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Body found in Ashland ... Calendar: Saturday, Oct. 4 ... Herb Rothschild: Peace begins at the table ... Body found in Ashland ... Calendar: Saturday, Oct. 4 ... Dr. Jeff Hersh: Ringworm is a very common infection DailyTidings.com Writer Posted Oct. 3, 2014 @ 11:11 am Posted Oct. 3, 2014 @ 11:11 am » Social News By Dr. Jeff Hersh More Content Now Q: My daughter got ringworm in her scalp. How did she get worms there? A: Ringworm gets its name from the ring-like rash it often forms. It was once thought that it was due to worms, but there are NO worms involved in this disease. Ringworm is an infection due to one of several types of fungus (called dermatophytes); the medical term for it is “tinea.” When it affects the scalp it is called tinea capitus, when it affects the body it is called tinea corporis, on the feet it is called tinea pedis (or more commonly athlete’s foot), in the beard tinea barbae and in the groin area tinea cruris (jock itch). It may also affect the nails of the feet (more common), hands or both. Ringworm is a very common disorder, especially in children where one study found that up to 1 in 20 elementary school kids had at least some area of tinea capitus. The fungus may be spread from person to person, even from someone colonized with the fungus (so it is on their skin but they do not have any rash or other manifestations of it), by direct skin-to-skin contact, although it is not highly contagious. The fungus can also survive on the surface of many objects, so can be spread from person to object to person; for example, it may be spread from an infected child sharing toys, hats, hairbrushes, etc., with another child. In addition, pets can harbor the fungus and spread it to people, with cats being a more common source than dogs. Even though it is only mildly contagious, outbreaks of ringworm can occur at schools and daycare centers. The fungus is killed by most disinfecting agents, so thorough cleaning helps stop the spread of this infection, as does hand washing and good hygiene. The symptoms of tinea infection include itching and a rash. The rash will have scaly red borders and as it grows it will often clear in the center, which is what gives it its ring-like appearance. As noted above, it can appear anywhere on the body, however, the ring-like aspect of it can be hard to appreciate when the rash is on the scalp or feet. When tinea affects the nails it may make them thick, brittle and yellowish. Tinea is usually diagnosed based solely on the clinical appearance. If needed, the skin can be examined under a special blue light (called a Wood’s lamp) in a dark room; under these conditions certain strains of the fungus may fluoresce. When it is necessary to further verify the diagnosis, the skin can be scraped and examined under a microscope where a “spaghetti and meatballs” appearance of the fungi will be noted. Treatment of tinea depends on where it is located; there are many over-the-counter topical antifungal agents that are quite effective when it is on the groin, body or feet. Severe or persistent infections, or ones that involve the scalp (where topical medications are more difficult to apply), are often treated with a prescription oral antifungal agent (for example griseofulvin which has a long history of safely treating children with this infection). Nail infections are much more difficult to eradicate, and may require long courses of oral antifungal medications. The complications of this disorder include possible secondary bacterial infections (usually because of breaks in the skin from scratching that allow bacteria to invade the skin), or, uncommonly, side effects from the medications such as systemic effects (mostly from oral medications) or skin changes (mostly from topical treatments, called over-treatment dermatitis). Tinea capitus can cause hair loss, and if the infection is long standing this can become permanent. So if you have a ring-like rash which is scaly and itchy you can try over-the-counter antifungal treatments; if you are not sure it is tinea or it does not respond to treatment, you should see your healthcare provider. In otherwise healthy patients, tinea typically clears within four weeks or so with topical treatment, and even more rapidly with antifungal pills; except nail infections which are slow to respond and may not have a complete response. Jeff Hersh, Ph.D., M.D., can be reached at [email protected]. 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