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The Doctors Book of Home Remedies II: Ringworm

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Ringworm

We are not alone.

Every day, people around the world, from every walk of life, experience visitations by alien life forms. These silent invaders use our skin as landing sites, burrowing and spreading, as if they were exploring some strange new world. The only evidence of their arrival: a red, scaly, O-shaped lesion, like the rings of Saturn.

Those lesions are the telltale signs of ringworm--which is not a worm but a group of fungi identical to the kinds that cause athlete's foot and jock itch. Invading the warm, moist areas of the groin, trunk, extremities and scalp, the fungi multiply to form a pronounced red ring or an itchy, eczema-like patch.

Ringworm is highly contagious. If your skin comes in contact with the fungi anywhere, parts of your hide may begin to display the telltale circular design. Bathrooms, gym lockers, theater seats, combs, pets and unwashed clothing have all served as launching pads for a nasty bout with ringworm.

Severe cases, specifically those of the scalp, can be treated only with prescribed oral antibiotics. But with milder cases, you have more down-to-earth weapons at your disposal to fight off this invasion of the body splotchers.

Cream it with an antifungal. "You can stop most ringworm infections of the trunk, groin or extremities with an over-the-counter antifungal cream," says Jack L. Lesher, Jr., M.D., associate professor of dermatology at the Medical College of Georgia in Augusta. "Go with a cream that contains an -azole product as its active ingredient. Clotrimazoles (Lotrimin AF, Mycelex) and miconazoles (Micatin, Monistat) do a great job of controlling ringworm fungi quickly."

"You may also see good results with a product containing a tolnaftate, such as Tinactin or Aftate," says dermatologist Joseph Bark, M.D., past chairman of the Department of Dermatology at St. Joseph's Hospital in Lexington, Kentucky. "These will cool down a ringworm infection, reduce the itching and limit the spread. They're more effective on smaller patches than on large ones."

For directions for application, check the package. You will need to apply any medication twice a day for about two weeks after the ring disappears to take care of any stubborn fungi that may be hiding.

When to See the Doctor

There are times when over-the-counter antifungals aren't appropriate or strong enough to stop a bad case of ringworm. That's when you need to see a dermatologist, who is armed with an arsenal of high-strength topical and oral medications. According to Loretta S. Davis, M.D., assistant professor of dermatology at the Medical College of Georgia in Augusta, you should seek medical treatment if any of the following occur.

The ringworm persists or grows even after you have treated your condition for two full weeks with an over-the-counter antifungal medication.
It is on your scalp, face or beard.
You see signs of infection on a baby.
There are several lesions scattered across the body.
The ringworm invades the toenails.

Establish a safety zone. "With antifungal creams, it is important to treat both the affected area and the area immediately around it," according to Elizabeth Whitmore, M.D., assistant professor of dermatology at Johns Hopkins University Outpatient Center in Baltimore. "Spread the cream on the area outside the ring, and work your way in toward the center. On a nickel-size patch, try to cover a half-dollar-size area."

Bathe daily. You can't wash away ringworm, but a daily bath or shower may hinder its spread and provide some itch relief. "No astringent, gritty or germ-fighting soaps are needed," says Dr. Bark. Just use a plain gentle soap to keep the area clean. Avoid harsh scrubbing; it will only aggravate the lesion."

Use a medicated shampoo. Dr. Lesher recommends trying medicated shampoos such as Selsun blue, Denorex or Head & Shoulders for ringworm of the scalp. "It won't cure ringworm, but it will limit its spread, prevent it from looking too scaly and provide itch relief. Don't scrub: Let the shampoo lather well and sit on the scalp for four to five minutes, then rinse."

Blow-dry the cozy crevices. Ringworm fungi thrive in moisture. "They love to make themselves cozy in the warm, moist areas on the body, especially between toes and in the groin area," says Loretta S. Davis, M.D., assistant professor of dermatology at the Medical College of Georgia. "After bathing, thoroughly pat the affected area dry. Then sprinkle on some absorbent powder. (Don't use cornstarch; fungi will use it as food.) You'll also see improvement if you air out problem areas with an electric hair dryer set on cool."

Rotate your shoes. Since shoes often harbor fungi, you need to be careful how you handle them, advises Dr. Davis. "In fact, your medication may not do any good if you step into the same fungus-infested shoes each day," she says. She recommends that you never wear the same pair of shoes two days in a row. "Give them a chance to air out," she says.

Put on socks before undies. "This will prevent your underwear from coming in contact with fungus-infected feet," says Dr. Davis. "When you pull up your underwear, you won't spread the fungi to your leg, groin or belly."

Wear loose-fitting clothing. "A good way to keep the ringworm area dry is to wear shorts or loose clothing. Tight clothing also generates far too much heat," says Paul Honig, M.D., director of pediatric dermatology at Children's Hospital of Philadelphia. "Cotton fibers are a good choice, because they breathe to keep the area exposed to air and free from perspiration. Change your clothing and bedding daily, so fungi don't have a place to breed."

Machine-wash clothes and linens. "Regular washing in hot water with chlorine bleach as well as detergent is the best way to kill fungi on underwear and linens," says Dr. Whitmore. Washing with detergent alone isn't usually enough. Combs and hats should also be thoroughly cleaned and disinfected.

Go light on the hydrocortisones. You don't want to scratch an itchy ringworm infection. On the other hand, anti-itch hydrocortisone creams alone will only encourage the fungi to grow. "However, a little hydrocortisone applied simultaneously with an antifungal for the first one to two days will diminish severe itching," says Dr. Lesher "On the third day, continue with the antifungal only."

Take your pet to the vet. Kids love to cuddle dogs and cats. Unfortunately, pets make great homes for ringworm fungi, according to Dr. Whitmore. If you suspect your child's ringworm is coming from a pet, take the animal to a veterinarian for a thorough exam and professional treatment.

Disinfect the trouble spots. Ringworm fungi love to collect in tubs, on bathroom floors and in hampers and dresser drawers. Dr. Whitmore recommends that you destroy these breeding grounds by regularly cleaning them with chlorine bleach.

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