Ringworm Treatment

Dr. Greene, my little sister has a ring worm, whatever that is, on her leg right underneath her buttocks. We took her to the doctors and they said to use Tinactin cream. Does this sound right?? I’ve never heard of using a cream for ring worms — friend of mine said they were put on antibiotics — plus if it’s not inconvenient, may I get a little information on what exactly a ring worm is, and how you pick them up??? They said she probably picked one up in the grass at one of our BBQ’s, is that possible??? Thank you very much for reading my question, I’m just a very protective and concerned big sister. God Bless!

P.S. Thank you very much for having this (Dr.Greene’s HouseCalls). I’ve gone through about what seems like a thousand topics and I’ve learned a lot, hopefully someday I too will become a pediatrician. (In about 10 years, not too bad eh??) Once again, Thanx a million!!!!!!!
Sincerely, Pearl C. – 14 years old – O.C., California

Ringworm Treatment

Dr. Greene`s Answer:

Pearl, you sound like an awesome big sister! Your little sister is really lucky to have someone like you watching out for her and helping her to learn about her own health. Taking her to the doctor AND making sure you understand the truth yourself is a winner combination. It sounds to me that you really are on the road to becoming a great Pediatrician.

Infections by worms have been recognized since antiquity. Treating some of these infections was among the few notable successes of early doctors. Physicians adopted as their professional symbol a staff encircled by two worms. This symbol, the caduceus, is used to this day.

One of the more obvious worm infections was one which we today call cutaneous larva migrans. As the worms travel through the body just under the skin, scaly red lines mark their paths. These lines are actually inflammatory reactions to the worms.

A very similar skin finding, with raised scaly rings instead of straight lines, was also noted in antiquity.

This infection came to be called ringworm, since the worms apparently traveled in laps around a short circle, rather than in a wandering line. Ringworm typically lasted several months and then, thankfully, resolved on its own. The infection was known to be mildly contagious, but the worm itself was never seen. It was a great mystery.

Some people thought that the ringworm skin lesions looked rather like the holes made in garments by moths — flat in the center, with a raised border. During the Middle Ages physicians began calling this infection tinea, the name of a common family of moths. Physicians added a descriptive word to the name to specify where on the body the infection was located: ringworm infections on the head were called tinea capitis, on the body tinea corporis, on the feet tinea pedis. They also had specific names for the same infection found in the groin, armpit, facial hair, or nails.

It was not until 1837 that the true cause of ringworm was found. A Polish physician looking at scrapings from the skin of people with ringworm identified a fungus (that he then massaged into his own arm!). Over the next several years, a number of investigators proved that what we call ringworm is always a fungal infection. This was the first time that any microscopic organism was ever proven to cause human disease. It has no connection at all with worms, other than the similar appearance of the skin lesions.

Fungi are tiny plants that survive by eating plant or animal material. The ringworm fungi feed on keratin — the material found in the outer layer of skin, hair, and nails. These fungi thrive best on skin that is moist, hot, and hidden from the light. When this infection is found on the feet, it is commonly called athlete’s foot; when it is found in the groin it is commonly called jock itch; and when it is found on the body it is still called ringworm. Up to 20 percent of the population has one of these infections at any given moment.

Ringworm is very mildly contagious. It can be caught from domestic animals (especially dogs and cats) as well as most farm animals. The infection can be caught from the animal directly, or from anything the animal rubs against (yes, Pearl, your sister could have gotten it from playing on the ground at the BBQ). Ringworm can also be caught from other humans, both by direct contact and by prolonged contact with flakes of shed skin (from sharing clothes or from house dust, for instance). Wrestlers commonly spread it back and forth with their sweaty contact (tinea gladiatorum!).

To catch ringworm, you have to be exposed to it and you have to be susceptible. Some people are much more susceptible than others. Those with eczema or other skin problems get ringworm more easily because the protective barrier of the skin’s outer layer is less intact. Children are more susceptible before puberty. Boys get it more easily than girls. Some people are genetically predisposed, and can get it easily throughout life (like me!).

The treatment for ringworm is one of the many effective topical antifungal creams, such as miconazole (Tinactin) or clotrimazole (Lotrimin). Several of these antifungal creams are now available without a prescription. Treatment may require several weeks. Only by treating for at least one week after the resolution of symptoms (and for a total of at least 4 weeks) can one guarantee eradication. (Pets can be treated with the same medicines, but this is difficult, since they often don’t get a rash with their infections. Contact your pet’s veterinarian to get up-to-date information on the best treatment for animals). As soon as treatment has begun it’s fine for her to play with others, but it’s best not to share clothing or to let other children rub the patch of ringworm.

