Ringworm (Tinea) in India: Why It Keeps Coming Back

Ringworm, or tinea (commonly called daad or khujli in India), is a contagious fungal infection of the skin, and India is currently facing an epidemic of extensive, recurrent and hard to treat cases. One of the biggest reasons is the widespread use of over the counter creams that mix a steroid with an antifungal and an antibiotic, which calm the itch while allowing the fungus to spread deeper and wider.

If you have used one cream after another and the rings keep coming back, this article is for you. Indian dermatology journals have described this as an unprecedented, epidemic like situation, and the IADVL has repeatedly warned against these combination creams.

What is ringworm and what does it look like?

Ringworm is caused by fungi called dermatophytes, which live on the outer layer of skin, hair and nails. It is not a worm.

Typical features:

• Itchy, ring shaped patches with a raised, scaly, sometimes bumpy edge and a clearer centre
• Patches that slowly expand outward, sometimes forming large rings or arcs
• On brown skin, the patches often look dark brown or grey rather than red

Names depend on the site:

Name	Where	Common in
Tinea cruris (jock itch)	Groin, inner thighs, buttocks	Men and women, especially in humid weather
Tinea corporis	Waist, trunk, arms, legs	All ages
Tinea faciei	Face	Often after steroid cream use
Tinea pedis	Feet and between toes	People in closed shoes
Tinea capitis	Scalp	Children
Tinea unguium	Nails	Adults

Why has ringworm become so common and stubborn in India?

Several factors work together:

• Steroid combination creams. Creams containing a potent steroid such as clobetasol along with an antifungal and antibiotic are sold widely without prescription. The steroid suppresses the immune response, so the fungus grows freely. The rash may look better at first, then returns larger and more inflamed. Dermatologists call this altered appearance tinea incognito.
• Changing fungal strains. Indian researchers have described a more aggressive dermatophyte strain, now often called Trichophyton indotineae, which spreads easily and can respond poorly to some standard antifungal medicines.
• Incomplete treatment. Stopping as soon as the itch improves leaves fungus behind.
• Heat, humidity and sweat, especially in the monsoon.
• Tight synthetic clothing, including jeans, leggings and innerwear, which trap sweat in the folds.
• Shared towels, clothes and beds, with infection passing around the whole family.
• Inadequate drying after bathing and wearing damp clothes.
• Diabetes, obesity and reduced immunity.

Why are steroid antifungal combination creams harmful?

This point deserves its own section, because it is the most common mistake we see.

• The steroid hides the infection. Itch and redness fade, so people stop, and the fungus comes back stronger.
• The rash spreads to large areas and can involve the face, buttocks and thighs.
• Long term use causes skin thinning, stretch marks, visible blood vessels, light patches and acne, some of which are permanent, particularly in the groin and inner thighs.
• It makes the infection harder to diagnose and treat later.

Indian dermatologists, including those writing in IJDVL and the IADVL tinea task force, strongly advise against using any steroid containing cream for fungal infections. Read more about this in our article on topical steroid misuse.

How is ringworm treated properly?

Treatment should begin with a correct diagnosis, because eczema, psoriasis and other rashes can look similar. Your dermatologist may examine a skin scraping under the microscope (a KOH test) or send it for culture.

Depending on the extent, your dermatologist may consider:

• Topical antifungal creams alone (without steroids) for small, early patches, applied beyond the visible edge and continued for some time after the skin looks clear.
• Oral antifungal medicines for extensive, recurrent or long standing infection, scalp or nail involvement. The choice, duration and need for blood tests depend on your history and other medicines. Many cases in India now need longer courses than in the past.
• Antifungal powders for prevention in sweaty folds.
• Treating family members at the same time.
• Checking for diabetes in recurrent cases.

Please do not take oral antifungal medicines without a prescription or stop them early. Using the wrong drug or dose contributes to resistance.

What hygiene steps prevent ringworm from coming back?

Medicines alone often fail if the environment keeps reinfecting you. Practical steps:

1. Bathe daily and dry the skin thoroughly, especially in the groin, under the breasts, between toes and in the waistline.
2. Wear loose cotton clothing and cotton innerwear. Change innerwear daily, or twice daily in hot weather.
3. Do not share towels, clothes, combs, bedsheets or pillows.
4. Wash clothes and towels in hot water where possible, and dry them fully in sunlight. Ironing innerwear can help.
5. Treat everyone affected at home together.
6. Keep feet dry and alternate shoes. Use antifungal powder in shoes if advised.
7. Do not use the same towel on the infected area and the rest of the body.
8. Avoid scratching, which spreads the infection to new areas.
9. Check pets if they have patchy hair loss.

Why does ringworm spread so easily in hostels, gyms and joint families?

Fungal spores survive on cloth, mats and floors. Shared bathrooms, gym benches, wrestling mats, borrowed towels and clothes dried together in damp corners all help the infection move from one person to the next. In joint families, one untreated member can keep reinfecting everyone else. Students in hostels and people who sweat heavily at work are especially affected.

If you live in shared housing:

• Use your own towel, soap and slippers.
• Wipe down gym equipment before use and shower soon after exercise.
• Dry clothes and innerwear fully, ideally in sunlight.
• Encourage anyone with itchy patches to get treated at the same time.

Do home remedies like lemon, garlic or antiseptic liquid help?

They are not a substitute for antifungal treatment. Applying lemon, garlic, raw turmeric pastes or undiluted antiseptic liquids to inflamed skin often causes burning, irritant dermatitis and dark marks, especially in the groin. Gentle washing with plain water and a mild soap, careful drying and the treatment your dermatologist recommends are safer.

Is it ringworm or something else?

Several conditions can mimic tinea:

• Eczema, which can also be itchy and patchy. See our eczema guide.
• Psoriasis, with thick, silvery plaques. See psoriasis symptoms and treatment.
• Pityriasis versicolor, a yeast infection causing light or dark scaly patches on the chest and back in humid weather.
• Intertrigo and sweat rash in skin folds. See our guide on prickly heat and monsoon skin care.
• Scabies, if the whole family is itchy, worse at night.

When to see a dermatologist

See a dermatologist if:

• The rash is spreading, extensive or keeps coming back.
• You have already used steroid containing creams.
• It involves the face, scalp, nails or genital area.
• A child has a scaly scalp patch with hair loss.
• You have diabetes, are pregnant, or have reduced immunity.
• Several family members are affected.
• You are unsure whether the rash is fungal.

Treating ringworm correctly the first time saves months of frustration. Dr. Maria offers online consultations to review your rash, the creams you have used and your household situation, and to suggest a complete plan.