Fungal Infection (Ringworm / Tinea)

A fungal skin infection, known in most Indian homes as daad, is caused by a group of fungi called dermatophytes that live on the dead outer layer of the skin, hair and nails. They grow best where skin stays warm, damp and covered, which is why the groin, inner thighs, waist, underarms, buttocks, feet and the folds under the breasts are the usual sites. The classic patch is round, red and scaly with a raised active border and a slightly clearer centre, and it is almost always itchy. Doctors call it tinea, and add a second word for the site involved, such as tinea corporis on the body, tinea cruris in the groin and tinea pedis on the feet.

Over the last several years, dermatologists across India have been seeing a very different kind of tinea from what textbooks used to describe. Patches are larger, more widespread, more inflamed, harder to clear, and they come back within weeks of stopping treatment. A major reason is the easy availability of over-the-counter combination creams that contain a strong steroid mixed with an antifungal and an antibiotic. These creams settle the itching within a day or two, so people keep using them, while the fungus quietly spreads deeper and wider under a suppressed immune response. Add to this our heat and humidity, tight synthetic clothing, long hours in closed shoes, shared towels and bedsheets in hostels and joint families, and the habit of stopping treatment the moment the itching improves. Most people also delay seeing a doctor because daad is dismissed as a minor skin problem, and by the time they come in, the infection has been going on for months and has often spread to other members of the family.

Diagnosis & Treatment

Diagnosis usually begins with a careful look at the pattern, site and border of the patches, along with questions about how long it has lasted, what creams have already been used, and who else at home is itching. Because steroid creams change the way tinea looks, a dermatologist will often ask to see the packet or strip of whatever was applied earlier. Where the picture is unclear, or where the infection keeps returning, simple bedside tests such as a KOH examination of skin scrapings under a microscope may be used, and in selected cases a fungal culture or dermoscopy may be advised. Similar-looking conditions such as eczema, psoriasis and pityriasis rosea are ruled out before treatment is planned.

Treatment falls into a few broad categories. Antifungal creams applied correctly to the patch and a margin of normal skin around it are enough for small, early, limited disease. Extensive, long-standing, recurrent or steroid-modified infection usually needs oral antifungal tablets taken for several weeks, sometimes longer, and the exact medicine and duration depend on the site, the extent, other medicines being taken and existing health conditions. Where tablets are used for a long period, a doctor may advise blood tests to monitor the liver and check for interactions with other medicines. Any steroid-containing cream is stopped, and the skin may look and feel worse for a short while as the suppressed inflammation comes back to the surface. Antihistamine tablets and plain moisturisers are often added for comfort. Realistically, most people need two to six weeks of treatment for straightforward infection, and difficult or long-standing cases can take several months. Improvement in itching is usually felt within the first week, which is exactly when people are tempted to stop.

The single most common mistake is stopping early. The fungus survives in the skin after the redness fades, so treatment is normally continued for a period beyond the point where the skin looks clear, as advised by the doctor. The second common mistake is treating only one person. Tinea spreads easily within a household through shared towels, clothes, bedding and bathrooms, so anyone at home with itching or patches should be examined and treated at the same time, otherwise the infection simply passes back and forth. Alongside medicines, day-to-day habits matter a great deal: bathe daily and dry the skin folds thoroughly, wear loose cotton clothing, change innerwear and socks daily, wash clothes and bedsheets in hot water and dry them in the sun, iron clothes if possible, stop sharing towels and clothing, and avoid scratching. Please do not buy the cream a friend or chemist recommended, do not restart an old cream when patches return, and do not use bleach, kerosene, ash, neem paste or other home applications on inflamed skin, as these frequently cause chemical burns and make the picture harder to treat.