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Ringworm has become dramatically harder to treat in India, and the main reason sits on the counter of every medical shop: steroid-containing combination creams.
What went wrong
Tinea — ringworm — was once straightforward to treat. Over the past decade, resistant strains have spread widely across India, and courses that used to take two weeks now often need six to eight, sometimes with different drugs entirely.
The principal driver is the widespread sale of creams combining a steroid with an antifungal and sometimes an antibiotic. The steroid suppresses redness and itching within days, so the patient believes it is working. Meanwhile the steroid suppresses the local immune response, the fungus spreads further and deeper, and the appearance changes so much that it becomes difficult even to recognise.
Worth knowing
If a cream relieves itching within a day or two, it almost certainly contains a steroid. Genuine antifungal creams take a week or more to produce noticeable improvement.
Treating it properly
- Get a proper diagnosis — a skin scraping confirms fungus and excludes eczema and psoriasis, which look similar and are made worse by antifungals
- Use a plain antifungal cream without any steroid
- Apply beyond the visible edge of the rash by two centimetres, since the fungus extends further than it appears
- Continue for at least two weeks after the rash disappears completely
- Oral antifungal tablets are usually needed for extensive or resistant infection, for four to eight weeks
- Complete the full course even after the skin looks normal
Stopping reinfection
- Treat every affected family member at the same time — untreated contacts reinfect everyone
- Wash clothes, towels and bed linen in hot water and dry in direct sunlight
- Iron clothing, particularly seams and waistbands, since heat kills spores
- Do not share towels, clothes, soap or combs
- Keep skin folds dry; use loose cotton clothing
- Change underwear and socks daily, and dry thoroughly after bathing
- Treat pets if they have patchy hair loss
- Discard or thoroughly disinfect footwear if there is foot involvement
The role of humidity and clothing
Fungi thrive in warmth and moisture. Tight synthetic clothing, prolonged sweating, wet clothes worn after bathing and occlusive footwear all create ideal conditions. In a hot climate this is difficult to avoid entirely, but loose cotton, thorough drying after bathing and changing out of sweaty clothes promptly make a real difference.
Sharing beds, towels and clothes within a household is the other major factor. Family-wide treatment plus hygiene measures is what breaks the cycle — treating one person alone rarely does.
When to see a dermatologist
- The rash has not improved after two weeks of proper antifungal treatment
- It is spreading, or covers a large area
- It involves the face, scalp or nails
- You have used a steroid-containing cream on it
- You have diabetes or a suppressed immune system
- It recurs repeatedly despite treatment
Key takeaways
- Steroid-containing combination creams are the main reason fungal infections have become resistant.
- A cream that relieves itching within a day almost certainly contains a steroid.
- Apply antifungal cream two centimetres beyond the visible edge, and continue two weeks after clearance.
- Treat all affected household members simultaneously or reinfection is certain.
A note on medical advice
This article is general health education written and reviewed by the Department of Dermatology at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
Fungal infectionRingwormDermatologySteroid creams