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You’ve got an itchy, red, uncomfortable rash on your skin, and it’s driving you crazy. But what is it? Could it be ringworm or eczema? How can you tell the difference? Let’s go head-to-head on ringworm vs. eczema.
What is ringworm?
Unlike the name might suggest, ringworm is not caused by a worm but by a group of fungi known as dermatophytes. The actual fungal infection is referred to in medical terms as dermatophytosis or tinea, usually followed by a Latin word that designates its location. Some examples of common fungal infections include tinea pedis (athlete’s foot), tinea cruris (jock itch), or tinea corporis (ringworm on the body) (Leung, 2020).
Ringworm shows up in different ways depending on the location of the body but is almost always characterized by itching, redness, and scaling.
Ringworm is contagious. A person can be infected in several ways, including skin-to-skin contact, by touching contaminated objects (brushes, hats, clothes, towels), and coming in contact with an infected pet. Ringworm is quite common in cows, dogs, and cats, so farmers or people involved with animal rescue shelters could become infected (Newbury, 2014).
Ringworm on the body
According to the American Academy of Dermatology Association (AAD), ringworm of the body (tinea corporis) forms distinctive red, scaly, circular patches that often have a slightly raised red border with a center that is less red or with normal-appearing skin (AAD, n.d.-a). The raised circular border appears as a “ring” shape, giving rise to the term ringworm (Yee, 2021). In medicine, no one thought it to be associated with actual worms of any description (Homei, 2013).
Other types of ringworm
Ringworm of the scalp (tinea capitis) is most common in children between 3 and 14 but can affect any age group. It causes patches of scaling, an itchy scalp, and hair loss in the affected areas (Al Aboud, 2020). Jock itch is most common in adult males and adolescents. It appears as an itchy rash starting in the groin and extending down the insides of one or both thighs. It can even affect the area around the anus (Pippin, 2020). Athlete’s foot is very common and usually affects the areas between the toes, causing intense itching, scaly patches, and redness (Nigam, 2020).
Ringworm can also affect the nails (tinea unguium), which is known as onychomycosis. Infected fingernails become brittle, white, and opaque, but infected toenails, while brittle, are usually thick and yellow (Leung, 2020).
What is eczema?
In contrast to ringworm, eczema is a non-contagious group of skin disorders with irritated, inflamed skin. Eczema is not just one disease, but a family of skin diseases. It includes various conditions, such as atopic dermatitis and contact dermatitis, which are the most common ones. Nummular eczema is less common than other types of eczema, but it can be confused with ringworm (AAD, n.d.-b).
What is eczema? The causes, symptoms, and treatments explained
These various eczema types present differently and have different triggers. Still, they all have some degree of dry skin, itching, and redness in common.
- Atopic dermatitis (also sometimes called atopic eczema) is the most common type of eczema. It affects mostly children, with dry, itchy patches on the face and scalp. Older children and teens may develop patches in joint creases, such as elbows, knees, and neck (Kolb, 2020). Adults can also develop atopic dermatitis, with up to 25% of adult cases thought to be new-onset atopic dermatitis (Lee, 2019).
- Contact dermatitis is just what its name implies—a rash that develops from contact with an irritating substance such as poison ivy, make-up, jewelry, nickel, and latex gloves. Itching and burning, hives, scaly skin, and a red swollen rash are common (AAD, n.d.-b).
- Nummular eczema, also known as discoid eczema, gets its name from the Latin word for “coin-shaped,” as this form of eczema consists of round or oval patches of red skin, which can be intensely itchy (Hardin, 2021). The patches appear red, brown, or pink and commonly show up on the arms, legs, hands, feet, and torso. Because of their round or oval shape, nummular eczema lesions can be easily confused with ringworm (AAD, n.d.-b).
How is ringworm diagnosed?
A primary care provider can usually diagnose ringworm, especially if the lesion presents as a classic circular patch with a raised red border and a clearing center. If the skin symptoms are less clear, you may need to see a dermatologist. They can examine a small skin scraping under a microscope or send the scraping to a laboratory for a fungal culture (Petrucelli, 2020).
Ringworm treatment and management
In many cases, ringworm can be treated with creams, lotions, or powders containing antifungals such as clotrimazole or miconazole, and many of those treatments are available over the counter. If the infection does not respond well to that treatment, your healthcare provider may prescribe a cream containing a higher concentration of antifungal medication. Sometimes, oral antifungals, such as griseofulvin, fluconazole, terbinafine, or itraconazole, are necessary to clear up the infection. That’s the case when the lesion is recurrent, chronic, or doesn’t get better after using prescription-strength topical antifungal products (Leung, 2020).
In addition to antifungals, your healthcare provider might recommend hygiene measures that make the growing conditions for the fungus unfavorable. These include wearing well-ventilated clothing, avoiding bandaging the area, and changing damp or wet clothes frequently.
Since ringworm is contagious, it is essential to prevent reinfecting yourself as well as passing the fungus on to others (Ely, 2014). According to the American Academy of Dermatology (AAD), a person with ringworm should avoid touching the rash and wash their hands frequently. Bedding, as well as clothing, should be washed frequently in detergent and hot water. You should wear shower shoes at the gym or pool locker rooms, and a shower should be taken after a workout, followed by changing into clean clothes (AAD, n.d.-a).
