Ringworm: Emerging Drug-Resistance & Treatment Challenges

Normally, ringworm is fairly easy to treat with anti-fungal creams or pills. However, over the last few years, there has been a rise in drug-resistant forms of ringworm across the globe, including in the United States.

Although there is some cause for concern, a board-certified dermatologist can still diagnose and treat these new forms of ringworm. Here, we’ll look at how they differ and what to do when you think you might be infected with ringworm.

What is ringworm?

Ringworm, also known as tinea, is a rash caused by a fungal infection (not a worm). This is the same fungus that causes “athlete’s foot” when it grows on the feet and “jock itch” when it grows on the groin, upper thighs, or buttocks. Ringworm can occur anywhere on the body and usually begins as a red, scaly patch or bump and develops into a ring pattern over time.

Symptoms of ringworm include:

  • Ring-like shape with raised edges and clearer center
  • If ringworm is on the scalp, hair loss might occur
  • Itching
  • Redness
  • Soreness
  • Bumps or blistering

How are drug-resistant ringworm strains different?

The new strains of drug-resistant ringworm don’t respond to normal ringworm treatments, like over-the-counter anti-fungal creams or the treatment most commonly prescribed by doctors and dermatologists, a medication called terbinafine. Patients may not realize that they have a drug-resistant ringworm until they find that it is not going away after weeks of treatment.

Researchers at the Center for Disease Control (CDC) have identified three new strains of drug-resistant ringworm that are being reported in the United States:

  • Trichophyton indotineae (T. indotineae) – this strain of ringworm tends to be more severe and difficult to treat, often covering large portions of the body. It is currently most common in South Asia.
  • Trichophyton mentagrophytes genotype type VII (TMVII) – this strain can be spread through sexual contact or through clothing, towels, and bedding that have not been disinfected after being used by an infected person. It can cause inflamed, painful, itchy, and persistent skin lesions, located on the genitals, buttocks, or face.
  • Terbinafine-resistant Trichophyton rubrum (T. rubrum) – while T. rubrum was already a common strain of ringworm and nail infections, it is being increasingly reported as resistant to terbinafine–requiring more aggressive treatments.

Tips for Avoiding Drug-Resistant Ringworm

Tips for avoiding drug-resistant ringworm are essentially the same as those for avoiding any ringworm. These include:

  • Wash your hands often, especially in public spaces or when traveling
  • Wear shoes in public showers, such as those in gyms
  • Avoid touching animals with patches of missing fur
  • Don’t share towels, clothing, or bedding with anyone who may have been exposed to ringworm or who lives outside your home
  • Wash sports gear and uniforms frequently

Thinking about the bigger picture, it’s important to curb the spread of drug resistance in fungal strains. Researchers believe drug resistance is becoming more common for ringworm because of the misuse of ringworm treatments. For example, many people use over-the-counter corticosteroid creams on ringworm. These may work for other types of rashes, but can make ringworm worse. More persistent strains can develop in these cases.

To curb the spread of drug-resistant ringworm, patients with ringworm should:

  • Avoid steroid creams on any rash that could be ringworm
  • Finish any prescribed medications as directed
  • Don’t skip doses
  • For the best results, see a doctor or board-certified dermatologist
  • Don’t wait to get treatment

Can drug-resistant ringworm be treated?

Although it can take longer to treat, drug-resistant ringworm can be treated by a knowledgeable doctor. Currently, the go-to treatment for ringworm that is resistant to other drugs is itraconazole, which is used for treating invasive fungal infections. It works in most cases where conventional ringworm treatments don’t, but treatment can take several months and it must be prescribed by a doctor or board-certified dermatologist.

When to contact a dermatologist about ringworm

For prompt treatment of any skin rash, it’s best to contact a board-certified dermatologist right away. Many people prefer to see if a rash goes away on its own, as many rashes caused by things like bug bites or stress often do. But it’s best to treat ringworm soon after it shows up, before it spreads and becomes harder to treat.

If you have ringworm and your symptoms don’t get better with treatment, you may have a drug-resistant strain. Make an appointment with a board-certified dermatologist when over-the-counter or prescribed treatments don’t work. Make sure to tell your dermatologists about any prior treatments or if you’ve traveled recently.

The board-certified dermatologists at Forefront have experience distinguishing between various common rashes and can help determine if you have ringworm right away. Contact us today if you have concerns about ringworm or any other rash.

LOCATIONS
SERVICES