Introduction

Ringworm is a common fungal infection that can cause a red or silvery ring-like rash on the skin. Ringworm commonly affects arms and legs, but it can appear almost anywhere on the body. Despite its name, ringworm doesn't have anything to do with worms.

Other similar fungal infections can affect the scalp, feet, groin and nails. These fungal infections, medically known as "tinea", are not serious and are usually easily treated. However, they are contagious and easily spread.

Tinea fungal infections

There are different types of tinea fungal infection, based on the affected area of the body:

  • ringworm (tinea corporis) – affecting the body
  • fungal nail infection (onychomycosis) – affecting the nails
  • athlete's foot (tinea pedis) – affecting the feet
  • jock itch (tinea cruris) – affecting the groin
  • tinea capitis – affecting the scalp

Ringworm usually looks like a round, red or silvery patch of skin that may be scaly, inflamed and itchy, but other fungal infections may present themselves slightly differently. Read more about the symptoms of ringworm and other tinea fungal infections.

When to see a doctor

See your GP if you or your child has a fungal scalp infection, as it’s treated with antifungal tablets, which are only available on prescription. Symptoms of a fungal scalp infection include small patches of scaly scalp skin (which may be sore), patchy hair loss and itchiness. Other types of fungal infections (including ringworm) are generally treated with antifungal cream from the pharmacy, and you don't need to see a doctor unless it persists. However, pharmacists often prefer children to see a GP to confirm a diagnosis.

What’s the cause?

Fungal spores are passed between people through direct skin contact and by sharing objects such as towels, hairbrushes and bedding. Athlete’s foot is commonly spread in gym and swimming pool changing rooms.

Pets, such as dogs and cats, can have ringworm, and you can catch it by stroking them.

Read more about the causes of ringworm.

Who is affected?

It's estimated that 10-20% of people will have ringworm in their lifetime.

Although children are more likely to get this, people of all ages can be affected.

Groin infections are more common in young men.

Fungal scalp infections (tinea capitis) are most common in children who have not reached puberty, particularly African-Caribbean children and those who live in urban areas.

Treatment

Most ringworm infections are mild and can be treated using a pharmacy antifungal cream. Scalp infections can be treated with antifungal tablets, sometimes combined with antifungal shampoo. If the skin is irritated or broken, it can lead to other bacterial infections, which may need treatment with antibiotics. Read more about how to treat fungal infections.

Stopping it spreading

It's important to prevent the infection spreading. You should avoid sharing towels, bedding or clothes with someone with a fungal infection. If you think your pet has ringworm, take it to the vet. If your pet is treated quickly, you’ll be less likely to catch it. If your child has a fungal infection, they can go to school, but you should inform their teacher. In addition to treatment, your child should maintain a good level of personal hygiene to prevent the infection spreading. Read more about how to stop the spread of fungal infections.

Symptoms

The symptoms of a tinea fungal infection depend on where the infection is.

Ringworm (on the skin)

The symptoms of ringworm include:

  • a ring-like red or silvery rash on your skin – your skin will look red and irritated around the ring, but healthy inside
  • scaly, itchy and inflamed skin

In more severe cases:

  • the rings may multiply, grow in size and merge together
  • the rings may feel slightly raised and the skin underneath may be itchy
  • blisters and pus-filled sores may form around the rings

The ring spreads outwards as it progresses. You can have one patch or several patches of ringworm, and in more serious cases, your skin may become raised and blistered.

Face and neck ringworm

Ringworm on the face and neck may not appear ring-shaped, but may be itchy and swollen, and it can become dry and crusted. If you have a beard, you may notice patches of hair breaking away.

Hand ringworm

Ringworm on the hand often causes the skin to become thicker on the palm and in between the fingers. It may affect one hand or both and normally only appears on one side.

Fungal scalp infection (tinea capitis)

The symptoms of a fungal scalp infection include:

  • small patches of scaly skin on the scalp, which may be sore
  • patchy hair loss
  • an itchy scalp

In more severe cases:

  • small, pus-filled sores on the scalp
  • crusting on the scalp
  • bald patches (if your hair is affected)

In very severe cases, a large inflamed sore called a kerion may form on your scalp. This can ooze pus, and you may also have a fever and swollen lymph glands.

