Q: I have a new rash on my body and think it might be ringworm. I am unsure what I should use when browsing all the options at the pharmacy and was also told pharmacists in New Brunswick can prescribe for this condition. Should I just use something over the counter or make an appointment with my pharmacist?
Ringworm, also known as tinea, is a common fungal skin infection caused by dermatophytes, a group of fungi that feed on keratin, the protein found in the outer layer of the skin. Despite its name, ringworm is not caused by a worm. The infection is classified according to the area of the body it affects. Tinea pedis, refers to athlete’s foot, tinea corporis affects the body, and tinea cruris, commonly known as jock itch, affects the groin.
These infections are highly contagious and can spread through direct skin-to-skin contact, contaminated surfaces such as public showers or sports equipment, and even from infected pets, or soil. Warm, humid conditions create an ideal environment for fungal growth, making excessive sweating a common risk factor. People with diabetes, weakened immune systems, or a family history of fungal infections may also be more susceptible.
The goals of treatment are to eliminate the fungus, relieve symptoms, prevent the infection from spreading to other parts of the body or to other people, and reduce the risk of secondary bacteria infection.
Ringworm on the body typically appears as a circular, red, scaly patch that gradually expands outward, often with a clearer-looking centre. It may be itchy, although not always. Athlete’s foot commonly begins between the toes, where the skin may become flaky, cracked, soggy or peel. Jock itch usually causes an itchy red or brown rash in the groin that may become scaly over time.
Several effective antifungal medications are available without a prescription. The most commonly recommended belong to a group called the azoles and include clotrimazole, miconazole, and ketoconazole. These are available as topical creams, while ketoconazole is available as a shampoo for certain fungal infections. You may also find tolnaftate (Tinactin) on pharmacy shelves, although it is generally considered less effective than the azole antifungals.
For best results, apply the medication not only on the visible rash but also 2 to 3 centimeters beyond its border, since the fungus often extends beyond what you can see. Clean and thoroughly dry the skin before each application. Most products are applied twice daily for two to four weeks, depending on the location and severity of the infection. Even after the rash appears to have resolved, continuing treatment for an additional week can help reduce the risk of recurrence.
Creams and lotions are generally preferred over sprays or powders because they maintain better contact with the skin and tend to be more effective. However, antifungal powders can still be helpful in areas prone to excess moisture, particularly as part of preventing future infections.
Keeping the affected area clean and dry is an important part of treatment. Wear loose-fitting cotton clothing, change socks or underwear regularly if the infection involves the feet or groin, and allow your feet to air out whenever possible. Avoid using cornstarch-based powders, as they may actually promote fungal growth.
One common mistake pharmacists see is the use of over-the-counter hydrocortisone cream to relieve itching before confirming the diagnosis. While steroid creams may temporarily reduce itching, they can also suppress the skin’s local immune response, allowing the fungal infection to spread more easily. They may also change the appearance of the rash, making it more difficult to diagnose. Although a corticosteroid may occasionally be used alongside an antifungal under the direction of a healthcare professional, it should never be used by itself to treat suspected ringworm.
Pharmacists in New Brunswick can assess and prescribe treatment for certain fungal infections, and these assessments are publicly funded through NB Medicare. Pharmacists can assess suspected ringworm of the body or groin in patients two years of age and older, and athlete’s foot in patients 12 years of age and older who do not have diabetes or peripheral vascular disease.
Speaking with your pharmacist is always worthwhile, even if you are considering an over-the-counter product. A pharmacist can confirm whether the rash is likely fungal, recommend the most appropriate treatment, provide instructions on how long to use it, and determine whether a prescription-strength medication or referral to another healthcare provider is needed. Referral is recommended if the rash is extensive, fails to improve after appropriate treatment, involves the nails, or is accompanied by symptoms such as fever or swollen glands.
Getting the correct diagnosis from the start can save time, prevent unnecessary treatment, and help the infection clear as quickly as possible.