scrotum

Scalp ringworm (tinea capitis)

• Scalp ringworm is highly contagious, especially among children.
• It occurs mainly in children between the ages of 2 to 10.
• It rarely occurs in adults.
• Symptoms of scalp ringworm may include:
  • red, scaly rash on the scalp
  • itching of the scalp
  • hair loss on the scalp
  • rash elsewhere on the body
• Ringworm of the scalp can also develop into a kerion, a large, tender lesion over the area of the initial ringworm. This is caused by a hypersensitivity to the ringworm and may be associated with a rash elsewhere and tender lymph nodes in the neck.

Nail ringworm (tinea unguium)

• It is an infection of the fingernail or toenail, characterized by a thickened, deformed nail.
• This condition more often affects the toenails than the fingernails.
• This occurs more often in adolescents and adults rather than young children.
• Symptoms of nail ringworm may include:
  • thickening of the ends of the nails
  • yellow color to the nails

Body ringworm (tinea corporis)

• This skin infection is characterized by a ring-like rash anywhere on the body or the face.
• It occurs in all ages but is seen more frequently in children. It is more common in warmer climates.
• The symptoms of body ringworm may include:
  • red, circular lesion with raised edges
  • the middle of the lesion may become less red as the lesion grows
  • itching of the affected area

The symptoms of ringworm may resemble other skin conditions. Always consult your child’s physician for a diagnosis.

Ringworm | Diagnosis & Treatments

How is ringworm diagnosed?

Ringworm is usually diagnosed based on a medical history and physical examination of your child. Because ringworm lesions are unique, your child’s physician can typically make a diagnosis based on a simple physical examination. Your child’s physician may also order a culture or skin scraping of the lesion to confirm the diagnosis.

How we treat ringworm

Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely. Treatment may need to be repeated.

Treatment for scalp ringworm (tinea capitis) may include:

• oral anti-fungal medication, which is usually prescribed for four to eight weeks; some children require longer treatment
• use of a special shampoo to help eliminate the fungus

If a kerion — a large, tender, swollen lesion — is present, your child’s physician may order additional medications such as steroids to help reduce the swelling.

Treatment for ringworm of the body, groin, and foot is usually a topical anti-fungal agent or an oral antifungal medication. The length of the treatment depends on the location of the ringworm.

Ringworm | Programs & Services

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Microsporia (ringworm)

Microsporia is considered the most common skin disease among ringworms. The causative agents of microsporia in cats in most cases are the fungi Microsporum canis and M.gypseum. They are very stable and can survive in the environment for up to several years. Cats are infected from each other by direct contact, less often from a person with microscopy. M.gypseum lives in the soil.

Symptoms . The clinical manifestation of microsporia in cats is very diverse. In long-haired cats, the disease is most often asymptomatic, without showing any clinical signs. In typical cases, lesions are located on the muzzle, in the upper part of the head near the ears, at the base of the tail, on the limbs, etc. Rounded hairless spots of irregular shape are formed. At the site of the lesion, the skin thickens, turns red. The quality of wool deteriorates, the hairs stick together, have a whitish case at the base, and break off easily. The affected areas are flaky.

For the diagnosis of Microsporum, Wood’s lamp illumination (green fluorescence) is often used – the affected hairs glow with emerald green light (this usually does not happen with trichophytosis). However, this method is not always effective, and the fluorescence of the affected hair is not always detected even in the presence of an infection (M.G. Manoyan, 2001). And for black cats, this method is generally ineffective – microscopic analysis of skin scrapings is used for them.

Treatment microsporia at home is very difficult. Traditionally, local disinfection is used, for example, using iodine, epacid-F, iodine 1:5-1:2 with salicylic alcohol. Very effective are also cipam, zoomicol (nitrohydroxyquinoline in combination with thiazolbenzimidazole) and ointments: vedinol and sulfodecortem. It is advisable to add gamavit and maksidin, or immunofan, to the complex treatment regimen. Gemovit-plus gives a good effect (4-6 drops per day for 2 months).

