A ringworm infection, contrary to what the name suggests, is actually caused by a fungus rather than a worm. The condition begins to manifest with the appearance of circular or oval spots with a smooth center and a red scaly outline that gradually expands. These ring-like patches generally grow to about 1 inch in width and can appear in different parts of the body.
The infectious pathogen, or fungus, also known as a dermatophyte, thrives in areas that are prone to excessive perspiration, such as the scalp, groin, buttocks, feet, legs, and particularly the upper thighs, and it can event affect the hands and nails.
The generic medical name for this ailment is dermatophyte or tinea infection. However, it is known by many different names based upon the site of involvement. For instance, when the patches appear in the pelvic area, the upper thighs, and buttocks, it is referred to as a jock itch.
Similarly, the infection is termed as tinea cruris or athlete’s foot if it affects the feet, and tinea unguium or onychomycosis if it grows on the nailbeds. It is called tinea capitis when it occurs on the scalp.
While the problem is common in adults, kids are also prone to this type of infection.
As ringworm is highly contagious, prompt treatment is required, and children may need to be kept at home and away from parks and school.
Causes of Ringworm Infection in Kids
Kids can pick up the ringworm infection in a variety of ways. It may be through:
- The use of public pools and showers, as the disease-causing fungi thrive in moist, warm areas.
- Spending time with infected pets
- Playing in contaminated soil
- Touching the affected site and then any other area of the body
- Direct skin-to-skin contact
- Shared objects such as combs or brushes, towels, clothing, and sports equipment
Signs and Symptoms of Ringworm Infection
The characteristic symptoms of ringworm in kids start showing 4 to 10 days after initial exposure and include the following:
- The appearance of round ring-like lesions at the infected site that gradually increases in size.
- Smoothening of the center of the patch as it grows in size, with a red, raised, and scaly border.
- Patch that generally stops growing once it reaches 1/2 to 1 inch (12–25 mm) in diameter.
- Loss of hair in the infected area, especially on the scalp, resulting in bald patches.
- Rings usually appearing on one side of the face or body.
- Mildly itchy skin.
- Vesicles or pus-filled sores may develop due to the immune system’s amplified response to the infection or if the infection grows deeper in the skin, affecting the hair follicles.
- In the case of infected nails, the infection can affect one or more nails, which may become brittle and appear thick, white, or yellowish.
- There are several sub-types of athlete’s foot. It can present as itchy, fissured patches between the toes that are unlike the usual ring-shaped lesions, as moist white patches between the toes, or as scaly pink patches or plaques on the bottom of the feet or in a moccasin-type distribution.
- The most common site of infection in children is the scalp wherein the condition may start off as a small pimple that expands into an itchy, dry, and balding patch, which can have black dots due to the broken-off hair just below the dermis, fine scaling of the dry skin, or even thickened and yellow-crusted blisters.
- The infected scalp may become red, swollen, and tender. The lymph nodes may be swollen, too.
Risk Factors Associated with Ringworm Infection
The following factors make children increasingly susceptible to developing a ringworm infection:
- If the child lives in a warm, damp climate
- If the child’s immune system is compromised due to a recent illness or any ongoing medication
- If the child has poor hygiene
- If the child uses a shared bathroom or locker rooms
- If the child is malnourished
- If the child has had contact with other infected children or pets
- If the child plays contact sports such as wrestling
Complications with Ringworm Infection
Two of the known complications of ringworm are:
- The itchy lesions and affected skin may become secondarily infected with bacteria due to incessant and rigorous scratching
- Other skin disorders that warrant additional treatment
How to Prevent Ringworm Infection
The following preventive measures can help your child from getting infected:
- Keep your child from coming in contact with an infected person or pet.
- Make sure that your child wears flip-flops or any appropriate footwear instead of walking barefoot in communal showers, locker rooms, or pool area.
- If your child is involved in contact sports, make sure he/she showers after every practice session.
