Babies and children are more likely to get ringworm because they are more often in close contact with others and because they are less aware of hygiene concerns. Even children in daycare settings and playgrounds are especially vulnerable.
Seeing that ugly-looking ring-shaped rash on that child can be alarming. But it could have been from household pet, sharing of towels, combs or hats, contact sports like football, walking barefoot on earth or even a hug from someone with this infection that is spread by fungi.
“Some types of ringworm are found in animals, so if you have a pet in your house, it can infect a child. It is the same when they play in the soil or even that farmer that works on the soil,” said Dr Funmilola Makanjuola, a medical microbiologist consultant at the University College Hospital (UCH), Ibadan.
Makanjuola, a mycologist, stated that young children are at a higher risk of ringworm, especially because they play with their peers, animals and soil.
“Ringworm is common in children but it can also affect adults. You will see adults with discoloured nails, which is caused by the same type of organisms that cause ringworm on the head and body of young children,” she added.
Both cats and dogs can catch ringworm and then pass it on to humans who touch them. Signs to be aware of in pets include hairless patches of skin that appear circular, crusty or scaly patches and opaque or whitish areas around the claws.
Patches that may not be completely hairless but have brittle or broken hairs may also be a sign.
Ringworm is a type of rash that looks like a pink or red worm has curled up just under the skin. It can appear on any part of the body, including scalp, feet, groin, face and neck.
But, ringworm is not actually a worm at all. It is a contagious fungal infection called tinea and several types of fungi can cause ringworm. The fungi that cause this infection can live on the skin, clothing, towels, and other surfaces.
In most children, ringworm is a mild infection, but it may itch or be painful. Without treatment, the rash may spread and become a serious problem if it is infected, especially if a baby aggressively scratches it, or when it is not adequately treated.
According to Dr Makanjuola, “Many people use inappropriate treatments or treat but not long enough. Its treatment takes a long time, at least a minimum of six weeks. Unfortunately, if you stop applying an antifungal cream after a few days because it seems it is clear, it will come back.
“Sometimes, it is not that it is not well treated but because someone can have reinfection. Ringworm is the only fungal infection that is communicable, that is why its prevalence is very high.”
But, the incidence of ringworm in different regions varies depending on the in climatic and environmental conditions. Moreover, more children in rural and underserved communities are disproportionately affected, where there is a thriving animal-human transmission route of this infection.
In 2014, researchers in Ile Ife found that ringworm of the scalp in 26.9 per cent of children they studied and Microsporum audouinii, the fungus that causes ringworm on cats and dogs, was its leading cause.
This cross sectional study was conducted between January and March 2011 involved 800 school children that were recruited from 10 schools—6 publicly funded and 4 privately owned primary schools in Ile-Ife. It was published in the journal, Dermatology Research and Practice.
Moreover, among school pupils in two selected government-owned public primary schools in Osogbo, researchers also found a high prevalence of the infection among pupils who owned pets. Its prevalence was highest among children aged four to seven years.
The 2019 study in the journal, Diseases, found playing with animals, the sharing of combs and not bathing with soap were significantly associated with ringworm on the scalp.
Other factors were irregular changing of uniform, playing with animals and sand, and the sharing of caps and headscarves.
Pupils who had more baths per day were less likely to have the infection. Amongst those who did not use soap regularly, almost all of them (99%) had ringworm of the scalp.
Pupils who lived in households that had six occupants or more were more likely to be infected; the majority of the pupils (65%) lived in houses with six or more occupants and 64% of this group were infected with ringworm.
The researchers said in “the majority of the children live in houses where free-range animals (goats, sheep and dogs) are reared. We suspect that a thriving infection transmission link may exist between the pupils and their pets, or domesticated animals in their homes and neighbourhoods.”
But situation in Northern Nigeria is not different. Researchers found 14.6 per cent of a total of 1752 pupils of five elementary schools from various parts of Sokoto town had scalp ringworm.
Infected domestic animals constituted the apparent source of infection for most pupils. This is because pupils from the home of animal keepers had significantly higher infection rates than those from the homes of non-keepers of animals.
The researchers in a 2004 Pakistan Journal of Biological Sciences added that playgrounds of children and animal fields were also sources of infection for children and animals. This involved Ameh IG and RU Okolo at the College of Health Sciences, Usmanu Danfodiyo University, Sokoto.
Several reports indicated that domestic animals constitute important reservoir of human ringworm epidemics. Sokoto in North western Nigeria is one of such areas exposed to zoonotic ringworm because of widespread engagement in household maintenance or stocking of domestic animals.
Dogs (30.5 per cent) and their keepers had the highest infection rates while lower infection rates if goats (15 per cent) donkeys and horses (14.5 per cent) corresponded with a low infection of their keepers.
It was observed that domestic animals, especially goats, sheep and dogs strayed or foraged freely and mix up with other animals in the vicinity during the day before retiring to the family homes towards nightfall to either sleep or keep watch under the same roof with their owners.
Certainly, ringworm is not life-threatening, but it could affect the psychosocial life of those suffering from it. It had a mild-to-severe psychosocial impact on more than half of the children in a semi-urban area of Rivers State.
Researchers in the Nigerian Postgraduate Medical Journal found that the psychosocial impact was significantly higher among the female children than the male children.
Having a patchy or total hair loss could be perceived as a trivial issue. But pupils with itchy scalp and patchy or total hair loss are frequently ridiculed, isolated, and bullied by classmates or playmates. The attached social stigma could also disrupt a child’s concentration in class.
When the psychosocial well-being of a school-going child is hampered, optimal learning could be threatened leading to poor academic performance.
A 2017 study, which involved Dr Agnes Fienemika and Dr Chukwuma Okeafor at the University of Port Harcourt Teaching Hospital, Port Harcourt, said female children with ringworm were 2.2 times more likely to suffer a psychosocial impact than their male counterparts.
This was a cross-sectional study involving 184 children aged six to 12 years with scalp ringworm in Emohua Local Government Area of Rivers State.
The researchers also challenged the perception that ringworm is merely a disease affecting the skin. According to them, “the management of these children, which hitherto has been limited to dermatological care alone, should include psychosocial care.”