Athlete’s foot (tinea pedis)

The main symptom of athlete’s foot is an itchy, dry, red and flaky rash, usually in the spaces between your toes. In more severe cases, you may have:

  • cracked skin in the affected area
  • blisters, which may ooze or crust
  • swelling of the skin
  • a burning or stinging sensation in your skin
  • scaling patterns around your sole, between your toes and on the side of your foot

Jock itch (tinea cruris)

The symptoms of jock itch include:

  • red-brown sores, which may have blisters or pus-filled sores around the edge
  • itchiness and redness around your groin area, such as your inner thighs and bottom (the genitals are not usually affected)
  • scaly, flaky skin on your inner thighs

Exercising, walking and wearing tight clothing or underwear can make the symptoms of a groin infection worse.

Fungal nail infection (onychomycosis)

The symptoms of a fungal nail infection include:

  • a whitish thickening of the nail
  • discolouration (the nail can turn white, black, yellow or green)
  • the nail can become brittle and start to fall off
  • the skin around the nail may be sore and irritated

Read more about fungal nail infection.  

When to seek medical advice

Make an appointment to see your GP if you:

  • or your child develop the symptoms of a fungal scalp infection
  • have ringworm that has not improved after two weeks of treatment with antifungal cream
  • have another medical condition, or you’re having medical treatment that is known to weaken your immune system, such as chemotherapy or steroid tablets

Read more about how fungal infections are diagnosed.

Causes

Tinea fungal infections are caused by a particular type of fungi, called dermatophytes, which live off keratin.Keratin is a tough, waterproof tissue found in many parts of your body, including your skin, hair and nails.This explains why fungal infections mostly affect your skin, scalp or nails.

How it spreads

The fungi are tiny spores tough enough to survive for months on your skin, in soil or on household objects, such as combs or towels. They thrive in heat and moisture, which helps them to grow and explains why they are often spread in swimming pool changing rooms and communal showers. The spores can be spread in four different ways:

  • human-to-human contact
  • human-to-animal contact – for example, by stroking an infected dog or cat
  • human-to-object contact – both animals and humans can leave traces of fungi spores on objects and surfaces, such as towels, clothing, bed linen, combs or brushes
  • human-to-soil contact – less commonly, it can develop after lengthy exposure to infected soil

As an adult, you can become a carrier of a scalp infection without developing any symptoms. This is because your body has usually developed a defence against the infection by the time you reach adulthood. If you’re a carrier of a fungal infection, you can unknowingly pass the condition on to children, who may then go on to develop symptoms.

Risk groups

You are more likely to develop a fungal infection if you:

  • are very young or very old
  • are African-Caribbean (in the case of scalp infections)
  • have type 1 diabetes
  • are very overweight (obese)
  • have a medical condition that weakens your immune system, such as HIV or AIDS
  • are receiving medical treatment that weakens your immune system, such as chemotherapy or steroid tablets
  • have had fungal infections in the past
  • have hardened arteries (atherosclerosis)
  • have poor circulation (specifically, a condition called venous insufficiency, where the veins in your legs have trouble moving blood back to your heart)

Diagnosis

Ringworm and other tinea fungal infections are usually easy to diagnose from their appearance and location.

Fungal scalp infections

Your GP will usually be able to diagnose a scalp infection after examining your scalp. Knowing exactly which fungus is causing the infection is useful, because some antifungal medications are better at treating certain types. Your GP will take a small scraping of skin from your scalp to test in a laboratory. You may be given an antifungal medication before you receive your test results. If the tests show that a different antifungal medication would work better, you will be prescribed that instead.

Ringworm and other fungal infections

Most fungal infections can be diagnosed by your GP after examining your skin and asking whether you have other related symptoms. Further tests will usually only be needed if your symptoms are severe or if they fail to respond to antifungal treatment. If this happens, your GP may take a small scraping of affected skin for analysis in a laboratory. Microscopic analysis will show if fungi are present and the specific type that is causing your infection. Read about how to treat ringworm and other fungal infections.

Treatment

Most tinea fungal infections, including ringworm, are easily treated by using antifungal creams, tablets or shampoo. You can also help to get rid of fungal infections and stop them from spreading by:

  • washing areas of affected skin daily and drying thoroughly, paying particular attention to skin folds and between your toes
  • in the case of a groin/foot infection, changing your underwear/socks daily, because fungi can persist in flakes of skin
  • with a scalp infection, not sharing combs, hairbrushes or hats
  • washing clothes, towels and bed linen frequently
  • wearing loose-fitting clothes, preferably made of cotton or other natural materials

Read more about preventing ringworm.

