One of the most distressing skin conditions for parents and daycare providers is ringworm. It looks and sounds awful, but is actually a very common, benign, and treatable skin condition in children and adolescents. Despite the name, ringworm is caused by a fungus, not a worm, and can be transferred from pets, soil, combs, hair accessories and other children.
What does ringworm look like?
Ringworm can affect the body (tinea corporis), scalp (tinea capitis), or nail (tinea unguium). On the body or face, ringworm will often appear as a ring shaped pink patch with a scaly, raised border. The center of the patch may clear as it becomes bigger. Sometimes the patch is itchy. A skin condition called nummular eczema looks very similar to ringworm. Nummular eczema is just a patch of dry skin that may appear pink or scaly but there is no raised border or central clearing. This type of eczema usually responds well to heavy moisturizers and/or hydrocortisone cream.
On the scalp, ringworm usually looks like round scaly patches that slowly increase in size. Usually, the patches will look grayish and sometimes hair is lost in that spot. Some children will develop tender little scabs with pus called “kerions” on the scalp. If you see large dry patches on the scalp without hair loss or discoloration, you may dealing with dry scalp or seborrheic dermatitis. Dry scalp will respond to anti-dandruff shampoos (generic Nizoral is a great one) and moisturizing conditioners. When ringworm affects the nail, there is usually a thickened area under the nail that may be discolored. Eczema or sensitive skin may look similar.
How do I treat ringworm?
Ringworm on the body is treated with over-the-counter antifungal creams. Our favorite antifungal to recommend is Lamisil (or generically Terbinafine). Apply the cream 2-3 x /day for 7 days. For best results, continue the treatment for a few days after the patch seems to be gone.
Ringworm of the scalp requires a special medication taken by mouth (Griseofulvin) because topical preparations cannot penetrate the scalp and get into the hair shaft where the fungus is. Treatment is daily for 4-6 weeks. Depending on the severity of the ringworm, we may also recommend an antifungal shampoo. It is unnecessary to get a haircut or shave the head because of ringworm. Hair loss is normal with ringworm and is not permanent. Hair will grow back with treatment although it may take several months for complete recovery. Please make an appointment if you think your child has ringworm of the scalp. Ringworm of the nail should also be evaluated in the office and treatment recommendations will be made at that time as both topical and oral medications have been used successfully.
How contagious is ringworm?
Ringworm is mildly contagious because it requires direct skin contact. If ringworm is on the body, your child can wear long sleeved shirts or pants to reduce contact with others or simply cover the exposed area with a bandage. Your child is not contagious once he or she has started the Griseofulvin or applied the antifungal cream for 24 hours. Your child should not miss school or day care because of ringworm.
Do I need to treat my pets?
If your cat or dog has ringworm patches or if your child has repeated episodes of ringworm, you should contact you vet.