Fungal skin infection (ringworm, tinea)
Also called: ringworm, tinea, dermatophytosis, jock itch, athlete's foot, scalp ringworm (tinea capitis)
Ringworm (tinea) is a common skin infection caused by a fungus, not a worm. It gives an itchy, scaly, often ring-shaped rash. Most cases on the body, groin or feet clear with antifungal creams, but scalp and nail infections need tablets from a doctor.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Ringworm is a skin infection caused by a fungus. Its medical name is tinea. Despite the name, no worm is involved. The fungus grows and multiplies on the skin, and does best where skin is warm and damp. It can affect almost any part of the body, including the scalp, beard area, body, groin (often called jock itch) and feet (often called athlete's foot). It can also infect the nails.
Ringworm spreads easily. You can catch it by touching a person or animal that has it, or by sharing items such as towels, combs, bedsheets and unwashed clothes. Cats are common carriers. Damp floors in showers and around pools can also spread it, and soil is a less common source.
The good news is that ringworm on the skin usually clears with antifungal creams, gels, sprays or powders that a pharmacist can recommend. You need to keep using the treatment for the full time advised, even after the rash fades. Ringworm on the scalp or in the nails is different: creams do not reach the fungus there, so a doctor usually prescribes antifungal tablets. Steroid creams used on their own can make ringworm worse, so it is best to have the rash checked before treating it.
In Pakistan
A study of 207 people with scalp ringworm at Jinnah Postgraduate Medical Centre, Karachi (2019), found that about 1 in 5 of the fungi grown were resistant to fluconazole and about 1 in 9 to terbinafine, so a laboratory test helps when scalp ringworm does not clear.
Symptoms
- A rash that is scaly, dry, swollen or itchy
- A rash that is often ring-shaped, though it can look different on the face, neck or scalp
- Redness on lighter skin; on brown and black skin the colour change may be harder to see
- A rash that slowly grows, or new patches appearing nearby
- Patchy hair loss when the scalp or face is affected
- Changes in the nails when they are infected
Causes and risk factors
Causes
- A fungus (tinea) that grows and multiplies on the skin, scalp or nails
- Close contact with a person who has ringworm
- Contact with an infected animal, especially cats
- Sharing towels, combs, bedsheets or unwashed clothes
- Damp surfaces such as shower floors and pool sides; less often, soil
What makes it more likely
- Skin that stays warm and damp, for example from sweating
- Small cuts or injuries to the skin, scalp or nails
- Living closely with someone who has ringworm
- Having pets that may carry the fungus
- A weakened immune system, for example from chemotherapy, steroid medicines or diabetes
- Using steroid creams on the rash, which can make the infection worse
Complications
If ringworm is not treated, it can spread to other parts of your body and to other people in your home. Scratching the rash can also spread it. Scalp ringworm can cause patches of hair loss. A fungal nail infection that is not treated can spread to the skin around it, and in people with diabetes nail infections are more likely to come back. Using steroid creams on ringworm can make it worse. In some parts of the world, a more severe type of ringworm has appeared that spreads widely and does not always respond to the usual antifungal medicines.
When to see a doctor
- You think you or your child has ringworm on the scalp
- The rash has not got better after using the treatment for the full time advised
- The rash is more severe or widespread than usual
- You have a weakened immune system, for example from chemotherapy, steroid medicines or diabetes
- Your nails have changed colour or shape and you think it may be a fungal infection
- You had contact with someone who has a severe ringworm infection, or the rash started after travel
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Diagnosis
A pharmacist or doctor can usually tell that a rash is ringworm by looking at it and asking how it started. For a simple rash on the body, groin or feet, tests are not usually needed and treatment can begin straight away.
A doctor may scrape a few skin flakes (skin scrapings), or take hairs or nail clippings, and send them to a laboratory to look for the fungus. This is done when the scalp is affected, when the infection is severe or covers a large area, or when it has not cleared with treatment. Nails are tested before treatment starts, because nail changes have many other causes and nail treatment takes a long time. Tell your doctor if you have travelled recently, as some types of ringworm seen in other countries are harder to treat.