Rarely, when ringworm of the body is resistant to topical therapy, we use oral antifungal medications for about one month.

When ringworm is found in the nails or on the scalp the infection is much more difficult to eliminate. Prolonged treatment with a prescription oral anti-fungal medicine (as well as other topical medicines) is usually necessary. Scalp ringworm is a major cause of hair loss, and should be treated aggressively.

Pearl, I expect that your sister’s patch of ringworm on her leg will clear up with the Tinactin. In the meantime, thanks for watching out for her!

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Tom

    Doc I need help? The first ringworm I had was several years ago and the doctor I was seeing then did not know much about it so he looked it up in a big book. The treatment was to take some pills for women yeast infection. It had a starter dose and then one pill a week for six weeks and it cleared it up no problem. Now that the doctor has moved out of town and I can’t see him. I have a large ringworm on my leg and others on my butt . The doctor I see now says use LAMISIL cream so I did for three months and no help as they got bigger. The next visit he says to try LAMISIL pills for two weeks. No help. Now he wants me to try a prescription cream (Hyrocortisone cream 2.5%) four times a day. Do you know had hard to come in and drop your pants four times a day to apply cream.
    Any help you can give me would be greatly appreciated.
    Thanks Tom.

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  2. Joe

    Hi I believe that I have ringworm. Until recently doctors couldn’t detect exactly what’s going on, but around April of 2014 it was a tiny dot just under the size of a dime on my right cheek and progressively throughout the month. It has grown to be the size of about 3 quarters (awkwardly). But it has also spread to the beginning of my scalp across my lining, at the starts of my eyebrows, on both sides of my nose and and now I see that same dot that I had last year of April on my opposite cheek and it’s really getting to me now. My confidence was holding up pretty good, but the more and more it grows the more hopeless I become. Please help me out Doc. I don’t know what to do.

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  3. patrick

    Hi Doc. I have a problem with ringworm on my buttocks the upper cheek and it’s the third time, so I don’t know what to do.

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  4. Arpita Mohanti

    I m 25 years old and facing this tinea infection problem for the last year on my intimate area. It’s being very irritating and growing day by day. I want a permanent solution. Please help me out. I will be very thankful.

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  5. patience temah

    Please I need help. I have a ten years old adopted son in Africa whom I have been taking care of from birth. He has this fungal infections on the head for five years. The it has not responded to the treatment he has been having. He still suffers. Please I need an effective treatment for him. Please help, please Dr Greene.

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    • Anon

      For an over-the-counter remedy for ringworm in your hair, try Selsun Blue shampoo, or any other shampoo with selenium sulfide as the active ingredient. It works slowly, but will help get rid of fungal scalp infections. You should also try taking your son to a different doctor, if your present doctor is not helping you. But do try the Selsun Blue. I caught ringworm in my scalp from some kittens we were raising, and this shampoo got rid of it. Best of luck!

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  6. Michaela

    I have a ringworm on my arm. How do I get rid of it? And I need it gone fast my dance is on Saturday

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    • Larry

      I have a ringworm on my arm. How do I get rid of it?

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  7. Liz

    Dr, I have ringworm. I been applying Ketaconozole cream 3 times at day for 6 weeks and drinking one pill of flu console 150 mg for 5 weeks. aI still have it. I don’t have insurance right now. What should I do?

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  8. Sunita Gurung

    Dear doctor,

    I have a severe problem of itchiness above my thighs and under my buttocks areas. There are red spots like ringworms and are very itchy. I have treated it with several medicines like sonaderm and terbiderm but the spots disappears for few days and apprears back again. Please help me cure this disease suggesting some best medicines. Hoping for your positive response.

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  9. Annie

    i have a cluster of red holes on my breast. They are itchy and are eating a hole through my skin. They have been there for 2 weeks. Also I have pimple like holes on my bottom cheeks. They don’t itch but nothing is in them. I will pick them and they just leave scares and will not go away. What do you think this is ??

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    • MAC

      Please go to an oncologist. That sounds like a type of breast cancer that my mom had.

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  10. Mr Fixit

    Can a heat rash turn into ring worm

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  11. Doree Hay

    Is lamisil a good treatment for my son’s ringworm. He is seven years old.

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