Chlorhexidine treatment is also used for extensive lesions. The high efficiency of microderm and vakderm-F vaccines, which are administered intramuscularly, has been shown. After 2-3 injections of the drug, crusts are rejected from the affected areas and new hair growth is observed. The Polivak TM vaccine has also proven itself well.

It should be borne in mind that sick animals can infect humans with microsporia. Children are especially susceptible. It is advisable to avoid their contact with a sick animal and thoroughly disinfect the room using 1-4. 5% solutions of iodesis, or epacid-F.

Prevention : observance of hygiene rules, timely vaccination with microderm, polivak or vakderm-F vaccine.

Homeopathic treatment. Microsporia is successfully treated with homeopathic remedies. Homeopathic treatment of kittens is especially important, for whom other treatment is contraindicated.

Engystol and Traumeel are used to treat microsporia. For kittens up to 2 months, drugs are prescribed orally (3-5 drops 3 times a day), kittens after two months, as well as adult cats, are treated with injection therapy (3 times a week). Additionally, traumeel C gel can be applied topically. The duration of treatment is at least three weeks.

Phytotherapy. Therapeutic collection (see “Dermatomycosis”), marshmallow, narrow-leaved fireweed, burdock, celandine. For adjuvant therapy, a collection of juniper berries, yarrow grass, sage leaf, eucalyptus, chamomile, calendula, birch buds, black poplar is prescribed. Outwardly, it is possible to recommend an anti-inflammatory phytoelite ointment, which includes extracts of the following herbs: meadowsweet, mullein, St. bedstraw, burdock root, budra, oregano, burnet, elder flowers, propolis.

What is ringworm (alopecia areata)?

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• What is ringworm (alopecia areata)?

You can find details on the question “What is ringworm (alopecia areata)?” in our article. Alopecia areata, commonly known as ringworm, is an autoimmune disease that affects the body’s hair decks and causes hair loss.

What are the causes and symptoms of ringworm?

Ringworm is an autoimmune disease in which a person’s immune system attacks the hair follicles. When this happens, the person’s hair begins to fall out in clumps, usually the size and shape of a coin. The degree of hair loss varies from person to person. Some people experience hair loss in only a few places, while others experience much more hair loss. In rare cases, a person may lose all hair on their head (alopecia areata) or all hair on their body (alopecia areata universalis).

It is believed that a person’s genetic make-up and the virus or substance they come into contact with can trigger the autoimmune reaction of alopecia areata.

Ringworm is an unpredictable disease. For some people, hair grows back but then falls out again. For others, hair grows back and stays that way. Each case is individual. Even if a person loses all their hair, there is a chance that the hair will grow back.

How is ringworm treated?

Ringworm is not completely cured, but it can be cured and the person’s hair can grow back.

In most cases, alopecia is treated with drugs that are used to treat other conditions. Treatment options for ringworm include:

1. Corticosteroids: Corticosteroids are anti-inflammatory drugs prescribed for autoimmune diseases. Corticosteroids can be given by injection into the scalp or other areas, by mouth as a tablet, or topically (applied to the skin) as an ointment, cream, or foam. The response to treatment may be gradual.
2. Minoxidil: this topical drug is currently used to treat hair loss. It usually takes about 12 weeks of minoxidil treatment for hair to start growing.

Other medicines for alopecia that are more or less effective include medicines used to treat psoriasis and topical sensitizers (medications applied to the skin that cause an allergic reaction that can cause hair growth).

Living with ringworm

In addition to medical treatment, there are various cosmetic and protective methods that patients with alopecia can try. Here they are:

• Applying makeup to hide or minimize hair loss.
• Wear sunglasses to protect eyes from the sun and the environment (if lashes fall out).
• Use of various coverings (wigs, hats or scarves) to protect the head from external factors.
• Compliance with a balanced diet. Hair growth is a process dependent on vitamins and minerals.