Ringworm—Child Care and Schools

What is ringworm?

Ringworm is a fungal infection of the skin of the body, feet, or scalp.

What are the signs or symptoms?

• Skin of the body or feet

  • ? Red, circular patches with raised edges and central clearing

  • ? Cracking and peeling of skin between toes

• Scalp

  • ? Patchy areas of dandruff-like scaling with or without hair loss

  • ? Redness and scaling of scalp with broken hairs or patches of hair loss

What are the incubation and contagious periods?

• Incubation period: 1 to 3 weeks but can be shorter.

• Contagious period: A child with ringworm of the skin is infectious until the lesion starts to shrink. Once the child begins treatment with antifungal medication, the child is no longer considered infectious. Spores of the fungus that cause ringworm of the scalp are found on objects in the environment and on people who have no obvious lesions.

How is it spread?

Contact with infected humans or animals (eg, pet rodents, cats, dogs) or contaminated surfaces or objects, such as combs, brushes, towels, clothing, mats, or bedding

How do you control it?

• Early treatment of infected people.

• Examination of siblings and other household contacts.

• Do not share bike helmets without wiping contact surfaces with a cloth dampened with water. Only use water to clean helmets because some products contain chemicals that make the impact-absorbing materials and straps less safe.

• Covering skin lesions. Direct contact with areas of infection should be avoided.

Tinea corporis in a 4-year-old with an enlarging lesion on the right arm

COPYRIGHT LARRY I. CORMAN

A child's arm shows a perfectly round, raised, scaly red patch of skin with slightly jagged edges and a couple inches in diameter.

Ringworm of the scalp (tinea capitis)

CHARLES PROBER, MD

View of the top and left side of a person's head with an uneven distribution of dark hair, showing red, patchy areas of hair loss across the scalp and areas of scaling throughout.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Give medication as prescribed.

• On arrival and by observation while the child is in care, note any areas of the skin or scalp that might be infected.

Exclude from educational setting?

At the end of the day, the parent/guardian should consult a pediatric health professional and, if ringworm is confirmed, the child should start treatment before returning. If treatment is started before the next day, no exclusion is necessary. However, the child may be excluded until treatment has started.

Readmit to educational setting?

Yes, when all the following criteria are met:

Once treatment is started. Athletes with ringworm of the body (tinea corporis) in sports with person-to-person contact cannot participate in matches for 72 hours after starting treatment unless the area can be covered.