MAY , 2023 | THE HEALTH

SEPSIS ALERT

BY ASSOC PROF DR TAN TOH LEONG

AND BY ASSOC PROF DR DING CHUAN HUN

The infection manifests as a circular red rash with a central clearing resembling a ring . Anyone ( including healthy individuals ) can get ringworm .

Medical professionals refer to ringworm as either “ tinea ” or “ dermatophytosis .” Ringworm infections can also sometimes be named based on their location on the body – for instance , a foot ringworm is also known as “ athlete ’ s foot ” while ringworm affecting the groin and inner thigh can be called “ jock itch ”.

Despite the abundance of hair that helps to protect or shield our scalp , the human scalp is not spared from infection . Scalp ringworm was once dubbed “ scald-head ” in the early nineteenth century .

In addition to the discernable reddish ring-like lesion on the skin , a ringworm infection can cause the skin to become scaly and itchy . If the scalp if affected , hair loss or even bald patches can be expected .

RISK FACTORS

Several fungal genera collectively known as dermatophytes have been implicated as causative agents of ringworm , of which Trichophyton and Microsporum are among the most notable . In contrast to other fungal genera that infect humans ( e . g ., Aspergillus and Candida ), dermatophytes are able to utilise the keratin in human skin , nails and hair as their nutrient source . Thus , the symptoms of ringworm are attributed to allergic and inflammatory responses elicited by the host in response to the presence of the dermatophyte ( and its metabolic products ) on the skin .

Among the risk factors for ringworm are using public showers or pools barefooted , playing contact sports such as rugby or wrestling , and

Assoc Prof Dr Tan Toh Leong is an Emergency Medicine Physician and Medical lecturer with the Department of Emergency Medicine , Faculty of Medicine , Universiti Kebangsaan Malaysia ( UKM ) and President & Founder of Malaysian Sepsis Alliance ( MySepsis ), while Assoc Prof Dr Ding Chuan Hun is a Clinical Microbiologist and Medical Lecturer with the Department of Medical Microbiology & Immunology , Faculty of Medicine , UKM and a member of MySepsis . sharing items intended for personal use such as footwear , combs or towels . Wearing damp or sweaty garments such as socks and underwear can also predispose a person to ringworm because fungi thrive in high-moisture environments .

Nonetheless , it is imperative to note that humans are not the sole reservoirs for dermatophytes – ringworm may also be contracted via close contact with domesticated farm animals ( e . g ., cattle and horses ), household pets ( e . g ., cats and dogs ) and even soil . Accordingly , washing hands with soap and running water after physical contact with such animals or soil is advised . While the infection can be diagnosed clinically by general practitioners and dermatologists alike , a definite diagnosis can only be achieved through the culture of skin scrapings or epilated hairs by a microbiology laboratory .

Among the risk factors for ringworm are using public showers or pools barefooted , playing contact sports such as rugby or wrestling , and sharing items intended for personal use such as footwear , combs or towels .”

MEDICATIONS TO AVOID

Topical corticosteroids ( in the form of creams or ointments ) are frequently employed by dermatologists to manage a variety of skin rashes . Some , such as discoid eczema , pityriasis rosea , psoriasis and contact dermatitis , can also present with ring-like skin lesions . Therefore , some individuals may unwittingly self-treat a skin rash with a potent steroid preparation without realising that it is ringworm . Alas , the respite in redness and itch brought about by steroid therapy alone does not indicate that the ringworm has been treated .

On the contrary , because of the steroid-induced suppression or weakening of the skin ’ s natural defenses , the fungus is able to propagate and involve more body areas or even invade deeper into the skin . A steroid-treated ringworm lesion can also have an atypical appearance , making it challenging for medical professionals to diagnose and manage .

Thus , an antifungal agent ( e . g ., terbinafine , clotrimazole or miconazole ) is the cornerstone of ringworm management . The antifungal agent is usually prescribed for two to three weeks and the extent of the infection would dictate whether the agent is to be administered orally or topically .

Although preparations combining a mild steroid ( typically hydrocortisone ) with an antifungal agent do exist and can even be bought over the counter in Malaysia , the general public should refrain from using them unless specifically sanctioned by a medical professional . – The Health