- Instill proper sanitary habits in your child, and instruct him/her to thoroughly wash his/her hands after playing with pets. Moreover, regularly sanitizing the hands by washing them with soap and drying them well thereafter is a habit that everyone should follow in their general lives.
- Don’t make your child wear tight-fitting clothes. Instead, opt for sizes and textures that allow their skin to breathe.
- Wash your child’s sportswear thoroughly and regularly and avoid sharing them.
- Make sure your child showers and has a change of clothes daily. Washing and drying the child’s skin completely after showering, swimming, and sweaty activities are perhaps some of the most basic steps towards preventing such infections.
- Ensure that the child’s towels, clothes, and bed linen are washed often with hot water and properly dried thereafter.
- Refrain from sharing your child’s clothing, towels, combs, brushes, and hats with others, and advise your child against it, too.
- Seek prompt treatment for an infected pet in the house,
- Change wet underwear and socks right away.
- Keep children’s skin and nails clean, and wash their hands with soapy water to help prevent ringworm.
- From time to time, wear open-toed or loose shoes to allow air to circulate around the feet.
- Avoid sharing clothing, towels, or bed linens with a person who has a ringworm infection.
- Take infected pets to a veterinarian for immediate treatment to prevent the spread of infection to your child.
In conclusion, maintaining proper hygiene is by far the most foundational and effective step against the occurrence and spread of ringworm infection. The World Health Organization recommends it as a potent preventive measure. You need to keep your child’s skin clean and dry, shampoo their hair regularly, and avoid sharing personal-care items with others.
When to See a Doctor
If your child shows signs of being infected, it’s best to seek your doctor’s help to figure out the best course of treatment. Most ringworm infections resolve with the use of certain over-the-counter antifungal medications, which can be in the form of a cream, gel, or spray depending upon the site of occurrence.
In the case of nail or scalp ringworms, the doctor may prescribe oral medication for several weeks (usually 4-12 weeks). If the symptoms fail to subside despite sticking to the prescribed course for 2 weeks, another visit to your healthcare provider is warranted.
Also, if your child has recently come out of an illness or is on medications that may have weakened his/her immunity, prompt medical diagnosis and treatment are all the more necessary.
It is well advised to seek medical help if you notice any of the following symptoms in your child:
- Appearance of bald patches on the affected scalp
- Development of painful sores on the infected site
- Occurrence of several ringworm sores on your child’s scalp or body
- A stubborn rash that shows no improvement even after a week’s treatment
- A rash that begins to grow in size or start spreading to other parts of the body
Treating Ringworm Infection
The fungi responsible for a ringworm infection feed on dead keratin, a protein in the top layer of the epidermis that is also found in the hair and nails. These dermatophytes can survive indefinitely on the skin, and thus, there is always a chance of recurrence of infection.
The primary treatment or treatment for a recurrent episode of your child’s infection is determined on the basis of the type and severity of the symptoms as well as your child’s age and general health.
Mild cases of ringworm are usually treatable with topical application of certain antifungal creams, gels, or ointments and the administration of over-the-counter drugs. However, in more stubborn cases where the infection is resistant to such primary treatment, particularly when the nails and scalp are affected, the doctor may prescribe a stronger oral medication.
Because children often develop a ringworm infection of the scalp, the stipulated treatment typically includes the following:
- Antifungal medicine is taken orally for 4 to 8 weeks. However, in some cases, the child may have to stick to the medicinal course a little longer.
- Special antifungal shampoos work as an effective adjunctive treatment to help get rid of the fungus in addition to the prescribed oral medication.
- Moreover, if your child develops a kerion or a secondary sore (abscess) or bacterial infection, additional medicines including steroids may be ordered by the doctor to bring down the associated swelling.
What Happens If the Ringworm is Left Unchecked?
Fungal infections are often uncomfortable and cause irritating symptoms that are often unpleasant to look at. It can also be quite itchy. While adults are capable of taking all the associated trouble in their stride, the same doesn’t hold true for your impressionable young ones.
Bald, sore-ridden patches on your child’s head or the itchy, flaky discolored patches anywhere else on the body can be quite unsettling for your little one. Prompt professional help can expedite recovery.