Ringworm, groin infections and athlete’s foot

Most cases of ringworm, groin infections and athlete’s foot can be treated using an over-the-counter antifungal cream, gel or spray. There are lots of different types, so ask your pharmacist to help you choose the right one for you. You usually apply antifungal creams, gels and sprays daily to the affected areas of skin for two weeks. The cream, gel or spray should be applied over the rash and to one inch of skin beyond the edge of the rash. Read the manufacturer's instructions first. You may be advised to use the treatment for a further two weeks, to reduce the risk of re-infection. See your GP if your symptoms have not improved after two weeks of treatment, because you may need to take antifungal tablets. Both terbinafine and griseofulvin tablets can be used to treat ringworm infections, as well as another antifungal medicine called itraconazole (see below).

Treat groin and feet together

Groin infections can sometimes occur at the same time as athlete's foot. It's vital to treat both infections at the same time to avoid being re-infected with either condition.

Fungal scalp infections

Scalp infections are usually treated using antifungal tablets, often alongside an antifungal shampoo. There are two main types of antifungal tablet:

  • terbinafine
  • griseofulvin

The antifungal medicine that your GP prescribes will depend on the type of fungi causing the infection.

Terbinafine tablets

Most people with fungal scalp infections are prescribed terbinafine tablets to take once a day for four weeks. It's an effective treatment for most cases. Side effects of terbinafine can include:

These side effects are usually mild and short-lived. Some people have also reported that terbinafine temporarily affected their sense of taste.

Terbinafine is not suitable for people with a history of liver disease or lupus (where the immune system attacks healthy tissue).

Griseofulvin

Griseofulvin is a type of antifungal medicine that prevents fungi from growing and multiplying. It’s available in the form of a spray and is usually taken daily for 8-10 weeks. Side effects of griseofulvin can include: 

However, these side effects should improve as your body gets used to the medicine. Griseofulvin can cause birth defects, so it shouldn't be taken during pregnancy, or if you intend to become pregnant soon after stopping treatment. Men shouldn't father a child within six months of stopping treatment. Griseofulvin is also not suitable for women who are breastfeeding, and those with severe liver disease or lupus. Griseofulvin can interfere with both the combined contraceptive pill and the progestogen-only pill, so women need to use an alternative barrier form of contraception, such as a condom, while taking it. Griseofulvin may also affect your ability to drive and can enhance the effects of alcohol.

Antifungal shampoo

Antifungal shampoo cannot cure scalp infections, but it can help to prevent the infection spreading and may speed up recovery. Antifungal shampoos, such as selenium sulphide and ketoconazole shampoo, are available from your pharmacist. Ideally, antifungal shampoo should be used twice a week during the first two weeks of treatment. There is no evidence that shaving a child's head will reduce the risk of an infection or speed up recovery.

Itraconazole

Itraconazole is usually prescribed in the form of capsules for 7 or 15 days. It is not recommended for use in children, elderly people or those with severe liver disease. Side effects of itraconazole can include:

  • nausea
  • vomiting
  • indigestion
  • diarrhoea
  • headache

Read about how to stop ringworm spreading or coming back.

Fungal nail infections

Fungal nail infections can be treated with antifungal nail paint, but it also often requires antifungal tablets. These tend to work better than nail paints, although they can cause side effects, such as headache, nausea and diarrhoea. Read more about treating fungal nail infections.

Prevention

The advice outlined below will help to stop fungal infections from spreading. The fungi that cause tinea infections can survive on items such as furniture, hairbrushes, clothing and towels, and can be spread through contact with these items. Therefore, if someone in your household has a fungal infection, you should:

  • avoid sharing personal items – such as combs, hairbrushes, towels, clothing and bed linen
  • avoid scratching the affected areas of your skin or scalp, because it could spread the infection to other parts of your body

It’s important that other household members check themselves for signs of infection and get treatment if necessary. If you suspect that your pet is the source of the infection, take them to your vet for treatment. Patches of missing fur is a sign that an animal has ringworm. Always wash your hands after touching a pet with the infection. If someone in your family has a fungal infection, there is no need for them to stay off work or school. However, treatment should be started as soon as possible. Good personal hygiene should also be followed to stop it spreading to other children. Wearing something on your feet in gym and swimming pool changing rooms will reduce your chances of getting athlete’s foot. Find out how to treat fungal infections.