DEAR DOCTOR, My nine year old daughter keeps on having recurring ring worms affecting her skin and scalp. What could be the cause and how can one treat this condition? Nina DEAR NINA, For how long has your daughter had recurrent ring worm infection and how frequent has it been? Does she have only itching and scaling over scalp or is there formation of multiple abscesses as well? Ring worm is a common contagious fungal infection. It is caused by common mould like parasites that live on the cells in the outer layer of the skin. Fungal spores, including that of ring worm prevail in the atmosphere around, particularly in dampness, these can settle over skin and scalp. Repeated infections can cause fungal growth over the skin and it can even enter deeper layers of skin. Poor hygiene leads to persistence and growth of the ring worm over the body. Dampness caused by situations like not wiping the body dry after a shower, wearing damp clothes, moving bare footed over damp surfaces, are some of the reasons due to which persistent or recurrent ring worm infections can occur. Wearing nylon clothes and socks aggravates the problem. Persons with reduced immunity like those with uncontrolled diabetes or HIV infection are more vulnerable to acquire the infection easily and in more severe form. Ring worm manifests as flat, scaly or discoloured patches over affected area, which are mostly itchy. Scratching by nails, to relieve the itching can give rise to abscess or multiple abscesses due to secondary bacterial infection. This can cause pain, redness and swelling, over affected sites. It is easily diagnosed by the typical skin lesion. Diagnosis can be confirmed by taking a small scraping from the affected skin and examining it under the microscope. Treatment is by antifungal medicines, either in form of tablets, ointment or dusting powder. Usually an infection visible over the skin, clears after 2 to 4 weeks of treatment, depending on its severity before. However, spores may persist in deeper layers of skin. On finding suitable conditions, these multiply again, leading to relapse of infection, repeatedly. Persistence of dampness over body and around also leads to recurrent or persistent infections. Therefore for complete cure, anti-fungal treatment should be taken for at least 8 to 12 weeks or even longer, depending on the recommendation of the dermatologist. This ensures complete eradication of the spores, present in deeper layers of skin. Prevention lies in improving personal hygiene. The body and scalp should be kept clean and dry. Surroundings also should be clean. Nylon clothes and socks should be avoided, as they cause dampness and can aggravate the infection. Scratching by nails should be avoided. If one feels itchy over any part, he can scratch it lightly by rubbing a soft cloth or tissue over it. Dr. Rachna Pande is a specialist in internal medicine