Moreover, if the symptoms are not attended to in a timely fashion, the skin can become increasingly irritated and painful. The condition might exponentially worsen if the skin blisters and cracks become infected, which can only be cured by antifungals.
Plus, there’s always the risk of the infection transmitting and spreading from the initially affected site to other parts of the body, including the feet, nails, scalp, and beard.
Can the Children Go to School With a Ringworm Infection?
Given that ringworm is extremely contagious and can spread through both direct and indirect contact, it’s best to keep your child away from other kids to minimize the chances of transmission.
However, in the case of mild fungal infection, the child may be allowed to attend school but only after instructing him about appropriate precautionary and preventive measures that entail maintaining a good level of personal hygiene and a strict policy of not sharing his/her things with other students.
Also, the child’s teachers should be kept in the loop to monitor his/her activities.
How Long Does it Take a Ringworm Infection to Go Away Completely?
Although a ringworm infection can resolve on its own in the absence of treatment, the recovery period is often prolonged, lasting several months. Such a casual approach is not advised, as the infection can become chronic if not attended to properly.
Ringworm symptoms in mild cases usually subside in 2-4 weeks’ time, given adequate precaution and treatment. In severe cases, however, the treatment period may extend to 3 months. This is especially typical for nail or scalp ringworm that is often resistant to traditional medicine and therapy.
Over-the-counter fungal creams, powders, and lotions are available to treat the infection. However, you can also use some simple home remedies to get relief from itching and inflammation.
Tips and Remedies to Get Relief from Ringworm Infection
Here are some home remedies to treat ringworm in kids.
1. Apply Lavender Essential Oil
Lavender essential oil exhibits potent antifungal properties that can arrest the growth of the ringworm fungus. Not only does it target and eliminate the disease-causing agent, but it also helps alleviate the associated discomforts such as itching, inflammation, and skin discoloration.
- The recommended remedial concoction for babies up to 12 months of age is only 1 drop of lavender essential oil diluted in 1 teaspoon of jojoba carrier oil.
- As for children over a year old, you can dilute 2 drops of lavender essential oil with 1 teaspoon of jojoba carrier oil.
- After mixing the essential oil with the carrier oil, stir the mixture gently and apply the solution with a Q-tip or cotton swab onto the affected site three times a day.
You can also use calendula or lemongrass oil for children 5 years or older.
2. Use Tea Tree Oil Topically
You can also use tea tree oil to treat ringworm in kids. This essential oil has an antifungal activity that will fight the fungus that is at the root of the problem. It also relieves itching and inflammation when applied to the infected area.
A 2003 study published in the Journal of Applied Microbiology reports that most components of tea tree oil display potent activity against a range of fungi.
This claim is further supported by another 2006 study published in the Clinical Microbiology Reviews, which also highlights the antifungal activity of tea tree oil.
It is, however, important to bear in mind that tea tree oil should only be used topically, and oral consumption is strictly prohibited.
- Put a few drops of tea tree oil on a cotton ball and dab it on the affected areas.
- Repeat this application two or three times a day for 1 week or so.
Alternatively, you can do the following:
- Dilute tea tree oil in an equal amount of coconut oil.
- Apply it on the affected skin.
- Use this treatment once daily.
Caution: Take extra precautions that your child doesn’t ingest any tea tree oil by putting their mouth anywhere near the rash. Also, it is advisable to conduct a patch test using only a drop of this oil on your child’s skin. Because tea tree oil is known to be slightly volatile, this patch test will help you ensure that it’s not too harsh for your child’s sensitive skin and does not cause any adverse reaction.
3. Moisturize Your Skin With Coconut Oil
Coconut oil is another good remedy that you can try at home for banishing a ringworm infection. The fatty acids found in coconut oil help kill the disease-carrying fungi by damaging their cell membranes.
Moreover, its moisturizing property helps reduce the itchiness in the affected area and promote the healing of the lesion-ridden skin.
