Ringworm in babies and children

Contrary to popular belief, a ringworm is not a worm! It is named as such because of the fungus, also called tinea, takes on a circular shape or worm-like appearance in infants and children. Ringworm is actually, a fungal infection of the skin, nails, and hair.

Fungi do not need light to live and thrive especially on people who has weak immune systems because of illness or medicines. It looks like a red skin rash that forms a ring around normal-looking skin.

Contrary to popular belief, a ringworm is not a worm! It is named as such because the fungus, also called tinea, takes on a circular shape or worm-like appearance in infants and children.

Ringworm can be of several types.

Which children are at risk for ringworm?

Children who are malnourished and have poor hygiene.
Toddlers and school-age children. Outbreaks of ringworm are common in schools and childcare centers where the infection easily spreads through close physical contact.
Children who have contact with other children or pets that have ringworm. A pet, such as a cat or dog, can have the infection without showing any signs. Children can get the infection by touching or petting the animal without handwashing.
Children who play contact sports, and especially when bathrooms or locker rooms are shared.
It may also be transferred indirectly from objects such as clothes, sheets, combs, and towels.

Children mostly have scalp lesions, while adults may commonly have athlete’s foot. It is not a serious condition but is irritating, unattractive and contagious.

How is the fungus transmitted?

Ringworm is highly contagious and easily transmitted. People-to-people transmission are more, but pets-to-people transmission occur worldwide. It can spread as follows:

Direct skin-skin contact with an infected person.
Object-to-human spread – contact with infected objects such as combs, brushes, linen.
Infected animal-to-human contact.

Symptoms of ringworm in a child:

While babies can get ringworm anywhere, two common locations are on the scalp and the body (including the face).

Ringworm in these areas can often resemble other conditions, so it is important to be aware of the distinctive appearance that ringworm can take on over time in babies.

Ringworm of the scalp

Ringworm of the scalp (tinea capitis) is a fungal infection of the scalp and hair shafts and is most common in toddlers and school-age children between ages 2 and 10. It rarely happens in adults.

The signs and symptoms of ringworm of the scalp may vary, but it usually appears as itchy, scaly, bald patches on the head that gradually expand. It is often accompanied by a rash elsewhere on the body and tender lymph nodes in the neck.

Some cases of ringworm of the scalp result in severe inflammation at the site of infection, and may develop into pus-filled areas, causing thick yellow crusting on the scalp, scarring or permanent hair loss.

Treatment of ringworm of the scalp

Treatment will depend on your child’s symptoms, age, nutritional status, and general health. It will also depend on how severe the condition is. Home remedies are many, but rarely successful.

Scalp ringworm is more difficult to treat as it does not respond to ointments and creams and oral antifungal medication (antibiotics and sometimes steroids) may be prescribed for 4 – 8 weeks.

After the rash disappeared, the treatment must still be continued with for at least 2 weeks.

The scalp ringworm may take several months to clear up, causing embarrassment and teasing. Fungi can live indefinitely on the skin, so ringworm is likely to come back and treatment often needs to be repeated.

Treatment for ringworm of the scalp includes oral anti-fungal medications, as well as special medicated shampoos that may lessen the spread of infection. These are prescribed by a health professional.

Seek professional help before your child has any permanent hair loss, scaling or itchiness of the scalp, or other unusual appearance of the scalp.

Body Ringworm

Ringworm may look like many skin problems. The incubation period (from contact with the infected person or pet) is 4-10 days before the rash appears.

If it appears on the body or face, it first appears as a ring-like rash. It is more common in children and more frequent in warmer climates. The symptoms may include:

Red, ring-like rash with raised edges
The middle of the rash may become less red as the lesion grows
Itching of the affected area
The patch that develops forms bald circular patches on the scalp that may be red or grey. The hair within the ring may break off but may re-grow once the skin in the center of the ring begins to heal.
It appears scaly and as the infection spreads, the edges remain scaly while the center begins to look like normal skin. The ring will grow bigger in diameter as the skin in the center begins to heal.
It appears on any part of the body, especially in warm moist areas
It is a slow-growing fungus and the ringed areas itch

Remember

Ringworm infection is not caused by an actual worm.
Ringworm is a type of skin infection caused by a fungus.
It looks like a red circular skin rash that forms around normal-looking skin.
The symptoms of ringworm vary, but most cause itching.
Ringworm is usually diagnosed based on a health history and physical assessment. A culture or skin scraping of the rash may also be done to confirm the diagnosis.
Most ringworm infections are treated with anti-fungal cream that you apply to the skin. But ringworm of the scalp and nails require a prescribed anti-fungal medicine [pill] that your child takes by mouth.
The length of the treatment depends on the location of the ringworm.

Prevention of Ringworm in babies and children

Ringworm is difficult to prevent because the fungi that cause it are common and highly contagious. By not sharing baths, towels, brushes and combs, the spread of the infection may be curbed. You can help reduce the risk of ringworm by taking these steps:

Knowledge is power: Educate yourself and your children about ringworm, what the symptoms are and how to avoid the infection.

Having good personal hygiene: Be aware of the risk of ringworm from infected persons or pets. Teach your child the importance of handwashing to avoid the spread of infection, and to keep the feet dry. Moist feet can easily blister.

Having good environmental hygiene: Keep communal areas [schools, childcare centres, gyms] clean and disinfect floors, showers, and bathrooms. In the locker room, wear flip-flops while showering to avoid the risk of athlete’s foot.

Regular hair washing and inspection of the scalp for lesions. Be sure to wash your child’s scalp regularly, especially after haircuts.

Never share personal items. Teach your children not to let others use their towels, hairbrushes, hair clips or other personal items, or to borrow such items from other children. And, never let them wear other people’s hats or clothing

Avoid infected animals and contact with someone who has ringworm. Take your pet to the veterinarian for regular check-ups. Inspect your pet’s fur for any itching, scaling, and/or bald spot areas that could indicate ringworm. Identifying and treating their ringworm can prevent your little one from being affected.

Ringworm happened, what now?

Disinfect all contaminated items (pillow slips, linen, wash cloths) and get new brushes and combs because the disinfectant might not destroy the fungus in them.

Bathe the child separately and do not share the facecloth.

While the spores are still present, your baby or child should not attend daycare or school.

All infected pets must be treated by the veterinarian.

What does the treatment entail?

Treatments for ringworm depend on the severity of the ringworm itself, the area affected and the age of the child. More severe and far-reaching infections on your baby’s skin can take anywhere from four to six weeks to fully go away.

Topical cream treatment is often prescribed if the lesions are small and will be applied 2 – 3 times per day. You will need to apply the cream directly to the affected area, including the circular area around it.

Examples of creams used to treat ringworm include: clotrimazole, miconozale, and tolnaftate.

In addition to these treatments, your healthcare provider may also prescribe an antifungal shampoo if the ringworm affects the scalp, though these are often ineffective, and treatment must continue for several weeks. The antifungal shampoo will remove the fungal spores and prevent the spread of the infection to other people or other parts of the body.

If your baby’s scalp ringworm persists, or if the child’s ringworm is spreading to other parts of the body, oral antifungal medication may be prescribed.

Dr Diana du Plessis

Diana du Plessis is an independent Midwifery consultant and researcher. She specializes in midwifery and neonatology and lectures widely to nursing professionals and academic audiences on a national and international level. She is a passionate childbirth educator and national spokesperson on breastfeeding. She is the author and co-author of various nursing and midwifery publications (books and peer-reviewed articles).