Ringworm a Round-Up of Remedies
RINGWORM A Round-Up of Remedies
Bathtime can be filled with wonderful discoveries. Your child learns to blow bubbles, she says the word boat or she grabs the washcloth and exclaims, ''Mine! I do it!''
But bathtime is not so wonderful for the parent who discovers a curious, round patch on a child's scalp or skin. Typically, the patch starts out looking just a little dry and flaky. But a day or two later, you may notice that the patch is larger, and it's clearly circular, with a flat center and a raised, reddish border. Your doctor's diagnosis: ringworm.
Named for the characteristic circular shape of the patches, ringworm isn't actually caused by worms. Instead, it's the result of a fungus infection. This particular type of fungus comes in a variety of forms, but the two that occur most often in children are on the scalp and the body.
If your child has scalp ringworm, first you'll see either flakes or little bumps on the child's head, says Bernard A. Cohen, M.D., director of pediatric dermatology at Johns Hopkins University School of Medicine in Baltimore.
Sometimes the symptoms can resemble severe dandruff. As the infection progresses, the marks spread out, forming circles or ovals with flat centers and raised, red borders, says Dr. Cohen. Sometimes there's itching, and you may see areas with broken hair shafts or definite hair loss.
A child with body ringworm develops similar-looking patches, but they occur only on hairless areas of the body. These can be flaky and itchy, too.
''Between 3 and 5 percent of kids in the United States get ringworm,'' estimates William L. Weston, M.D., chairman of the dermatology department and professor of dermatology and pediatrics at the University of Colorado School of Medicine in Denver. ''Nationwide, ringworm of the scalp predominates because the majority of kids live in cities, and scalp ringworm prevails in urban areas,'' Dr. Weston says. ''Ringworm of the body is seen more often in rural areas.''
| Avoid Major Hair Fallout If your child has scalp ringworm, he's likely to lose some hair. But if the ringworm is treated early and properly, this loss is only temporary and the hair grows back, says Bernard A. Cohen, M.D., director of pediatric dermatology at Johns Hopkins University School of Medicine in Baltimore. You should, however, be aware of warning signs and take prompt action to avoid more serious or extensive hair loss. Permanent hair loss can happen if the child who gets scalp ringworm has an allergic reaction to the fungus. In these cases, a crusted area called a kerion can form. Often about the size of a fifty-cent piece, a kerion has pustules, or raised swollen plaques. Not only is it tender, the kerion can also break down, and you may see some oozing and weeping. Later, scar tissue may form. ''A kerion is not a common problem,'' says Dr. Cohen, ''but when it does occur, if it is not treated early, there is a significant risk of scarring.'' When scarring occurs there can be a permanent bald spot in that area, he says. So the bottom line is to get your child's ringworm treated promptly. |
Scalp Ringworm
If your doctor determines that scalp ringworm is the problem, he'll probably prescribe an oral medication (usually griseofulvin or ketoconazole). While you're waiting for the medicine to work, here are some additional steps you can take at home.
Pair the medicine with milk, not juice. ''Griseofulvin is best absorbed when it is taken along with something that contains fat,'' says Dr. Cohen. ''So your child should take it with a meal, ice cream or a glass of whole milk, not juice or water.''
Segregate combs, brushes and hats. The fungus that causes ringworm can be transmitted via contaminated objects, says Dr. Cohen. So don't let your child share personal items with any other kids when she has ringworm. Keep her combs, brushes and hats on a high shelf so other children in the family don't use them. And because the fungus can also be spread through hand-to-hair contact, try to keep little girls from braiding or playing with each other's hair, says Dr. Cohen.
Settle for a little less scratching. There is nothing you can do to stop your child from scratching her head during the night, says Sandra Hurwitch, R.N., a dermatology nurse at the Dermatology Clinic of Children's Hospital in Boston. But during the day, try to distract your child from the itching by engaging her in activities. Give her something to occupy her hands, such as crayons or paints, she suggests.