A study concluded that coconut oil should be used in the treatment of fungal infections in view of its effectiveness against drug-resistant Candida species.
A study published in the Natural Medicine Journal highlights the topical anti-infective properties of coconut oil due to the medium-chain fatty acids it contains.
- For topical use:
- Apply extra-virgin coconut oil directly on the infected areas.
- Massage the area for a few minutes. Leave the oil overnight, and then wash it off the next morning.
- Do this daily before going to bed.
- For consumption: Include extra-virgin coconut oil in your child’s diet. Start with 1 teaspoon and gradually increase the dosage up to 1 tablespoon daily.
4. Smear Garlic Paste On the Affected Area
Garlic works as a natural antifungal agent and can help treat different types of fungal infections, including ringworm in kids. Its antifungal properties help stop the growth of the fungi and provide relief from the itching.
A study published in the Iranian Journal of Basic Medical Sciences revealed that while pure allicin (active component of crushed garlic) is more efficient in the inhibition of the growth in hyphal cells (building blocks of the branching filamentous structure of the fungus) compared with garlic extract, both could be used as alternatives in treating dermatophytosis (ringworm).
Another study published in Avicenna Journal of Phytomedicine further confirms this antifungal activity of garlic.
For topical use:
- Make a paste by blending two or three crushed garlic cloves with some olive or coconut oil.
- Apply a thin layer of the paste on the affected skin and cover the area with gauze or a bandage.
- Leave it in place for up to 2 hours before rinsing it off.
- Repeat twice daily until the symptoms resolve.
Alternatively, you can do the following:
- Apply garlic oil on the affected areas.
- Wait for 20 minutes, and then wash it off.
- Repeat once daily for a few weeks.
For consumption:
- Try to include garlic in your kid’s diet, too.
Caution: Garlic can be irritating to the skin and cause a rash.
5. Licorice Solution
Licorice, a common herb used in traditional Chinese medicine, has strong fungicidal compounds and can be used to treat fungal infections such as ringworm.
According to a study published in 2015, licorice has potent antiviral, antimicrobial, anti-inflammatory, antitumor, and other activities that make it a worthwhile candidate in the treatment of infections such as ringworm.
For topical use:
- Pour 1½ cups of water into a saucepan, and add 5 or 6 teaspoons of licorice root powder to it.
- Bring it to a boil, and then let it simmer for another 20 minutes.
- Strain it and allow the solution to cool down.
- Soak a cotton ball in the liquid and dab it on the affected area.
- Leave it on for at least 10 minutes, and then rinse it off with lukewarm water.
- Repeat this routine two or three times a day.
6. Soothe Your Skin With Indian Lilac
Indian lilac, also known as neem, is rich in antifungal properties that help treat ringworm in kids. It helps prevent the fungus from spreading and also provides quick relief from the symptoms.
A study published in the Brazilian Journal of Microbiology reports that 20 percent ethyl acetate extract from neem leaves has the strongest inhibiting effect against the culpable pathogen in comparison with the activity demonstrated by the same concentration of other extracts from neem leaves.
Another 2014 study published in the Brazilian Journal of Oral Sciences also highlights the antifungal efficacy of neem extracts.
For topical use:
- Apply neem oil on the affected areas two or three times a day until the infection clears. You can rinse the oil off your skin after 30 minutes of application.
- Alternatively, combine equal parts of neem leaf paste, turmeric powder, and sesame oil. Apply this paste on the affected areas and leave it on for 1 hour. Rinse it off with lukewarm water and pat dry the area thoroughly. Repeat twice daily until the infection has cleared.
7. Reduce Itchiness With Aloe Vera Gel
Aloe vera is celebrated for being a skin restorative balm since ages and is used as an effective natural healer for a number of fungal infections including ringworm. It helps fight the cause of the infection and palliates the associated symptoms of itchiness, inflammation, and discomfort.
