Is My Rash Ringworm or Something Else?


A ringworm rash on the inside of someone's arm.
Summary
  • Around one in five people will have a fungal infection in their lives.
  • Ringworm is a type of fungus that can infect a range of areas on your body.
  • Treatments include topical antifungal creams and prescription oral antifungal medications. The treatment you need will depend on which area of the body is infected.
  • The key to preventing a ringworm infection is good personal hygiene.
  • There are a number of conditions that could be misdiagnosed as ringworm, which highlights the importance of a proper diagnosis.

Ringworm is a type of contagious fungal infection that can cause a variety of different conditions depending on the area of the body that is infected. There are around 40 different species of fungi that can cause ringworm.

While a ringworm infection is typically treatable and rarely leads to severe illness, it can cause some physical discomfort.

According to the American Family Physician (AFP), one out of every five people will have a fungal infection at some point in their life. Despite how common the condition is, it still makes many people feel self-conscious.

This article will cover everything you need to know about ringworm, including the causes, treatments, and prevention.

We'll also take a look at other conditions that may resemble ringworm.

What is Ringworm?

Ringworm — which is also known as dermatophytosis or tinea — is a common skin infection caused by fungi.

It's known as ringworm because of the red circular or ring-shaped rash that forms on the skin of the infected area.

Anyone can be infected by ringworm and symptoms are generally mild, but it may be more severe in individuals with a weakened immune system. These individuals may also struggle to fight off the fungal infection.

Depending on which area of the body gets infected, ringworm can go by other names such as athlete’s foot or jock itch.

What Causes Ringworm?

You may not like to think about it, but your skin is home to millions of bacteria, viruses, and fungi, and this careful balance of skin microorganisms plays an important role in protecting your skin.

But sometimes this balance is disrupted and unhelpful fungi invade the skin — this can cause infections.

The group of fungi responsible for a ringworm infection is called dermatophytes.

Key Point: What Are Dermatophytes?

Dermatophytes are a type of fungus that requires keratin for growth.

Keratin is the protein that your hair and nails are made of, and it is also found on the outermost layer of the skin.

These organisms can live on a person’s body indefinitely and never cause an infection. When an infection happens, it’s often due to a weakened immune system.

How Do You Catch Ringworm?

Every day you could be exposed to dermatophytes since they are found on people, objects, animals, and in the soil.

You are more at risk of contracting a ringworm infection if you:

  • Use public showers, swimming pools, and locker rooms.

  • Walk barefoot in public areas.

  • Engage in close-contact sports such as wrestling or football.

  • Work closely with animals or have pets such as dogs and cats. Farm animals such as goats, pigs, lambs, and horses commonly transmit ringworm to humans.

  • Work with soil.

  • Share items such as razors, nail clippers, clothes, and towels without properly washing and disinfecting them.

What Are Some Ringworm Risk Factors?

Once you’ve been exposed to dermatophytes, they need a warm, moist environment to grow and cause infection.

This is more likely to happen if you:

  • Are overweight and have excess skin that traps moisture

  • Wear non-breathable tight-fitting shoes or clothes

  • Live in a tropical or humid climate

  • Have poor personal hygiene

  • Sweat excessively

How to Prevent a Ringworm Infection

Ringworm infections are easy to prevent if you follow some simple habits:

  • Practice good personal hygiene. Bathe and shower regularly, and make sure to dry your body thoroughly before putting on clothes and shoes.

  • Disinfect and wash clothes and shoes regularly.

  • Wear breathable shoes and clothing that are airy and don’t trap moisture or cause excessive sweating.

  • Wear shoes in public places such as showers or gyms.

  • Always shower immediately after playing contact sports.

  • Don’t share items such as nail clippers, towels, razors, clothing, and shoes unless thoroughly disinfected and cleaned.

  • Wear socks that absorb excess moisture. Acrylic socks are better than cotton for this reason.

Symptoms of Ringworm

General symptoms of ringworm infection are red, itchy, and scaly skin, but depending on the area of infection there may be other symptoms.

Symptoms generally appear between 4 and 14 days after exposure to the fungus.

Infection may stay in a specific area, or it could spread to other areas of the body.

Feet (tinea pedis or “athlete’s foot”)

Athlete’s foot is a condition where the skin on the feet — and particularly between the toes — itch, sting, and burn.

The skin becomes scaly and flakey and in severe cases, it may crack and fluid-filled blisters can form. The skin on the soles may thicken over time.

Groin (tinea cruris or “jock itch”)

This is an itchy, burning rash that develops on the inner thighs, buttocks, and groin. The skin may crack and flake, and blisters may occur.

Scalp (tinea capitis)

Ringworm on the scalp usually begins with a small scaly bald patch and spreads to the rest of the scalp. This may cause widespread hair loss.

