Ringworm; why is it not leaving me?
Background
The situation that we have been witnessing has never been so serious ever! Every other one is suffering from ringworm. Now, everyone knows the name, and they also have come to know about its seriousness.
But there are many who do not know this and they simply cannot accept incomplete cure of their disease after one month of therapy. I have seen patents patients who have shown other doctors and did not get a satisfactory response and come to me for a better treatment thinking it was the failure of the previous doctor. I can understand many of my patients doing the same thing and consulting other. Patient getting significantly annoyed and expressing their unhappiness is not uncommon in today’s practice. We, the doctors are often frustrated with this kind of poor response after the right treatment. The situation is seriously unsatisfying, both for doctors and suffering patients and I know, things will be worse during for the next few years.
What is ringworm?
It is a type of fungal infection. The scientific name for this condition is ‘tinea’ and the dermatologists are the doctors who treat this skin problem.
How does it look?
[Ringword in armpit]
As the common name suggests, this often appears as a ‘ring’ shaped skin eruption. Generally, multiple rings merge to form a larger, irregular patch and the margin is formed by the convex outer border of many rings. Commonest site is body folds like groin (thigh junction), under breast and axilla (armpit). It can spread beyond these areas in untreated cases and nowadays, virtually no areas are immune.
Read my previous post to know more about this.
How does it spread?
Primarily, this starts over the highly moist skin like groin and axilla. This is infectious. So, once it enters the body, it can spread anywhere. Once one member of the family is affected, other members may be affected easily. Clothes, towels may help to spread within the family. Close body contact among children in schools or playground also spread the disease through direct contact.
What is the concern?
Although this infection is reported since unknown time in history, recently, maybe since last 3 to 4 years, this infection has shown a definite change in its behavior. A large number of populated is getting affected and the prevalence has turned so high that it has penetrated almost every household.
Not only increased prevalence, the chance to get cured with all available drugs has become extremely low. Increasing the dose and the duration of the drug within safety limit, using multiple drugs simultaneously or sequentially, detailed advising on personal hygiene, and mandatory treatment of all family members are all tried for a cure that has become a tough target to achieve by the doctors.
Why is this menace?
The sudden spurt in prevalence level, poor response to drugs and early recurrence after an apparent satisfactory cure is unexplained by the researchers. Various factors are proposed but all are difficult to prove.
Over the counter (OTC) drugs are suspected to be one big factor in the emergence of poor efficacy of the right drugs. In India and many other developing countries, most drugs are available as OTC, meaning availability of these without prescription. Improper dosage, duration has caused inefficiency as well as toxicities.
Common people have made the medicine shop personnel as first-line medical advisors and it seems many of them have not disagreed with this either. The immediate result is the selling of many vital drugs by them based on their ‘experience’ on the symptom-based evaluation of the condition. Such evaluation is usually a discussion that too, mostly with the family members of the patient. The dose, the duration is often wrong and it leaves no scope for discussion that indication or necessity of use of the drugs prescribed is often grossly erroneous. The result is various adverse events including the resistance to the drug. Lack of awareness, regulation and most importantly, the minimum importance is given to proper medical consultation for a negligible condition like skin disease have created the situation worse. Now, if you closely follow what the medicines are commonly sold for itching of the groin or apparent fungal infection by the medicine shops, someone must be stunned. Most, if not all contain some or other very strong steroids. This gives an immediate impression of cure significant improvement of all symptoms like itching. The relief creates a faith in the cream and the sufferer now buys the drugs by himself each time he develops the symptom. Steroid by its distinctive property relieves all symptoms at the cost of various adverse effects like suppression of local immunity, poor response to drugs, leading to a wider spread of the disease silently. Skin thinning, atrophy and even break (stria) are not an uncommon complication of steroid creams. It is important to note that stria develops naturally in the female abdomen during pregnancy.
Fungus might have developed some resistance to the available drugs as a natural protective mechanism to protect its extinction. This is seen in all organisms. Research is going on on newer drugs.
What to do now?
Keep yourself dry. Use light, cotton clothes
Change your dresses as frequently as possible. A frequent sufferer may consider carrying an extra set in office if there is a facility for a change.
Do not use cotton threads in your body. Read their harmful effects.
Take bath with a normal soap daily. No need for a special soap.
Consider fungal infection as very infectious. Avoid contact with family members. Use separate towels, beds, and soap.
Cut your nails regularly.
Finally, it may not be a wise decision to consider fungal infection as a less serious problem. Ringworm that has been known for a self-limiting harmless condition, has become virulent. It is always best to depend on the right person for the right advice. Regular updating of knowledge is required and is the key to success of a specialist doctor. Dermatologists are the right person a skin ailment.
