Treatment of ringworm

Ringworm is a fungal infection of the skin, hair and nails that may be easily treated using antifungal creams, tablets and shampoo.

The difficulty of treatment lies in the fact that the infection reappears and is highly contagious and may spread to other persons before it is controlled.

Antifungal Skin lotions, gels, sprays, shampoos, powders and creams (1-5)

Antifungal shampoos used for scalp ringworm contain Selenium sulphide and ketoconazole.

Ideally, antifungal shampoo should be used twice a week during the first two weeks of treatment.

For ringworm infections of the body, hand, face, groin and foot over-the-counter antifungal creams, gels or sprays may help.

The antifungal preparation needs to be applied daily to the affected areas of skin for two weeks.

The cream, gel or spray should be applied over the rash and to 4 to 6cm of healthy skin beyond the edge of the rash.

For fungal nail infections antifungal nail paint may be used.

For skin that is inflamed, physicians may prescribe an antifungal cream combined with a mild steroid cream. This would normally be used for no more than seven days.

Skin lotions and creams contain agents like:

• Naftifine (1% cream or gel)
• Terbinafine (1% cream or solution)
• Butenafine (1% cream)
• Clotrimazole (1% cream, solution, or lotion)
• Econazole (1% cream)
• Ketoconazole (1% cream, shampoo)
• Miconazole (2% cream, spray, lotion, or powder)
• Oxiconazole (1% cream or lotion)
• Sulconazole (1% cream or lotion)
• Ciclopirox (1% cream or lotion)
• Tolnaftate (1% cream, solution, or powder)

Oral antifungal medications (1-5)

Antifungal medications include drugs like terbinafine and griseofulvin. Those with ringworm are prescribed terbinafine.

Tablets may be prescribed to be taken once a day for four weeks.

Common side effects include nausea, diarrhea, rashes and stomach upsets. Terbinafine should be avoided in people with liver diseases.

Griseofulvin works by preventing fungi from growing and multiplying. It is taken daily for 8-10 weeks. Common side effects include nausea, diarrhoea, headaches and indigestion.

Griseofulvin should be avoided in pregnant women and those intending to conceive as it may harm the unborn baby.

Griseofulvin is the only agent that the U.S. Food and Drug Administration (FDA) has approved for the treatment of tinea capitis or scalp ringworm.

Terbinafine may also be used in scalp ringworm.

Another oral drug for ringworm infection includes Itraconazole. It is available as capsules for seven or 15 days.

Itraconazole cannot be given in children, elderly people or those with severe liver disease.

Common side effects include nausea, indigestion, headache, diarrhea etc. These are mild and go away when drugs are stopped.

An alternative oral drug that can be used includes Fluconazole. It is prescribed to be taken once daily for 4 to 6 weeks.

Nail infections are particularly difficult to cure and may require oral drug therapy for 12 months to 24 months.

Prevention of spread of ringworm

Prevention of spread of infection is a key part of ringworm management. Since the infection is spread by contact, good hygiene and care to avoid person to person contact helps.

Some ways to prevent spread include (1) –

• Avoiding sharing personal items, such as combs, hairbrushes, shoes, socks, towels, clothing and bed linen
• Regular washing of bed linen, pillow cases and towels in hot water and detergent
• Regular and frequent hand washing
• Avoiding scratching the infected lesions to prevent spread to other parts of the body
• Checking pet animals for infections and treating them
• Isolation of the infected person by avoiding school or work to prevent spread.

Further Reading

What is ringworm? 
Ringworm Causes
Ringworm Symptoms
Ringworm Diagnosis