These areas itch and may develop open sores that ooze pus. Scalp ringworm is generally found in children and rarely affects adults.

Beard (tinea barbae)

These are multiple ring-shaped rashes that develop on the neck, upper chin, and on the skin under the beard. These rashes may cause hair loss and itchiness.

As the infection worsens, the spots may crust over and fill with pus, and these bumps and blisters can be confused with acne.

Key Point: Can Women Get Tinea Barbae?

Tinea Barbae, or ringworm of the beard, generally only affects men since they tend to have coarse facial hair.

However, women who have thick facial hair may also be affected. This is typical in women who have hirsutism, a condition that causes excessive hair growth.

It’s not known what causes hirsutism, but it is often a symptom of other health conditions such as polycystic ovary syndrome (PCOS).

Arms and legs (tinea corporis)

A ring-shaped rash with slightly raised edges develops, and this causes itchy cracked skin. The inner ring of the rash or patch is usually clear at first and gradually becomes scaly and bumpy.

On fair skin, the patches appear pink or red, and on darker skin patches they appear brown or grey. Hair loss in the area may also occur.

Nails (tinea unguium)

With this infection, nails become thick, discolored, cracked, and misshapen. Over time they may lift away from the nail bed.

How is Ringworm Diagnosed?

Ringworm is easily diagnosed by a healthcare professional by simply looking at the infected area and asking you questions about your symptoms. A sample of hair, skin scrapings, or nail clippings may be taken to further examine under a microscope.

In some cases, a sample may be sent to a laboratory to grow the fungus in a test tube. This process takes longer as fungi grow slowly, but they will be able to tell you the exact type of fungus that is causing your infection.

According to the American Academy of Family Physicians, further testing may be advised as many other health conditions can be confused with ringworm rashes.

How is Ringworm Treated?

Treatment options will depend on the part of the body that’s infected. Oftentimes, treatment is simple and the infection will clear up quickly.

However, if ringworm occurs in certain areas, treatment will take much longer and you may struggle with recurrent infections.

For example, toenail fungus treatment can be a long and tricky process. A treatment plan for toenail fungus can last months or years, and even then it may return.

Nails cannot absorb creams and ointments as the skin does, which makes treatment difficult.

Infections That Can be Treated with Nonprescription Medications

Ringworm of the feet (athlete’s foot), groin (jock itch), or arms and legs (tinea corporis) can usually be treated with nonprescription antifungal creams.

These medications are used once or twice a day for one to four weeks.

Over-the-counter medications include:

  • Clotrimazole (Lotrimin, Mycelex)

  • Miconazole (Aloe Vesta Antifungal, Carrington Antifungal, DermaFungal, Mitrazol, Podactin, Secura Antifungal)

  • Terbinafine (Lamisil)

  • Ketoconazole (Xolegel)

If your symptoms are severe or don't respond to treatment, your healthcare professional may prescribe prescription-strength topical medication.

Infections that Should Be Treated with Prescription Medications

Ringworm of the scalp (tinea capitis), beard (tinea barbae), and nails (tinea unguium) needs to be treated with prescription oral antifungal medications such as:

  • Griseofulvin (Gris-PEG).

  • Terbinafine (Lamisil).

  • Itraconazole (Sporanox).

With scalp ringworm, your healthcare provider may recommend that you use selenium sulfide shampoo once or twice a week.

Oral antifungal medications have a high success rate but may result in unwanted side effects.

People with heart, liver, or renal disease should discuss with their medical provider if they can use oral medication.

Common side effects include:

  • Nausea

  • Vomiting

  • Headaches

  • Rash

These medications may have negative interactions with other medications and will not be suitable for everyone.

If you choose to take oral antifungal medication, you will need to take it over a long period. Your healthcare provider will use blood tests to monitor your liver function and look into any other unwanted side effects.

Key Point: Corticosteroids and Why You Shouldn't Use Them to Treat Ringworm

Corticosteroids (steroids) are a type of anti-inflammatory drug that contains a man-made version of cortisol, a hormone produced by the adrenal glands. They may be effective against many skin conditions but not against ringworm.

Steroid creams weaken the skin’s defenses and may lead to the infection spreading to other parts of the body. Steroids may also change the appearance of a ringworm rash, making it more difficult to diagnose.

These creams may temporarily reduce symptoms such as redness and itchiness. However, they can’t kill the fungus that is causing the infection.

Can a Ringworm Infection Be Serious?

Ringworm infections are generally not serious, but sometimes a secondary infection can develop.

Ringworm infects the outermost layer of your skin called the epidermis. The primary function of the epidermis is to protect the body from the outside environment.