According to a 2008 study published in the Indian Journal of Dermatology, aloe vera contains six antiseptic agents: lupeol, salicylic acid, urea nitrogen, cinnamic acid, phenols, and sulfur. Each of these compounds has shown significant inhibitory action against the various kinds of disease-causing pathogens: fungi, bacteria, and viruses.[15]
For topical use:
- Cut open a leaf from an aloe vera plant.
- Scoop out the gel and apply it directly on the infected area.
- Wait for 30 minutes, and then wash it off with warm water.
- Repeat twice a day.
8. Use Oregano Oil to Combat the Infection
Oregano oil is another good remedy for fungal skin infections. Potent components of oregano oil, such as carvacrol, display impressive antifungal powers that can be optimized for the treatment of a ringworm infection.
This is further corroborated by a 2001 study published in Molecular and Cellular Biochemistry, which highlights the efficacy of oregano oil for combating fungal infections.
When used topically for ringworm, oregano oil can give positive results rather quickly.
- Mix 2 or 3 drops of oregano oil in 1 tablespoon of olive oil.
- Apply it on the infected areas.
- Leave it on for 20 to 30 minutes. You do not need to rinse it off.
- Do this two or three times a day.
9. Grated Turmeric Juice
You can also use turmeric to treat ringworm in children. It has powerful anti-inflammatory and antifungal properties that help relieve the symptoms and kill the fungus that is at the base of the problem.
Moreover, turmeric is also good for boosting your child’s immunity.
For topical use:
- Extract the juice from grated, raw turmeric root.
- Apply the juice on the ringworm 2 or 3 times a day until the infection clears.
- Leave the juice on your skin for at least 30 minutes before rinsing it off.
Alternatively, you can do the following:
- Mix ½ teaspoon of turmeric powder with enough olive oil to form a paste.
- Apply it on the affected areas.
- Cover the areas with a bandage or gauze.
- After 1 to 2 hours, rinse off the turmeric paste and reapply it.
- Do this a few times a day until the infection is gone.
For consumption:
- Add 1 teaspoon of turmeric powder to a glass of warm milk. Give it to your child to drink twice daily.
Anecdotal Remedies
Although these remedies lack enough scientific evidence, they have nevertheless gained popularity due to word of mouth given their considerable beneficial effects against ringworm.
1. Apple Cider Vinegar
Apple cider vinegar has demonstrated infection-fighting prowess against species of fungi given its rich content of natural acids and probiotics.
- Before topically applying this or any healing potion, it is very important to effectively clean the affected area.
- Soak a cotton ball in undiluted apple cider vinegar, and dab it on the affected skin.
- Apply this remedy three times a day for maximum benefits.
2. Colloidal Silver
Colloidal silver is a great nonmessy option to promote natural recovery from a ringworm infection. This clear and odorless remedial agent has been touted as an effective germicide for many years, and what makes it even more appealing is the fact that it engenders no side effects.
- Topically apply some colloidal silver by spraying it onto the affected site.
- Let it sit until it dries on its own.
- Repeat this application twice or thrice daily until the infection subsides.
3. Grapefruit Seed Extract
Another potent natural antifungal remedy that surfaced due to anecdotal support is the use of grapefruit seed extract for healing cases ringworm.
- Mix 1 to 3 drops of grapefruit seed extract with 1 tablespoon of water.
- Apply the concoction on the affected area two to three times a day until you see improvement.
4. Plain Yogurt
Much of the effectiveness of yogurt in combating fungal infections is due to the presence of live active cultures in it that mitigate the growth of the fungi. The inherent probiotics or good bacteria in yogurt promote gut health by lining the digestive tract and enhancing the absorption of vital nutrients from food. All these work in favor of a bolstered immunity, which in turn helps keep infection at bay.
5. Salt Water
Salt water, especially the kind that has Epsom salt in it, works as an excellent astringent that sucks in the moisture that the fungus might be thriving on. Moreover, this solution also helps disinfect the affected skin and promotes faster healing of the wounds.
- Mix ¼ cup of Epsom salt in 1 cup of warm water.
- Soak the affected area in salt water. Repeat this remedy regularly for optimal effects.
