Comprehensive Wellness Guide to Understanding and Managing Ringworm

1 in 5 people get ringworm yearly—90% cure with 4-week topical therapy. KOH prep: 95% sensitive. This 2025 expert-reviewed guide covers dermatophytes (T. rubrum), tinea types (corporis, capitis, pedis), KOH/Wood’s lamp, terbinafine cream, griseofulvin for scalp, itraconazole pulse, onychomycosis laser, Majocchi, tinea incognito, and AI dermoscopy. Includes daily protocols, pet screening, and recurrence prevention.

Epidemiology and Risk Factors

• Agent: Dermatophytes (Trichophyton, Microsporum, Epidermophyton)
• Most Common: T. rubrum (60%), T. mentagrophytes
• Risk: Warm/humid climate, occlusive shoes, contact sports, pets, diabetes, immunosuppression
• Contagion: Direct skin, fomites, zoophilic (M. canis from pets)

Clinical Presentations: Tinea Variants

Type	Location	Classic Sign	Wood’s Lamp
Tinea corporis	Trunk, limbs	Annular, central clearing	—
Tinea cruris	Groin	Half-moon, sharp border	—
Tinea pedis	Feet	Moccasin, interdigital	—
Tinea capitis	Scalp	Alopecia, black dots, kerion	Green (M. canis)
Tinea unguium	Nails	Thick, yellow, onycholysis	—

Diagnostic Workup

1. Clinical Suspicion

• Annular lesion with active border
• Itch, scale, central clearing

2. KOH Preparation (Gold Standard)

• Scrape active edge → 10% KOH → hyphae (branching, septate)
• Sensitivity 95%, Specificity 90%

3. Wood’s Lamp

• M. canis → bright green fluorescence
• T. schoenleinii → dull blue

4. Culture (Sabouraud Agar)

• Species ID, resistance testing
• 2–4 weeks

5. Dermoscopy

• Comma hairs, Morse code hairs (tinea capitis)
• Peripheral scale, broken hairs

First-Line: Topical Antifungals (Tinea corporis/cruris/pedis)

Agent	Class	Duration	Cure Rate
Terbinafine 1% cream	Allylamine	1–2 weeks	90%
Clotrimazole 1%	Azole	2–4 weeks	80%
Butenafine 1%	Allylamine	1 week	88%

Apply: 2 cm beyond lesion, twice daily

Systemic Therapy Indications

• Tinea capitis (all cases)
• Extensive tinea corporis (>10% BSA)
• Onychomycosis
• Majocchi granuloma
• Immunosuppressed
• Topical failure

Tinea Capitis (Children)

Agent	Dose	Duration
Griseofulvin microsize	20–25 mg/kg/day	6–8 weeks
Terbinafine	<20 kg: 62.5 mg 20–40 kg: 125 mg >40 kg: 250 mg	2–4 weeks (T. tonsurans) 6 weeks (M. canis)

Onychomycosis

• Terbinafine: 250 mg/day × 12 weeks (toenail)
• Itraconazole pulse: 200 mg BID × 1 week/month × 3 months
• Cure rate: 70–80%

Special Forms

Majocchi Granuloma

• Follicular invasion → nodules
• Biopsy + culture
• ITCZ 200 mg/day × 4–6 weeks

Tinea Incognito

• Steroid-modified → atypical
• Stop steroid → treat with systemic

Prevention and Hygiene Protocol

• Keep skin dry (talc, moisture-wicking socks)
• Don’t share towels, combs, shoes
• Pet screening (Wood’s lamp, vet check)
• Disinfect shoes (UV or antifungal spray)
• Post-gym shower + antifungal wash

7-Day Ringworm Clearance Plan

Time	Action
Morning	Wash with ketoconazole 2% shampoo (body wash)
After wash	Apply terbinafine cream to lesion + 2 cm margin
Evening	Repeat cream
Daily	Change socks, dry feet thoroughly, avoid occlusive shoes

Red Flags: Seek Dermatology

• No improvement after 2 weeks topical
• Hair loss, pustules, boggy swelling (kerion)
• Nail involvement
• Recurrent or widespread
• Immunosuppressed patient

Emerging Tools (2025)

• AI Dermoscopy Apps: 95% accuracy in ringworm vs eczema
• Photodynamic Therapy (PDT): ALA + red light for onychomycosis
• Terbinafine Nail Lacquer: Once-weekly
• MALDI-TOF: Species ID in 24h

Conclusion

Ringworm is common, contagious, but curable. Diagnose with KOH, treat with terbinafine, prevent with hygiene. 90% clear in 4 weeks. With AI dermoscopy and pet protocols, recurrence drops to <5%. Clear skin starts with one KOH slide.