Ringworm: symptoms, treatment and how it spreads

The NHS says to speak to a pharmacist first if you think you have ringworm. They can look at the rash and recommend the best antifungal medicine. This might be tablets, cream, gel or spray, depending on where the rash is. You may need to use it every day for up to 4 weeks, and it is important to use it for the right amount of time even if the rash has gone away.

NICE Clinical Knowledge Summaries says that for mild, non-extensive ringworm of the body or groin, a topical antifungal cream such as terbinafine or an imidazole is used, with a short-term mild steroid cream if there is marked inflammation. Oral terbinafine may be considered in adults with severe or extensive disease. It also notes that fungal infections of the hands, feet or nails should be treated to reduce reinfection.

The NHS says the main symptom is a rash that may look red or darker than the surrounding skin depending on your skin tone, and may be scaly, dry, swollen or itchy. It can appear anywhere on the body, including the scalp (tinea capitis) and groin (jock itch). The rash is usually ring-shaped but may look different on the face, neck or scalp. It may be less noticeable on brown and black skin, and sometimes it grows, spreads, or there is more than one rash. On the face or scalp it may cause patchy hair loss.

NICE Clinical Knowledge Summaries describes single or multiple red or pink, flat or slightly raised ring-shaped patches that enlarge outwards, typically with an active, red, scaly edge and a clear central area.

The NHS says ringworm is caused by a type of fungi and can be passed on through close contact with an infected person or animal, infected objects such as bedsheets, combs or towels, or infected soil, although soil is less common.

• start treatment as soon as possible

• wash towels and bedsheets regularly

• keep your skin clean and wash your hands after touching animals or soil

• regularly check your skin if you have been in contact with an infected person or animal

• take a pet to the vet if it might have ringworm, for example if it has patches of missing fur

• do not share towels, combs or bedsheets with someone who has ringworm

• do not scratch the rash, because this could spread it to other parts of your body

Ringworm is a fungal infection of the skin caused by fungi called dermatophytes, and the medical name is tinea. NICE Clinical Knowledge Summaries says body and groin infections are predominantly caused by dermatophytes such as Trichophyton rubrum, and that groin infection is usually caused by spread from infection of the hands, feet or nails. Risk factors include hot, humid environments, tight-fitting clothing, obesity and excessive sweating.

The NHS says that if you have ringworm on your scalp you should see a GP, because you will usually need prescription antifungal tablets and shampoo. NICE Clinical Knowledge Summaries says scalp ringworm is most common in prepubescent children and can cause scaling and itch of the scalp and patches of hair loss. In some cases there are painful, pus-filled boggy masses called a kerion, which needs urgent referral to a dermatology specialist.

NICE Clinical Knowledge Summaries advises sampling skin and hair to confirm the cause, discarding or disinfecting objects that can spread infection, and checking other family members and household pets for signs of infection.

The NHS says it is fine for your child to go to school or nursery once they have started treatment, and to let the teachers know they have ringworm. NICE Clinical Knowledge Summaries says topical antifungal treatment can be used in children with mild, non-extensive disease, and that dermatology referral is advised if disease is severe or extensive, or topical treatment is unsuccessful in a child.

The NHS says you may need to use an antifungal medicine every day for up to 4 weeks, and to keep using it for the full time even if the rash has gone away. See a GP if ringworm has not improved after using antifungal medicine recommended by a pharmacist.

NICE Clinical Knowledge Summaries lists causes of treatment failure to check for, including not following the treatment regimen, reinfection from close contacts, and tinea incognito caused by inappropriate use of steroid creams.

The NHS says to see a GP if ringworm has not improved after using antifungal medicine recommended by a pharmacist, if you have ringworm on your scalp, or if you have a weakened immune system, for example from chemotherapy, steroids or diabetes.

The NHS and NICE pages read for this guide do not give pregnancy-specific advice for ringworm. Tell the pharmacist you are pregnant or breastfeeding before buying antifungal treatment, as some products and tablets may not be suitable, and ask your GP, midwife or pharmacist what to use.

Most ringworm is managed through a community pharmacy, with a GP appointment for scalp ringworm, treatment that is not working or a weakened immune system. NICE Clinical Knowledge Summaries lists dermatology referral where disease is severe or extensive, the diagnosis is uncertain, primary care treatment is unsuccessful or there are frequent recurrences. Private dermatology and GP appointments are available but are rarely needed for a first, uncomplicated rash.