“I have dry red scaly lesions on my arms and neck. They look similar to ringworm but there is no itch. Doesn’t ringworm always itch? Is it candida? What is the difference between candida and ringworm?”Many patients tend to suffer from ringworm like rash, which actually turns out to be something else. Therefore, proper diagnosis of every skin rash is a must. Often, ringworm or Tinea corporis/cruris rashes start out as brownish reddish, scaly patches that are clear in the center. Their appearance is just like a worm under the skin, leading to the moniker ‘ringworm’. In reality, a ringworm rash is a fungal infection caused by nearly 5 different types of fungi, including Trichophyton or dermatophyte fungi. The problem is, many different types of skin rashes are ‘lookalikes’ of ringworm rashes.Let us study some common types of ringworm rashes and also others similar to it.
The ringworm of the trunk is easily confused with nummular eczema. Clinical diagnosis alone is not sufficient and a culture of the skin is often needed for exact diagnosis. It helps to confirm if you have been in contact with animals like horses, guinea pigs, cats, dogs etc. The species of fungus found in the skin culture can help accurately determine the source of infection as well as the medicine to be used. Signs of tinea corporis are: unilateral rash, circular, itching, well demarcated lesions with single or several concentric rings. Treatment -Terbinafine cream must be applied on the rash three times a day, for at least 2 weeks. Ketoconazole cream may also be applied twice a day for 3-4 weeks. Other ‘azole’ based creams can also be applied 3-4 times a day for 4 weeks.
This ringworm is seen mainly in wrestlers or other contact sports players. This is highly contagious ringworm infection with or without itch that spreads from one wrestler to another usually from trunk to scalp. Apart from topical medication, systemic medicine is also indicated. Itraconazole or terbinafine 100mg/day based on the weight of the person is generally prescribed. It is best to keep away from wrestling and contact sports till the duration of the treatment. Training companions and asymptomatic family members must take care not to share personal items with infected people. They should continue using ketoconazole based products like soaps and shampoos etc for bathing to prevent ringworm. It is essential to wash the wrestling training facility,mats, bathrooms etc with sodium hypochlorite solution to prevent the spread of ringworm rashes.
Scalp ringworm is common fungal ringworm often without itch. It is characterized by scaling, bald patches and clumps of broken hair on scalp region. It could lead to a pus filled infection called kerion. Early diagnosis and treatment is necessary to prevent permanent hair loss. Terbinafine 250mg/day for a period of one month is indicated.
Candida is a skin rash caused by a fungus and is very similar to ringworm. Candida albicans is the most common pathogen responsible for this rash. It may be seen in the angles of the mouth, under breasts, vagina and other folds of the skin. Common causes of candida infections are immune-suppression, diabetes, HIV, etc. Candida intertrigo is also a rash very similar to ringworm or often confused with eczema rash. It is mainly seen in between the fingers, inguinal folds, folds between the buttocks, under breast area, in the navel region etc. Candida Balanitis is another ringworm like rash often mistakenly diagnosed as seborrhea dermatitis. It is seen in female patients in their groin areas. Culture test often yields false positives, hence balanitis often goes misdiagnosed.
Treatment for candida, ringworm like rash, also includes azole based creams, lotions, shampoos etc. Fluconazole and Miconazole hydrocortisone based ointments must be applied for at least 2 weeks. If this ringworm like rash recurs, then blood test must be done to check out blood glucose levels or immunodeficiency.
Paronychia Monilia: Ringworm like rash
Paronychia Monilia presents itself as ringworm and is also similar to rashes of candida, eczema, warts, or sometimes misdiagnosed as tumors. People who have to work in moist and humid conditions, especially cleaners, and kitchen personnel etc are more prone to such rashes. The clinical presentation of this rash is a horizontal growth with wavy appearance. Treatment includes antifungal medication as well as antibiotics to clear up bacterial infection. One must keep their hands clean and dry to prevent Paronychia Monilia.
Treating and preventing fungal skin infections
All kinds of ringworm like rash infections can be prevented and treated in the same or similar manner.Here are some steps to prevent these rashes:
- All fungal infections arise due to presence of moisture and humidity. So try and keep the skin dry.
- Protect your nails when you go for manicures/pedicures etc. Take your own mani/ped kit to avoid sharing tools.
- Contact sports players must exercise extra precaution such as bathing immediately with antifungal soap/shampoo etc. Try and place at least 2-3 teaspoons of ketoconazole shampoo all over the skin for 3-4 minutes before washing off with hot water. Pat the skin dry and dust liberally using antifungal powder.
- Always wear footwear when walking on wet surfaces especially found near swimming pools, public washrooms etc. Take care of your feet from time to time by soaking them in warm water and brushing away the dead, dry skin layers. Apply some antifungal powders or creams if you have a tendency to developing Athlete’s Foot infections. Use cotton socks to absorb sweat and keep feet dry. Air out the feet from time to time. Throw away infected shoes, socks and underclothes etc.
- Wash your swimwear, workout clothing, sweaty T shirts etc and avoid wearing them repeatedly since fungal spores tend to spread due to these habits.
As can be seen, there are many ringworm like rash infections which are similar to each other and produce the same symptoms. Most fungal creams available over the counter can be used successfully to treat them. If, however, you do not see improvement after a couple of weeks, you must visit a dermatologist and get a complete culture/blood work done.