- Alternatively, you can apply sea salt paste on the infected skin.
Tips
- You can use an over-the-counter antifungal cream or powder, two or three times a day for a few weeks.
- As ringworm is very contagious, make your child stay away from close contact with other children until after they begin treatment.
- It is advisable to keep the ringworm covered with a bandage to prevent the infection from spreading to other parts of the body.
- You can also soak a cotton ball or cotton swab in a 2 percent iodine solution and dab it on the affected areas two or three times a day for a few weeks.
- Build your child’s immune system to help fight the infection by giving them foods rich in vitamin C and D, and zinc.
- Avoid foods such as sugar, cheese, bread containing yeast, and chocolate.
- Prepare some carrot and spinach juice in the ratio of 3:2 and give a glass of this juice to your child to drink.
Expert Answers (Q&A)
Answered by Dr. Amy Spizuoco, DO (Dermatology)
How can we differentiate between a ringworm patch and a common skin rash?
The difference between ringworm (dermatophyte infection) and a common skin rash, is that ringworm will have what we call “central clearing.”
Meaning it will be red and scaly only at the periphery and the center of the ring will appear like the normal skin.
What is the most common cause of contracting ringworm?
The most common cause of contracting ringworm is from a type of fungus (dermatophyte) that can infect the skin, hair, and nails. It commonly appears from contact from another host, which can be another human or even a pet. And this type of fungus thrives when there is too much moisture on the skin for an extended period.
What are the common symptoms of ringworm?
A ringworm patch is characteristically itchy. It has a few other distinguishing features:
- It is scaly
- It has reddish hues
- It appears in the form of a ring
Can antifungal medicines be used to treat ringworm without consulting a doctor?
Most over-the-counter antifungal creams and powders can be effective in treating ringworm, but most patients don’t use the medicine appropriately.
For example, the medicine needs to be applied twice daily, the skin needs to be kept dry, and you need to continue applying it to the affected area for at least a week more, even though the patch seems to have resolved.
This is because the microscopic fungus is not visible to the naked eye, and can still be present despite the disappearance of the rash and other noticeable symptoms.
Does hair grow back on the infected area after ringworm has been cured?
Once the fungus is cleared, the affected skin will go back to normal. So, any lost hair in the area will return.
Which food items should be recommended to a person suffering from ringworm infection?
People suffering from ringworm infection are usually advised to consume a low sugar/carbohydrate diet.
What precautions should be taken to keep ringworm infection from spreading to other body parts?
Keeping the skin dry and not scratching the area and touching other body parts thereafter is the best way to keep it from spreading.
Can ringworm be cured without any treatment?
It’s not unheard-of for ringworm to go away without being treated, but considering the possible complications that could arise due to non-treatment, I would certainly not recommend that to anyone.
What will happen if ringworm is not treated?
Ringworm will typically keep growing on the skin if not treated. It can infect hair follicles and cause a condition called Majocchi’s granuloma which can become very painful.
Worst case scenario, the infection can penetrate into the bloodstream and cause sepsis, which means that the infection will spread to your internal organs via blood flow, and can even lead to death.
It can also infect the toenails and fingernails and cause a condition called onychomycosis. This condition typically requires an oral medication, whereas ringworm is treated with topical medications.
Can ringworm lead to other skin ailments also?
Majocchi’s granuloma is the most common result of non-treatment, but most patients will find their ringworm will not cause further complications if handled in a timely fashion.
About Dr. Spizuoco: She is a dermatologist at ‘Bobby Buka MD Dermatology‘ in New York City. A doctor of osteopathic medicine, Dr. Spizuoco brings a unique, holistic approach to dermatology, taking neuromusculoskeletal (NMS) systems into account when treating patients.
Dr. Spizuoco trained under leading specialists at the Mayo Clinic Scottsdale as well as the Phoenix Children’s Hospital. Today, she is a member of various trade groups (such as the American Society of Mohs Surgery), and an Assistant Clinical Professor at Mt. Sinai-Beth Israel Hospital.