Treatment
- Show the rash to a pharmacist or doctor to check that it is ringworm before you treat it.
- For ringworm on the body, groin or feet, use an antifungal cream, gel, spray or powder as advised, usually for a few weeks.
- Keep using the treatment for the full time advised, even after the rash has cleared, so the fungus does not come back.
- Do not put steroid creams on ringworm or on a rash that might be ringworm, because they can make it worse.
- Scalp ringworm needs antifungal tablets prescribed by a doctor, often with an antifungal shampoo, because creams do not work on the scalp. Treatment usually lasts weeks to months.
- Fungal nail infection is tested first and then usually treated with antifungal tablets; it can take months to a year to clear.
- If the rash does not improve, see a doctor. Samples may be sent to a laboratory, and a different medicine may be needed. If a pet may be the source, take it to a vet.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
- Steroid creams used alone (Hydrocortisone): do not use on ringworm or a rash that may be ringworm, as steroids can make the infection worse
| Group | Role | Medicines |
|---|---|---|
| Topical antifungals (creams, gels, sprays, powders) | first choice for ringworm of the body, groin and feet; many are available from a pharmacy | Terbinafine (100 brands), Clotrimazole (139 brands), Miconazole (53 brands), Ketoconazole (1 brand) |
| Oral antifungals (tablets) | prescribed by a doctor for scalp and nail infections, and for skin infections that are severe, widespread or not clearing; your doctor decides the medicine and dose | Terbinafine (100 brands), Griseofulvin (5 brands), Itraconazole (54 brands), Fluconazole (217 brands) |
Also used (not yet in our price list): Undecenoic acid (for athlete's foot), Tolnaftate (for athlete's foot), Antifungal shampoo (used with tablets for scalp ringworm)
Self-care and prevention
Self-care
- Start treatment as soon as you notice the rash
- Keep using the treatment for the full time advised, even if the rash clears
- Try not to scratch the rash, as this can spread it
- Keep your skin clean and wash your hands after touching the rash, animals or soil
- Wash towels and bedsheets regularly
- Do not share towels, combs or bedsheets while you have ringworm
- Take a pet to the vet if it has patches of missing fur
Prevention
- Do not share towels, combs, bedsheets or clothes
- Wash your hands after handling animals or soil
- Check your skin if you have been close to a person or animal with ringworm
- Get pets with bald or scaly patches checked by a vet
- Wash towels and bedsheets often
Common questions
Is ringworm caused by a worm?
No. Ringworm is caused by a fungus that lives on the skin. The name comes from the ring shape the rash often has.
Can my child go to school with ringworm?
Yes, once treatment has started. Let the teachers know, and make sure your child does not share towels or combs with other children.
Can I use a cream that mixes a steroid with an antifungal?
Steroid creams on their own can make ringworm worse and should not be used. A large review found only weak evidence about mixed steroid and antifungal creams. Use one only if a doctor advises it after checking the rash.
Why does my ringworm keep coming back?
Common reasons are stopping treatment too early, using steroid creams, or catching it again from a family member, a pet or shared items. Some fungi do not respond well to the usual medicines. If it keeps coming back, see a doctor, who may send a sample to a laboratory.
Why do creams not work on scalp ringworm?
Creams, lotions and powders do not clear ringworm on the scalp. It usually needs antifungal tablets from a doctor, often with an antifungal shampoo.
Sources
- CDC. Treatment of Ringworm (2026).
- Cochrane. Treatments applied to the skin for fungal infections of the groin and body (2014).
- NHS. Ringworm - NHS (n.d.).
- NHS Forth Valley (antimicrobial prescribing guidance). Fungal skin infection | Right Decisions (n.d.).
- MedlinePlus. Ringworm: MedlinePlus Medical Encyclopedia (n.d.).
- Journal of the Pakistan Medical Association. The rising menace of antifungal resistance in dermatophytes among the patients of tinea capitis (2022).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
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