Ringworm, Facial (Tinea Faciei)

Who's At Risk?

Facial ringworm affects both sexes and all populations and ages, although it is quite common in children. Typical to fungal infections, ringworm is more common in warm and humid climates. Facial ringworm is often found on the cheeks of children and infants and can be spread by direct contact with affected individuals or by contact with infected animals. A common way that ringworm is spread is through a new pet (for example a kitten adopted from a shelter) that has the infection. When the child holds the kitten near his or her face, the child becomes infected with the spores and the fungus spreads.

Signs & Symptoms

The most common locations for facial ringworm include:

• Cheeks
• Nose
• Around the eye
• Chin
• Forehead

Facial ringworm appears as one or more pink-to-red, scaly patches ranging in size from 1–5 cm. The border of the affected skin may be raised and may contain bumps, blisters, or scabs. Often, the central portion of the lesion is clear, leading to a ring-like shape and the descriptive (but inaccurate, because there is no actual worm) name ringworm.

Facial ringworm is almost always itchy, and it may become itchier or feel like a burn after exposure to the sun.

Self-Care Guidelines

If you suspect that your child has facial ringworm, you might try one of the following over-the-counter antifungal creams or lotions:

• Terbinafine
• Clotrimazole
• Miconazole

Apply the cream to each lesion and to the normal-appearing skin 2 cm beyond the border of the affected skin for at least 2 weeks until the areas are completely clear of lesions.

Since people often have tinea infections on more than one body part, examine your child for other ringworm infections, such as in the groin (jock itch, tinea cruris), on the feet (athlete’s foot, tinea pedis), and anywhere else on the body (tinea corporis).

Have any household pets evaluated by a veterinarian to make sure that they do not have a dermatophyte infection. If the veterinarian discovers an infection, be sure to have the animal treated.

Treatments

To confirm the diagnosis of facial ringworm, your child’s physician might scrape some surface skin materials (scales) onto a glass slide and examine them under a microscope. This procedure, called a KOH (potassium hydroxide) preparation, allows the doctor to look for tell-tale signs of fungal infection.

Once the diagnosis of facial ringworm is confirmed, your physician will probably start treatment with an antifungal medication. Most infections can be treated with topical creams and lotions, including:

• Terbinafine
• Clotrimazole
• Miconazole
• Econazole
• Oxiconazole
• Ciclopirox
• Ketoconazole
• Sulconazole
• Naftifine

Rarely, more extensive or long-standing infections may require treatment with oral antifungal pills, including:

• Griseofulvin
• Terbinafine

The infection should go away within 4–6 weeks after using effective treatment.

Visit Urgency

If the lesions do not improve after 1–2 weeks of applying the over-the-counter antifungal creams, see your child’s doctor for an evaluation.

Trusted Links

• Clinical Information and Differential Diagnosis of Tinea Faciei (Ringworm of Face)

References

Bolognia, Jean L., ed. Dermatology, pp.1179. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick’s Dermatology in General Medicine. 6^th ed. pp.1998. New York: McGraw-Hill, 2003.