It is the most common and annoying skin infection, affecting people of all ages. Ringworm, also known as dermatophytosis, dermatophyte infection, or tinea, is a fungal infection of the skin. The term is a misnomer, since a fungus, not a worm, causes the infection. The lesion caused by this infection resembles a worm in the shape of a ring — hence the name. Ringworm is usually specifically used to describe tinea corporis (ringworm of the body), although it can sometimes be used to describe tinea infection in other locations, such as tinea cruris (ringworm of the groin).
SIGNS AND SYMPTOMS
Symptoms vary depending on site of infection. A skin infection may cause the following:
red, itchy, or scaly patches, or raised areas of skin called plaques
patches that develop blisters or pustules
patches that may be redder on the outside edges or resemble a ring
patches with edges that are defined and raised.
When nails are affected, they may become thicker or discoloured, or they may begin to crack. This is called dermatophytic onychomycosis, or tinea unguium. When the scalp is affected, the hair around it may break or fall off, and bald patches may develop. The medical term for this is tinea capitis.
CAUSES
Three different types of fungi can cause ringworm: Trichophyton, Microsporum, and Epidermophyton.
Ringworm of the scalp (tinea capitis) often starts as isolated scaling in the scalp that develops into itchy, scaly bald patches. It’s most common among children.
Ringworm of the body (tinea corporis) often appears as patches with the characteristic round ring shape.
Jock itch (tinea cruris) refers to ringworm infection of the skin around the groin, inner thighs, and buttocks. It’s most common in men and adolescent boys.
Athlete’s foot (tinea pedis) is the common name for ringworm infection of the foot. It’s frequently seen in people who go barefoot in public places where the infection can spread, such as locker rooms, showers, and swimming pools.
PATHOPHYSIOLOGY
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 without being sloughed off prior to invasion of the skin. The causative fungus can produce proteases (enzymes that digest keratin), serine-subtilisins (enzymes that digest protein by initiating the nucleophilic attack on the peptide bond through a serine residue at the active site), and keratinases (enzymes that penetrate keratinized tissue), which allow the fungus to invade the horny layer of the skin and spread outward. Infection is usually cutaneous and confined to the outer, non-living, cornified layers of the skin. The fungus is unable to penetrate the deeper tissues in healthy immunocompetent hosts because of host defense mechanisms, such as activation of serum inhibitory factor, polymorphonuclear leukocytes, and complements. Scaling of the active border results from increased epidermal cell proliferation in response to the fungal infection.
DIAGNOSIS
Clinical examination
Skin biopsy
Fungal culture
KOH exam
TREATMENTS
Jock itch, athlete’s foot, and ringworm of the body can all be treated with topical medications, such as antifungal creams, ointments, gels, or sprays. 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
Generally good with complete clearance in2-4 weeks.
COMPLICATIONS
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
Disease & Ayurveda
Krimi – Raktaja
Nidana
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
Purvaaroopa
Not mentioned separately
Samprapti
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 skin. Such body reactions are understood as allergic manifestations and mostly are seen as skin rashes.
Lakshana
Kotha – papules
Pitaka – pustules
Kandu – itching
Ganda-cysts or small lumps or even enlarged lymph nodes in severe cases
Divisions
- Bahyam-external
- Aabhyantaram-internal
- Bahirmalaja-from external impurities
- Kaphaja-from kapha
- Rakthaja-from rakta
- Pureeshaja-from faecal matter
Prognosis
Kricchrasadhyam
Chikithsa
The Ayurvedic treatment of Krimi depends upon the type.
Here, the infestation is external and it is raktaja. The main procedure is to physically remove the krimi from 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 strong patient.
Commonly used medicines
Vidangakrishnadi kashayam
Avipattichoornam
Krimisodhinivatika
Brands available
AVS Kottakal
Vaidyaratnam oushadhasala
SNA oushadhasala
Home remedies
No home remedy is effective in completely curing the ring worm. But trying these herbs can reduce the severity of infestation.
Garlic
Apple cider vinegar
Aloe vera
Turmeric
Coconut oil
Diet
- To be avoided
Red meat, fried non-veg items, and sea foods
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 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
Following a routine with regular exercises and specific yoga asanas like Ardhamathsyentra asanam, Halasanam, Vakrasanam, Dhanurasanam etc is recommended.
Regular exercise helps improve 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
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 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 as a risk factor for Chronic and recurrent dermatophytosis (CRD) in a total of 80 patients. Among them, 55% had chronic dermatophytosis and 45% hadrecurrent dermatophytosis respectively. The presence of tinea unguinum was not significant.
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
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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