Talk to the teacher. Experts agree, there's no reason to keep a child out of school just because she has ringworm. But you should tell your child's teacher about the problem, explain where the infection is located and discuss what to tell other kids in the class. Being careful not to single out the child, the teacher should take the opportunity to reinforce good personal hygiene habits, which include not sharing combs, brushes and hats. ''Children may get frightened about catching the fungus from someone else,'' says Hurwitch. ''But ringworm won't spread from one person's scalp to another's unless there is close contact.''
| Shampoo with Special Suds If your child has scalp ringworm and is taking the oral medication griseofulvin, she should also wash her scalp with a lotion containing selenium sulfide, says A. Howland Hartley, M.D., associate professor of dermatology and pediatrics at the George Washington Medical Center and head of dermatology at Children's National Medical Center in Washington, D.C. ''Selenium kills fungus spores and seems to expedite the therapy,'' he says. Your physician may prescribe Selsun Rx, a lotion that contains 2½ percent selenium sulfide. If the scalp is crusty and oozing, he may advise shampooing every day. For less serious cases, two or three shampoos per week are sometimes recommended. And other members of the family can also use the selenium sulfide shampoo as a preventive. Over-the-counter shampoos with selenium sulfide are available, but some of them contain less than 2½ percent selenium sulfide, cautions Dr. Hartley. You should check with your physician before using these nonprescription products because they may be less effective than prescription formulas, he says. |
Top it off with a cap. If your child is embarrassed by the appearance of her patchy scalp, or if people overreact to seeing it, send her out with a hat, suggests J. Martin Kaplan, M.D., professor of clinical pediatrics at Hahnemann University in Philadelphia. Covering ringworm will not encourage the growth of the fungus. You can buy your child a cap that has a favorite cartoon character or sports team logo on it, or a stylish hat from a kids' clothing store.
Don't rely on OTC creams. The experts agree that trying an over-the-counter antifungal cream to treat scalp ringworm can do more harm than good. ''Tinea capitis is not something to be treated with OTCs,'' says A. Howland Hartley, M.D., associate professor of dermatology and pediatrics at the George Washington Medical Center and head of dermatology at Children's National Medical Center in Washington, D.C.
If you apply a topical ointment, it can kill the fungus on top of the skin, but it won't reach the fungus below the scalp at the hair follicles, Dr. Hartley says. That could make it harder for your doctor to detect the fungus and diagnose the problem.
Consider a communal checkup. That childhood saying, ''There's a fungus among us'' is all too appropriate here. Ringworm is contagious. And if your child has scalp ringworm, it's possible that other family members could get scalp or body ringworm. ''If one child in the family is infected, I recommend other family members get checked, too,'' says Dr. Cohen.
Body Ringworm
''Because ringworm on the body can be confused with other skin disorders such as eczema, you need a physician to diagnose it,'' says Dr. Kaplan. But once it's been positively identified, treatment can begin.
Rub on some relief. Your doctor may prescribe a topical antifungal medication. But it's also possible to treat body ringworm with over-the-counter ointments, according to Dr. Cohen. Among the nonprescription creams recommended by doctors are the miconazoles, such as Micatin, and the clotrimazoles, such as Lotrimin.
Generally, these ointments are applied to the affected area two or three times a day for six weeks--but check the package label for specific directions. ''Don't expect to see results for at least a week,'' says Janice Woolley, M.D., a pediatrician in private practice in Mercer Island, Washington. ''And even if you see good results within two weeks, continue using it until the last sign of ringworm disappears,'' she says.
One sign that the area is getting better is if the rash begins to flatten out and the blisters start to dry up, says Dr. Cohen. The skin may get flaky and peel off, he adds. ''If the area is so flat that you can close your eyes and run your finger over it without feeling a thing, then the ringworm is gone,'' he says.
( If over-the-counter products let you down, however, ask your doctor about topical ointments that are available by prescription only, suggests Dr. Cohen.)
Leave cortisone combos on the shelf. When selecting an over-the-counter ointment, read the labels carefully and steer clear of products that contain both an antifungal agent and cortisone. ''There is no role for combination medications in treating ringworm,'' says Dr. Cohen. Cortisone suppresses the redness so it looks like the problem is getting better faster than it really is, he explains. ''But as soon as you stop the medication, the fungus comes back,'' he warns.
Say yes to school. Kids with body ringworm, like those with scalp ringworm, can go to school, Dr. Kaplan says. But he warns that other children should not touch the affected area. Be especially sure to tell your child not to share clothing, such as sweatpants or sweatshirts, that may have touched the affected area.