Is eczema contagious? What you need to know
Eczema diagnosis and treatment
Let’s say you go to your general healthcare provider with a rash, and the treatments they try don’t work. In that case, you’ll likely be referred to a dermatologist who will take a thorough medical and family history, conduct a physical exam, and may run tests to look for common allergens.
Since there is no definitive cure for eczema, the goal is to control the symptoms, including itchiness. Many treatments are available to help you maintain a good quality of life and ease symptoms like itchiness. You may benefit from a combination of lifestyle, over-the-counter, and prescription therapies. Treatment consists of (AAD, n.d.-b):
- Medications such as topical corticosteroids and antihistamines can help reduce the swelling, itch, and tenderness.
- Home remedies (moisturizers, cool compresses, cool-mist humidifier).
- Identification and removal of irritants
- Stress control
Also, research into new therapies continues (Fishbein, 2020). Some dermatologists see positive results in atopic dermatitis using phototherapy if first-line treatments have failed (Sidbury, 2014).
If you think you may have ringworm or eczema, see your healthcare provider for a proper diagnosis and treatment plan.
- Al Aboud AM, Crane JS. Tinea Capitis. [Updated 2020 Aug 10]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK536909/
- American Academy of Dermatology (AAD). (n.d.-a). A to Z Diseases: Ringworm. Retrieved on Apr 8, 2021 from https://www.aad.org/public/diseases/a-z/ringworm-overview
- American Academy of Dermatology (AAD). (n.d.-b). Eczema Resource Center. Retrieved on Feb 8, 2021 from https://www.aad.org/public/diseases/eczema/
- Ely, JW, Rosenfeld, S., Stone, M.S. (2014). Diagnosis and Management of Tinea Infections. American Family Physician;90(10):702-711. Retrieved on February 8, 2021 from https://www.aafp.org/pubs/afp/issues/2014/1115/p702.html
- Fishbein, A. B., Silverberg, J. I., Wilson, E. J., & Ong, P. Y. (2020). Update on Atopic Dermatitis: Diagnosis, Severity Assessment, and Treatment Selection. The journal of allergy and clinical immunology. In practice, 8(1), 91–101. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S221321981930635X?via%3Dihub
- Hardin CA, Love LW, Farci F. Nummular Dermatitis. [Updated 2021 Jan 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565878/
- Homei A, Worboys M. (2013). Fungal Disease in Britain and the United States 1850–2000: Mycoses and Modernity. Basingstoke (UK): Palgrave Macmillan; 2013. Chapter 1, Ringworm: A Disease of Schools and Mass Schooling. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK169210/
- Kolb L, Ferrer-Bruker SJ. Atopic Dermatitis. [Updated 2020 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448071/
- Lee HH, Patel KR, Singam V, Rastogi S, Silverberg JI. (2019). A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. Journal of the American Academy of Dermatology;80(6):1526-1532.e7. doi: 10.1016/j.jaad.2018.05.1241. Retrieved from https://pubmed.ncbi.nlm.nih.gov/29864464/
- Leung, A., Lam, J. M., Leong, K. F., Hon, K. L., Barankin, B., Leung, A., & Wong, A. (2020). Onychomycosis: An Updated Review. Recent patents on inflammation & allergy drug discovery, 14(1), 32–45. doi: 10.2174/1872213X13666191026090713. Retrieved from https://pubmed.ncbi.nlm.nih.gov/31738146/
- Leung, A. K., Lam, J. M., Leong, K. F., & Hon, K. L. (2020). Tinea corporis: an updated review. Drugs in context, 9, 2020-5-6. doi: 10.7573/dic.2020-5-6. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32742295/
- Newbury, S., & Moriello, K. A. (2014). Feline dermatophytosis: steps for investigation of a suspected shelter outbreak. Journal of feline medicine and surgery, 16(5), 407–418. doi: 10.1177/1098612X14530213. Retrieved from https://journals.sagepub.com/doi/10.1177/1098612X14530213
- Nigam PK, Saleh D. Tinea Pedis. [Updated 2020 Sep 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK470421/
- Petrucelli, M. F., Abreu, M. H., Cantelli, B., Segura, G. G., Nishimura, F. G., Bitencourt, T. A., et al. (2020). Epidemiology and Diagnostic Perspectives of Dermatophytoses. Journal of fungi (Basel, Switzerland), 6(4), 310. doi: 10.3390/jof6040310. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712040/
- Pippin MM, Madden ML. Tinea Cruris. [Updated 2020 Dec 28]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK554602/
- Sidbury, R., Davis, D. M., Cohen, D. E., Cordoro, K. M., Berger, T. G., Bergman, J. N., et al. (2014). Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. Journal of the American Academy of Dermatology, 71(2), 327–349. doi: 10.1016/j.jaad.2014.03.030. Retrieved from https://www.jaad.org/article/S0190-9622(14)01264-X/fulltext
- Yee G, Al Aboud AM. Tinea Corporis. [Updated 2021 Jan 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK544360/
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.