A ringworm infection can lead to a condition called Majocchi’s granuloma when the infection spreads to the deeper skin layers.

Majocchi’s granuloma causes:

  • Skin lesions

  • Pustules

  • Inflamed hair follicles

This condition typically occurs in people who shave their legs often or in instances where topical steroids have been used to treat a ringworm infection.

Topical antifungal ointments are usually not effective against fungal folliculitis, and a 4 to 6 week course of oral antifungal medication such as terbinafine, fluconazole, or itraconazole is recommended.

You will need to consult your doctor and receive a prescription for these medications.

What if it’s Not Ringworm?

There are many skin conditions that have similar symptoms to a ringworm infection. This can lead you to believe you have a ringworm infection when you in fact have something completely different going on.

This is why it’s essential to have any rash or infection checked out by a healthcare expert who can properly diagnose you and prescribe an effective treatment method.

The two most commonly confused conditions with ringworm are eczema and granuloma annulare.

Eczema

This is a common inflammatory skin condition that causes dry, itchy skin, as well as scaly patches, blisters, and infections.

There are different types of eczema, but the one most often confused with ringworm is nummular eczema. With nummular eczema, the rashes that appear are coin-shaped — similar to ringworm.

Granuloma annulare

This is a rash that develops in a ring pattern with small, raised bumps that can be purple, pink, or skin-colored. It is not contagious or painful, but can be slightly itchy. The rash generally appears on the ankles, feet, hands, and elbows.

It is not clear what causes the rash, but sometimes it’s triggered by certain medications, vaccinations, animal or insect bites, or an infection like hepatitis.

Granuloma annulare normally disappears on its own within a few months or up to two years. However, it often reappears over time.

Psoriasis

Psoriasis is a common skin condition and autoimmune disease that causes a rash with red, itchy, scaly patches. These rashes often occur on the elbows, knees, lower back, face, and scalp.

Other symptoms include:

  • Swollen, painful joints

  • Thick nails

  • Dry skin that may crack and bleed

These rashes appear due to the body producing skin cells too quickly. This creates a buildup of cells on the skin which leads to scaling.

Each person has different triggers for their psoriasis; it often goes through cycles where symptoms are worse, and other times where symptoms could subside altogether.

Common triggers are stress, alcohol, and certain medications.

Alopecia areata

Alopecia areata is an autoimmune disease that causes a person's hair to fall out often in clumps. The extent of hair loss varies between people; for some it’s permanent and for others it's temporary.

Ringworm of the scalp may be confused with alopecia areata since they both result in hair loss.

Contact dermatitis

When your skin comes into contact with something that causes inflammation, it’s called contact dermatitis. The substances that cause this reaction differ depending on the person.

There are two main types of the condition:

  • Allergic contact dermatitis is a reaction caused by an allergen such as chemicals, nickel, gold, and perfumes.

  • Irritant contact dermatitis is a reaction caused by an irritant — generally over a prolonged period of time. Examples of this include detergent, bleach, hand sanitizer, dyes, and paints.

Contact dermatitis symptoms vary from person to person, as does the severity of the reactions.

General symptoms are:

  • Red, itchy, and inflamed skin

  • Dry, scaly, cracked skin

  • Blisters and bumps

  • Swelling

  • Tender and sensitive skin

  • A burning sensation

Lyme disease

This is a bacterial infection caused by the bite of a black-legged tick. A bullseye pattern rash appears on the body — known as erythema migrans — and may be mistaken for a ringworm infection.

The rash usually appears within a month after being infected, but it may take as long as three months. As the disease progresses, more erythema migrans may appear.

Lyme disease symptoms vary depending on the stage of infection, but flu-like symptoms such as fever, joint stiffness, headache, and dizziness are common.

In more serious cases, people may experience facial paralysis.

It's important to catch Lyme disease early as the longer you wait for treatment, the more severe symptoms can be. The only way to properly diagnose Lyme disease is through a blood test.

When to Speak to a Doctor

There are many rashes that look like ringworm but aren’t — and it can be difficult to diagnose.

Many conditions have overlapping symptoms, and only a healthcare professional can properly diagnose ringworm.

Treating a rash without receiving a proper diagnosis can make your condition worse, and you may end up dealing with symptoms that could be resolved or minimized with proper treatment.

It’s always a good idea to see a doctor to be certain you’re taking the right steps to resolve what’s going on.

Where Can I Learn More About Ringworm?

Think you might have ringworm? Or maybe another skin condition? Head over to LifeMD and make a telehealth appointment with a board-certified doctor or nurse practitioner.

Dr. Lilliana Ramirez

Dr. Ramirez is a licensed, board certified dermatologist. She received her medical degree from the University of Puerto Rico School of Medicine.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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