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VOL: 100, ISSUE: 03, PAGE NO: 33




- Ringworm is a superficial fungal infection affecting the skin and nails.



- Tinea corporis, ringworm of the skin, is a relatively common infection, usually caught from animals such as dogs, cats and cattle.



- Tinea capitis, ringworm of the scalp, has increased in prevalence in the past two decades, owing to increasing infection from human spread.



- There are sometimes epidemics in inner-city schools.



- Tinea capitis particularly effects those of Afro-Caribbean origin - the reason for this remains unknown (Prodigy, 2003).



- Transmission of ringworm is from skin-to-skin contact.



- Risk of infection is increased by prolonged wetness, for example from perspiration, and if there are minor injuries to the skin or scalp.






Tinea corporis



- This causes a raised, circular rash over flat, exposed areas of skin, typically beginning as an erythematous, raised area.



- As it spreads, the interior inflammation clears, leaving a ring-like shape.



- Swelling and blisters and scaling may occur.



- Several rings may develop and merge.



- If scratched, affected areas can bleed and become encrusted with blood; bacterial infection may occur.



Tinea capitis



- This causes circular, patchy alopecia with a scaly rash.



- A more severe form of tinea capitis causes a kerion - a large, oozing lesion with pain, swelling and sometimes fever. Untreated kerions can result in permanent scarring and hair loss.



- Skin scale samples should be taken for laboratory investigation to identify the causative fungus.



- For tinea capitis, plucked hair samples should be taken.



- For tinea corporis, exclude psoriasis, pityriasis rosea, granuloma annulare and annular erythema.



- For tinea capitis, exclude seborrhoeaic dermatitis, atopic dermatitis, psoriasis, alopecia areata, bacterial flocculates.



Tinea corporis



- Topical application of antifungals (imidazole or terbinafine) on affected area and 4-6cm around it will clear lesions. These are available over the counter or on prescription.



- Antifungals should be continued for one to two weeks after the skin has healed to eradicate residual fungi in the keratin layer.



- Topical corticosteroids should be considered if infection is particularly inflamed and irritated.



- Oral antifungals are unnecessary unless the skin is widely affected or there is severe, non-resolving infection.



Tinea capitis



- If tinea capitis is identified as being of human origin, family and other contacts such as school friends should be examined and specimens taken.



- If the infection is of animal origin, pets should be investigated.



- An oral antifungal (griseofulvin) is necessary for tinea capitis, usually for eight to 10 weeks.



- Griseofulvin is unsuitable for pregnant women, while men should not father a child within six months of treatment.



- Selenium or povidone iodine, used once or twice weekly, may reduce the risk of the condition spreading to other people.



- Kerions can be soaked and removed to soothe pain.



- Patients should be referred to a dermatologist if response to treatment is poor or reinfection occurs.



NHS Direct
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