Ringworm

What is ringworm?

A fungal infection of the skin of the body, feet, or scalp

What are the signs or symptoms?

• Skin of the body or feet

  • Red, circular patches with raised edges and central clearing

  • Cracking and peeling of skin between toes

• Scalp

  • Patchy areas of dandruff-like scaling with or without hair loss

  • Redness and scaling of scalp with broken hairs or patches of hair loss

What are the incubation and contagious periods?

• Incubation period: 1 to 3 weeks but can be shorter.

• Contagious period: A child with ringworm of the skin is infectious as long as the fungus remains present in the skin lesion. The fungus is no longer present when the lesion starts to shrink. Spores of the fungus that cause ringworm of the scalp are found on objects in the environment and on people who have no obvious lesions. Once the child begins treatment with a medication taken by mouth, the child is no longer considered infectious.

How is it spread?

Contact with infected humans, animals (eg, cats, dogs), or contaminated surfaces or objects, such as combs, brushes, towels, clothing, or bedding

How do you control it?

• Early treatment of infected people.

• Examination of siblings and other household contacts.

• Not sharing ribbons, combs, or hairbrushes. Launder ribbons and dress-up clothes between users. Do not permit sharing of bike helmets without wiping the contact surfaces of the helmet between users with a cloth dampened with water. Do not use anything other than water to clean the surface of a helmet because some products contain chemicals that make the impact-absorbing materials and straps less safe.

• Covering skin lesions.

What are the roles of the teacher/caregiver and the family?

• Report the infection to the staff member designated by the child care program or school for decision-making and action related to care of children with ringworm. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Give medication as prescribed.

• On arrival and by observation while the child is in care, note any areas of the skin or scalp that might be infected.

• Do not permit the sharing of bike helmets, hats, combs, brushes, barrettes, scarves, clothing, bedding, or towels without washing these items between users. Wash helmets between users with a cloth dampened with water. Do not use anything other than water to clean the surface of a helmet because some products contain chemicals that make the impact-absorbing materials and straps less safe.

• Restructure dress-up corner to make sure an outfit is laundered before a second child wears it or by having and making sure children use and properly discard disposable outfits.

Exclude from group setting?

At the end of the day, the child should consult a health professional and, if ringworm is confirmed, the child should start treatment before returning. If treatment is started before the next day, no exclusion is necessary. However, the child may be excluded until treatment has started.

Readmit to group setting?

Yes, when all the following criteria have been met:

Once treatment is started. Athletes with ringworm of the body (tinea corporis) in sports with person-to-person contact cannot participate in matches for 72 hours after starting treatment unless area can be covered.

Comments

• This infection is only mildly contagious.

• Extreme measures of shaving the head or wearing a cap are unnecessary.

• Ringworm of the scalp occurs most commonly in children between 3 and 9 years of age and seems to be more common in African American children. This infection of the scalp requires about 6 weeks of oral antifungal medicine. Antifungal cream can be used for ringworm of the skin of the body or feet. Sometimes, the fungus can produce a reaction, causing the scalp to swell and be painful (kerion).

• One type of fungus that can cause ringworm of the body and scalp can be transmitted to humans from animals, especially dogs. These animals should be treated.

Adapted from Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide.

Any websites, brand names, products, or manufacturers are mentioned for informational and identification purposes only and do not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.