Ring­worm is a strange dis­ease. First, the name. It does ap­pear in the shape of a ring, but there is no worm in­volved. It gets its name from its vi­su­al ap­pear­ance: a red­dish-brown raised cir­cle on the skin that vague­ly re­sem­bles a worm curled up un­der the skin.

The fear that there may ac­tu­al­ly be a worm un­der their child’s skin caus­es moth­ers more dis­tress than the fear of COVID. In ad­di­tion, it is of­ten con­fused with im­peti­go or eczema, lead­ing to in­ef­fec­tive treat­ments be­ing used for months un­til the cor­rect di­ag­no­sis is made.

It is very com­mon. It af­fects about a quar­ter of the world’s pop­u­la­tion at any giv­en time. It thrives in hot, hu­mid trop­i­cal cli­mates and seems to par­tic­u­lar­ly favour the Caribbean.

Any­one can con­tract it, and it is not caused by be­ing “dirty”. It is a con­ta­gious fun­gal in­fec­tion that any­one can get, re­gard­less of clean­li­ness, al­though the fun­gus does thrive in warm, damp en­vi­ron­ments. While be­ing un­washed is not the di­rect cause, leav­ing your skin damp, heavy sweat­ing, or poor hy­giene can make it eas­i­er for the fun­gus to grow and spread.

You catch it through con­tact with the fun­gus, which lives on in­fect­ed hu­mans, an­i­mals such as cats and dogs, con­t­a­m­i­nat­ed ob­jects (like gym equip­ment or tow­els), and oc­ca­sion­al­ly soil. The fun­gus can linger on gym floors, lock­er rooms, brush­es and cloth­ing for sur­pris­ing­ly long pe­ri­ods, usu­al­ly up to a year, be­cause it thrives in warm, moist ar­eas such as bath­rooms and lock­er rooms.

The ways to pre­vent ring­worm in­clude avoid­ing the shar­ing of tow­els, clothes, combs or oth­er per­son­al hy­giene items; show­er­ing im­me­di­ate­ly af­ter con­tact sports and ex­er­cise; and dry­ing your skin thor­ough­ly af­ter show­er­ing, es­pe­cial­ly be­tween your toes.

Wear­ing san­dals at pools and in pub­lic lock­er rooms and show­ers, wash­ing clothes, ath­let­ic gear, sheets and tow­els in hot wa­ter, dis­in­fect­ing sur­faces with bleach, and treat­ing in­fect­ed pets when nec­es­sary are al­so im­por­tant. Pup­pies, kit­tens, old­er pets and an­i­mals with weak­ened im­mune sys­tems are par­tic­u­lar­ly sus­cep­ti­ble.

Cats, in par­tic­u­lar, are prone to car­ry­ing and spread­ing the fun­gus.

Ring­worm has dif­fer­ent names based on where it ap­pears on the body, and it can oc­cur al­most any­where.

The one most of us think about is ring­worm of the skin, but “ath­lete’s foot” is al­so a form of ring­worm. So is “jock itch”, while the scalp, hands, beard, toe­nails and fin­ger­nails can al­so be af­fect­ed.

Ring­worm of the skin be­gins as a flat, dis­coloured patch, which may ap­pear red in lighter com­plex­ions and brown in dark­er com­plex­ions. The typ­i­cal patch is itchy and has a ring-like or cir­cu­lar shape, with a raised, scaly bor­der and a lighter cen­tre.

It is usu­al­ly so typ­i­cal that the di­ag­no­sis is straight­for­ward. How­ev­er, many peo­ple treat them­selves, and these treat­ments can al­ter the ap­pear­ance of the fun­gus, mak­ing di­ag­no­sis more dif­fi­cult and re­quir­ing a vis­it to a der­ma­tol­o­gist for mi­cro­scop­ic test­ing.

A par­tic­u­lar­ly im­pres­sive form is ring­worm of the scalp, which is as­so­ci­at­ed in T&T with con­t­a­m­i­nat­ed bar­ber equip­ment. It is com­mon to hear par­ents say that the rash on their child’s scalp be­gan a cou­ple of weeks af­ter a hair­cut.

It is al­so very dif­fi­cult to treat and re­quires weeks of oral med­ica­tion, med­icat­ed sham­poos and, oc­ca­sion­al­ly, oral steroids.

Lo­cal steroid creams, by the way, are of­ten used here by peo­ple who are un­aware of the risks when treat­ing itch­ing. They do re­duce the itch but make ring­worm worse.

As with many com­mon health con­di­tions, home reme­dies are wide­spread. Mild cas­es of ring­worm can dis­ap­pear with­in a few weeks, so al­most any­thing can be cred­it­ed with cur­ing ring­worm. More se­ri­ous in­fec­tions re­quire treat­ment for up to three months.

Home reme­dies such as ap­ple cider vine­gar or tea tree oil pro­vide lit­tle to no ben­e­fit. Ap­ple cider vine­gar may cause open sores or in­flam­ma­tion. Tea tree oil has an­ti­fun­gal and an­timi­cro­bial prop­er­ties, but it has not been stud­ied suf­fi­cient­ly to be of­fi­cial­ly rec­om­mend­ed.

Treat­ing the most com­mon form of ring­worm is easy, us­ing an­ti­fun­gal creams or sprays, but the course of treat­ment is lengthy and must be com­plet­ed; oth­er­wise, the fun­gus can re­turn.

It takes at least two to four weeks of ap­ply­ing the cream dai­ly, and it is cru­cial to con­tin­ue ap­ply­ing the cream for an­oth­er week or so af­ter the rash dis­ap­pears to pre­vent the in­fec­tion from re­turn­ing. Af­ter 48 hours of treat­ment, ring­worm is no longer con­ta­gious.

Oral treat­ment is avail­able for more se­ri­ous in­fec­tions, but needs to be tak­en for sev­er­al months.

Oc­ca­sion­al­ly, the home may re­quire treat­ment as well. The ring­worm fun­gus can sur­vive on sur­faces for months. Dis­in­fec­tant sprays such as Lysol® or bleach can re­move the fun­gus. It is of­ten nec­es­sary to wash clothes, sheets and tow­els in hot wa­ter and de­ter­gent to pre­vent ring­worm from spread­ing through the fam­i­ly.