It is the most common and annoying skin infection, affecting people of all ages. Ringworm is otherwise called dermatophytosis, dermatophyte infection, or tinea. It is a fungal infection of the skin. A fungus causes the infection, not a worm. So, the name is misleading. It is named as the skin lesion in this disease looks like a worm in a circular shape, like a ring. Ringworm is tinea corporis or ringworm of the body mostly, but it can be tinea infection in other locations, like tinea cruris or ringworm of the groin.
SIGNS AND SYMPTOMS of Ringworm
Symptoms vary depending on the site of infection. A skin infection may cause the following:
Plaque – red in colour, itchy, or scaly patches in the skin
Patches that develop blisters or pustules
Patches red on outside edges
Patches that resemble a ring
Patches with defined and raised edges.
Dermatophytic onychomycosis, or tinea unguium – nails become thicker or discoloured, or with cracks.
Tinea capitis – scalp is affected, the hair surrounding the area falls off and bald patches develop.
CAUSES of Ringworm
Three categories of fungi namely Trichophyton, Microsporum, and Epidermophyton can cause this condition.
- Ringworm of the scalp (tinea capitis)
- Ringworm of the body (tinea corporis)
- Jock itch (tinea cruris)
- Athlete’s foot (tinea pedis)
PATHOPHYSIOLOGY of Ringworm
Mannans in the cell walls of some dermatophytes, such as T. rubrum, have immune-inhibitory properties. This allows the fungus to stay on the skin. The causative fungus produces proteases (enzymes that digest keratin), serine-subtilisins (enzymes that digest protein), and keratinases (enzymes that penetrate keratinized tissue), which allow the fungus to invade skin layers and spread around. Infection is on the surface and confined to outer layers of the skin. The fungus can not penetrate the deeper tissues in healthy people due to host defense mechanisms. Scaling of the active border happen because of increased epidermal cell proliferation in response to the fungal infection.
DIAGNOSIS of Ringworm
Clinical examination
Skin biopsy
Fungal culture
KOH exam
TREATMENTS of Ringworm
Topical medications, such as antifungal creams, ointments, gels, or sprays are the main therapies available. Ringworm of the scalp or nails may require oral medications such as griseofulvin (Gris-PEG) or terbinafine. Medications and antifungal skin creams may be recommended for use containing clotrimazole, miconazole, terbinafine etc.
PROGNOSIS of Ringworm
Generally good with complete clearance in2-4 weeks.
COMPLICATIONS of Ringworm
spread to other areas of the body
spreading the infection to other individuals
hair loss and scarring
nail deformities
tinea capitis can produce life-long permanent hair loss
Ayurvedic Concept of Ringworm
Krimi – Raktaja
Ayurvedic Nidana of Ringworm
Causative factors for krimi are the same as that of Kushtha.
Sparsa
Aahaara together – By touch and sharing food, bed etc.
Sayya
Amrijothbhava – Due to lack of proper personal hygiene
Ayurvedic Purvaaroopa of Ringworm
Not mentioned separately
Ayurvedic Samprapti of Ringworm
Due to contact with krimi (microbes or parasites) and due to lack of proper hygiene, the microbes enter the body through skin, wounds or cuts, mouth, nose or eyes. They enter the bloodstream and release toxins. The vitiated rasa-raktadhatus cause the symptoms, mostly on the skin. Such body reactions are understood as allergic manifestations and mostly are seen as skin rashes.
Ayurvedic Lakshana of Ringworm
Kotha – papules
Pitaka – pustules
Kandu – itching
Ganda-cysts or small lumps or even enlarged lymph nodes in severe cases
Ayurvedic Divisions of Ringworm
- Bahyam-external
- Aabhyantaram-internal
- Bahirmalaja-from external impurities
- Kaphaja-from kapha
- Rakthaja-from rakta
- Pureeshaja-from faecal matter
Ayurvedic Prognosis of Ringworm
Kricchrasadhyam
Ayurvedic Chikithsa ( Treatment) of Ringworm
The Ayurvedic treatment of Ringworm ( Krimi) depends upon the type.
Here, the infestation is external and it is raktaja. The main procedure is to physically remove the krimi from the skin and other body parts infested. Also following good hygiene and preventive measures are advised.
Samana
Apakarshana – extraction with hand or tool
Uthkharshana-powder massage
Lepana-external application of herbal combinations
Parisheka-Pouring medicated herbal decoctions on the area
Sodhana
In raktaja krimi, minimal sodhana therapies to balance Pitta (like virechana) is indicated as the samprapti is mostly confined to the skin and not originated from the gastrointestinal tract. If other associated signs & symptoms are present sodhana of koshtha is done in the strong patient.
Commonly used Ayurvedic medicines for Ringworm
Vidangakrishnadi kashayam
Chithrakadi Kashayam
Panchakolasavam
Pippalyasavam
Aragwadharishtam
Avipattichoornam
Krimisodhinivatika
Gorochanadi Gulika
Brands available
AVS Kottakal
Vaidyaratnam oushadhasala
SNA oushadhasala
Home remedies for Ringworm
No home remedy is effective in completely curing the Ringworm. But trying these herbs can reduce the severity of infestation.
Garlic
Apple cider vinegar
Aloe vera
Turmeric
Coconut oil
Diet for Ringworm
- To be avoided
Red meat, fried non-veg items, and seafoods
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods and spicy food- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Maintain proper personal hygiene.
Avoid a sedentary lifestyle. Be active.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid forcing or holding of natural urges like urine, faeces, vomiting, hiccups etc.
Avoid Stress and emotional imbalance as much as possible.
Yoga for Ringworm
Following a routine with regular exercises and specific yoga asanas like Ardhamathsyentra asanam, Halasanam, Vakrasanam, Dhanurasanam etc is recommended.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
Ardha mathsyentra asanam
Halasanam
Vakrasanam
Dhanurasanam
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
RESEARCH ARTICLES on Treatment of Ringworm
doi: 10.1186/s12906-017-1970-2
A randomized, placebo-controlled, double-blind, parallel, single centre study was conducted on 28 subjects with severe to very severe tinea or onychomycosis. All patients were randomized in a ratio of 1:1 for the treatment or placebo group. Subjects in the treatment arm received Calmagen® cream or lotion, while subjects in the placebo arm received a similar inert topical preparation. Tinea subjects were treated with cream for four weeks, while onychomycosis subjects were treated with lotion for 12 weeks. The Calmagen® cream and lotion containing AMYCOT® represent a potentially safe and efficacious natural alternative in the treatment of Tinea and onychomycosis.
A case-control study was done to evaluate various epidemiological and clinical factors including the presence of tinea unguium is a risk factor for Chronic and recurrent dermatophytosis (CRD) in a total of 80 patients. Among them, 55% had chronic dermatophytosis and 45% had recurrent dermatophytosis respectively. The presence of tinea unguinum was not significant.
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Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
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