Ringworm
What is ringworm?
Ringworm is a rash caused by fungus. It is usually itchy, but not always. The fungus can come from other people or animals, especially pets. Ringworm starts as a single, ring-shaped spot that tends to grow bigger over time. The edges are usually raised and more red or dark. You can get a few spots, but the fungus is lazy - it’s easier to make one spot bigger than for the fungus to infect your normal skin elsewhere. If you have several round, itchy, dry spots on different parts of your body, it is usually nummular (coin-shaped) eczema. See my page on Eczema for ways to help with eczema.
Why do I have ringworm?
Ringworm is usually picked up from two main sources: 1) touching a person with ringworm (usually athletes like wrestlers), and 2) touching an animal with ringworm (usually a pet). It is more common if you live where it is humid or share housing with others (dorms, extended family). Tight-fitting clothing, sweating and having dry skin also increase your chances of getting ringworm.
How do I fix ringworm?
Several things can help make ringworm better. None of these are perfect, but hopefully, you can find the best combination for you:
Apply a thin layer of topical antifungal cream twice a day. Head-to-head studies don’t exist on the best antifungal creams, but antifungals ending in “-afine” appear to work better (and are pricier) than antifungals ending in “-azole.” I would try a cheaper “azole” first.
“-afine” antifungals (more expensive): butenafine or terbinafine.
“-azole” antifungals (less expensive): miconazole or clotrimazole.
NOTE: The percentages of each medicine are only important for that specific medicine, so ketoconazole 2% (prescription) is twice as strong as ketoconazole 1% (over-the-counter), but miconazole 2% is NOT stronger than clotrimazole 1%.
If it’s itchy, use steroid (cortisone) ointments WITH the antifungal cream
Don’t use steroid ointments alone for ringworm. Fungus loves steroid medicine, and the ringworm can get deep in the hair follicles and need oral antifungal medicine to fix. But, antifungal creams don’t really help the itch of ringworm.
An over-the-counter hydrocortisone ointment works best (instead of cream). Apply a thin layer of hydrocortisone ointment twice daily after putting on the antifungal cream. You would stop the steroid ointment when it is not itchy anymore.
WARNING: Overuse of topical steroids like hydrocortisone can cause skin thinning, stretch marks, and easy bleeding or bruising.
If you are sweaty or it is humid where you live, use an antifungal powder.
Powders help keep the skin dry and have an antifungal medication in them (brand name or generic) to help clear the skin quicker.
You can also use a clinical-strength antiperspirant (see my Sweating page).
Try vinegar soaks to speed up the process.
Vinegar soaks are immensely helpful for cleaning up superficial infections with fungus or bacteria and healing up any scratched, broken, or damaged skin. Safe for all ages.
Combo creams (antifungal medicine + mild acid to peel off dry skin) make treatment simple - the go-to option is Whitfield’s ointment.
What if my ringworm isn’t getting better?
Usually, the steps above can help most people get their ringworm better. Other rashes can look like ringworm (usually a type of eczema). If over-the-counter options are not working or if ringworm keeps coming back, look for a board-certified dermatologist in your area to check them. There are stronger prescription medications - a course of oral antifungal medications works really well for most people. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
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