Ringworm

1. Ringworm Cape Girardeau County Public Health Center Presented by Sand Gibbons R.N.

2. Ringwrom • Also known as Tineacorporis-which refers to a fungal infection that appears on the scalp, between the toes, in the groin, in a man’s beard and other places on the body.

3. Symptoms • Small, reddish, itchy, scaly patches that gradually expand outward clearing in the middle, forming a flat, spreading ring-shaped lesion with scaling margins and clear centers. • New legions may form in the middle of an expanding ring. • Usually appear as a single lesion.

4. Incubation period • 4-10 days. The condition may persist and recur for many years

5. Period of Communicability • Contagious as long as active lesions are present.

6. School and Daycare Attendance • Exclude until effective treatment is started. Usually treated with anti-fungal topical creams or ointments. In severe cases may require oral prescription.

7. Contacts/Follow-up • Watch for development of infection in other children and caregivers who provide direct, physical care to young children. • Parents should be notified that there has been a case or cases of ringworm, and advised to watch for the development of symptoms. If found, they should seek medical attention for diagnosis and treatment. Infected children should be excluded form swimming or other activities likely to lead to the exposure of others.

12. Ringworm • Also known as TineaCapitis-(can also be known as craddle cap)refers to a fungal infection particularly of the scalp, but can also appear in a man’s beard, in the ground and between toes.

13. Symptoms • Round, scaly, localized patches on the scalp with short, broken-off hairs. • Redness and scaliness may be present and range from mild to severe.

14. Incubation Period • 10-14 days. The condition may spread for 3-4 months, and then spontaneous regression may occur

15. Period of Communicability • As long as active lesions are present or viable fungus persists on contaminated areas(may persist for a long time)

16. School Attendance • Exclude until effective treatment is started. Usually requires prescription oral medication and anti-fungal shampoos or other topical treatment.

17. Contacts/Follow-up • Watch for development of infection in other children and caregivers who provide direct, physical care to young children. Have family check pets and farm animals for infection and treat if infected.

20. Facts • Ringworm is not actually caused by a worm, but by fungi • It is a contagious fungal infection caused by mold-like parasites, known as dermatophytes, that live on the outer skin. • Ringworm occurs more commonly in warm, tropical environments. • It affects men and women of all ages fairly equally, although it is more common amongst children.

21. Transmission • Highly contagious • Transmitted from direct skin-to skin contact with infected people or pets. • By sharing hats and personal hair grooming items (eg. hairbrushes, combs) • Contact with locker rooms floors, shower stalls, seats • Clothing from an infected person

22. Transmission continued • It can also be spread by touching surfaces contaminated with the fungus, such as door knobs, towels, bedding and soil.

23. Other Causes • Having damp skin for an extended period of time (eg. sweat) • Lack of hygiene • Minor skin and nail injuries • Close contact with others(eg. Sports like wrestling)

24. Risk Factors • Contact with surfaces( eg. Seat backs, shower stalls), clothing, or personal grooming items used by an infected person • Skin-to-skin contact with an infected person or pet • Age 12 or younger-ringworm of the scalp rarely occurs in children after puberty or in adults • Spending time in nurseries, schools, daycare center, or locker room

25. Diagnosis • Many cases are self diagnosable, but some can mimic other skin conditions. • A primary care physician or dermatologist will likely be able to identify a ringworm, solely by its appearance. • A KOH test will provide an accurate diagnosis • Fungal cultures are rarely taken to identify the exact fungus causing the infection.

26. Treatments • Topical anti-fungal cream are applied to lesions twice a day for at least 3 weeks. • The lesions usually clear up within two weeks, but treatment should be continued for another week to insure the fungus is completely gone. • Topical creams can be purchased over-the- counter, or a Dr. may prescribe.

27. Treatments continued • When using a topical cream, wash and dry the affected area(s) before applying the cream to the rash. • Be sure to wash hands thoroughly after applying the cream to the rash. • Do not apply bandage over the rash

28. Most commonly Topical Creams • Monistic (miconazole) • Mycelex (clotrimazole) • Nizoral (ketoconazole) • Lamisil (terbinafine)

29. Oral treatment • Rarely used (used if severe infection or several lesions) • Taken once a day for 7 days and have a 100 percent clinical cure. • Oral anti-fungals medications: • Terbinafine (Lamisil) 250 mg • Itraconazole (Sporanox) 200 mg

30. Prevention • Keep skin dry and clean • Avoid contact with infected materials • Maintain proper hygiene habits, especially if participating in sports that require close physical contact with others • Wash hands after handling animals, soils and plants • Do not touch characteristic lesions on other people

31. Prevention continued • Wear loose-fitting clothing • Keep damp areas where fungi thrive clean, (eg. Bathtubs, bathroom floors, sinks etc).

32. True or False • Ringworm in general is highly contagious • True— • As long as lesions are present

33. True or False Ringworm is cause by ingesting food contaminated with the worms? False- It is not actually caused by a worm, but fungi

34. True or False • Ringworm generally affects older men more than women? • False- • It affects women and men equally, although it is more common amongst children under the age of 12

35. Name 3 ways ringworm can be transmitted • Skin-to-skin with infected people or pets • Sharing hats and personal hair grooming items • Contact with locker rooms, shower stalls, and seats • Clothing from an infected person • Touching surfaces contaminated with the fungus, such as doorknobs, towels, bedding and soil

36. Name 3 things that may increase your chance of contacting ringworm ? • Having damp skin for an extended period of time • Lack of hygiene • Minor skin and nail injuries • Close contact with others (eg. Sports like wrestling) • Spending time in nurseries, schools daycare centers, or locker room

37. True or False • A doctor must diagnose and prescribe treatment for all types of ringworms? • False • Many cases or self diagnosable, by its appearance. • Most ringworm of the skin can be treated with over the counter topical creams • Rarely, oral medicine is used unless severe infection or several lesions. • Also, sometime with ringworm on the scalp, a prescription oral medicine or shampoo is needed.

38. Name 3 preventions to take against ringworm? • Keep skin dry and clean • Avoid contact with infected material • Maintain proper hygiene habits, especially if participating in sports that require physical contact with others

39. Name 2 types or ringworm • TineaCorporis- • fungal infection that appears on the scalp, between the toes, in the groin, in a man’s beard and other places on the body • TineaCapitis • -a fungal infection particularly of the scalp.

40. True or False • The child can return to school as long as he has the area covered with a bandage? • False • You should never cover a ringworm with a bandage, and the child should not return until after proper treatment as been started

41. True or False • You apply cream until you can no longer see the area, then you may stop treatment? • False • The area may disappear after two weeks of applying the cream, but you must continue for three full weeks.

42. Remember • Have a policy and a parent letter to send home ready at your daycare, before you need it • Thank you