What is ringworm? What is eczema?

Ringworm and eczema both cause itchiness.
Ringworm and eczema both cause itchiness.

Ringworm is a common fungal infection of the skin (ringworm is also termed tinea or dermatophytosis), and the different types of ringworm are named for the location of the rash on the body (for example, tinea corporis [arm and/or leg], scalp [tinea capitis]). These infections were originally termed ringworm because they form circular rashes (rings) with redness and itchiness. Hair loss may occur. Eczema is a skin condition (dermatitis) in which patches of skin become dry, rough, and inflamed with blisters that are itchy and cause scratching, bleeding, and typically have no obvious cause. Eczema is also termed atopic dermatitis and has subtypes like contact dermatitis, dyshidrotic eczema, stasis dermatitis, and neurodermatitis. It is a chronic skin disease that usually begins in babies (infants and toddlers) and can continue into adulthood. In many individuals, the cause is unknown. Stages of eczema are termed acute, subacute, and chronic.

What are the causes and risk factors for ringworm and eczema?

About 40 different fungal species can cause ringworm. Signs and symptoms appear about 4-14 days after exposure to the fungus. Ringworm is contagious. Risk factors include direct contact with an individual (or animal) infected with the fungus or indirect contact by sharing clothing or towels from someone infected. Other risk factors include contact sports like

  • wrestling,
  • walking barefoot in a locker room,
  • close contact with animals, and
  • wearing tight clothing.

In contrast to ringworm, the cause of eczema is unknown, although researchers suggest risk factors such as a family history, genetics, skin colonization with S. aureus, reduced exposure to childhood diseases, and a hot climate are risk factors to trigger the disease or a flare-up. Eczema is not contagious.

Is Ringworm Contagious?

Ringworm is very contagious. Ringworm can be transferred from person to person by direct contact (skin to skin) and also by indirect contact such as touching an infected person's clothing or even by touching a bench or other object that has contacted an infected person's skin. It can be acquired in swimming pool and hot tub areas by indirect contact. Humans can acquire ringworm from animals (for example, from dogs).

How do signs and symptoms of ringworm differ from those of eczema?

Eczema usually has no ring formation on the skin in contrast to ringworm. The groin and axillary regions are spared in eczema but are not spared in certain ringworm infections (for example, tinea cruris or "jock itch"). Ringworm is contagious, but eczema is not. Eczema has incessant pruritis (chronic severe itching sometimes with a burning sensation) that can trigger uncontrolled scratching. This is the major sign of the disease. Eczema patches on skin are usually not in a ring formation and are leathery.

What tests do doctors use to diagnose ringworm and eczema?

Ringworm may be presumptively diagnosed by simply observing the skin lesions. If a black light is used, the fungi will glow (fluoresce). Skin scrapings may be used to microscopically confirm the presence of fungi or be used to culture and identify fungi. Eczema is diagnosed essentially the same way as ringworm to rule out infections. Some doctors may do a serum IgE level to support the diagnosis of eczema.

How do treatments and home remedies for ringworm differ from those for eczema?

Treatments of ringworm are directed at curing the infection. Treatments depend on the location on the body and the severity of the infection. Over-the-counter antifungals like clotrimazole, ketoconazole, miconazole, and terbinafine treat ringworm on the skin. Scalp ringworm usually needs prescription-strength antifungals like griseofulvin, terbinafine, itraconazole, or fluconazole. Eczema treatments do not cure the disease but are geared to reduce symptoms and/or complications of the disease. Topical creams and ointments may contain corticosteroids, tacrolimus, pimecrolimis, or crisaborole. Dupilumab (injection) may also be used to modulate immune system function. Some creams claim to improve the skin's barrier function and are used in combination with other drugs like topical steroids. In addition, antihistamines may reduce pruritis, and antibiotics and antifungals may treat the skin lesions if infected. Phototherapy (UVB light) may also reduce eczema symptoms in some patients.

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What is the prognosis for ringworm and eczema?

The prognosis of ringworm is excellent when treated appropriately. Ringworm is curable. The prognosis ranges from good to fair for eczema. Some individuals may get flares of this disease over their lifetime, but treatments can reduce the symptoms. There is no cure for eczema.

Is it possible to prevent ringworm and eczema?

It is possible to prevent and reduce the risk of ringworm infections by

  • avoiding direct contact with an infected individual,
  • by not sharing towels and other personal items with others,
  • washing your hands after handling pets,
  • wearing loose clothing, and
  • staying hydrated.

Athletes in contact sports should shower immediately after activity and should not share sports gear like helmets. Reduce your eczema risk by

  • avoiding any substances that trigger symptoms,
  • taking all medication as prescribed,
  • moisturizing your skin,
  • avoiding sudden changes in temperature and humidity (may use a humidifier),
  • reducing stress,
  • use of fragrance-free cleaners, and
  • wearing protective gloves and clothing if you handle chemicals.

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Medically Reviewed on 12/17/2019
References
Kim, B. "Atopic dermatitis." Medscape. August 2, 2019. <https://emedicine.medscape.com/article/1049085-overview>.

United States. CDC. "About Ringworm." August 6, 2018. <https://www.cdc.gov/fungal/diseases/ringworm/definition.html>.
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