Ringworm (erythema infectiosum), which belongs to the pediatric diseases, is one of several possible manifestations of infection by the erythrovirus (parvovirus B19). Ringworm, which is relatively harmless, should not be confused with rubella.
What is ringworm?
Children often suffer from ringworm. Ringworm is a common and highly contagious disease primarily in childhood that can also affect adults. Characteristic of ringworm is the distinctive, butterfly-shaped, bright red facial rash that spreads across the cheeks. The historical name of ringworm as the “fifth disease” is now used primarily in the English-speaking world and comes from the original cataloging of childhood diseases associated with a skin rash. In most children, the course of ringworm is mild and requires little treatment, but can cause significant complications if contracted in adulthood. Typically, children between the ages of 5-15 years are most affected. By the time they reach adulthood, half of adolescents are expected to be immunized via contact with ringworm.
Causes
Ringworm is caused by human erythrovirus. This human pathogenic virus is so small that it consists of only one strand of DNA. It was not verified as the causative agent of ringworm until 1981. The erythrovirus multiplies in the bone marrow via so-called precursor cells of red blood cells and is transmitted via secretions of the respiratory tract (saliva or nasal mucus). Infection with ringworm can also be caused by direct contact with infected persons. The time between infection and the appearance of symptoms (incubation period) is usually between 4 and 21 days for ringworm. The risk of infection exists primarily in the days before the onset of symptoms.
Symptoms, complaints, and signs
The disease varies greatly in its severity; some people remain asymptomatic and do not even realize that they are infected. The garland-shaped rash is the most typical sign of ringworm, although it does not occur in all patients. It is also called infantile erysipelas. It forms about four to fourteen days after infection. It spreads in waves on the cheeks and forehead, and does not affect the region around the mouth. It is also called a butterfly rash because it appears symmetrically in the area around the nose in a shape reminiscent of a butterfly. On the rest of the body it appears especially on the legs, arms and buttocks. A few days after its onset, the rash fades; however, it may flare up repeatedly over a longer period of time. Exposure to sunlight or heat favors this new outbreak. Usually the red spots do not cause any discomfort; in some people they cause itching. In addition, flu-like symptoms may occur. The patient feels sick, tired and sometimes has a fever. Since the virus also causes anemia, the skin becomes pale. The pulse may increase because the heart has to work harder to supply the body with enough oxygen despite the anemia.
Diagnosis and course
Most people with ringworm have no signs or symptoms. When symptoms do occur, they vary greatly depending on the age of the person with the disease. Early signs and symptoms of ringworm in children may include sore throat, low-grade fever, upset stomach, headache, fatigue, or itching. A few days after the first symptoms of ringworm appear, a distinctive bright red rash may appear on the face, usually extending to both cheeks. As it progresses, the pink and slightly raised rash extends to the arms, trunk, thighs or buttocks, already heralding the final phase of ringworm. The slightly fleeting rash may remain in appearance for several weeks. Adults with ringworm usually do not develop the characteristic cheek rash. Instead, the main symptoms are joint pain in the hands, wrists, knees, or ankles, which may last for several weeks.
Complications
In healthy people, complications of ringworm are rare. However, danger sometimes exists for pregnant women and people suffering from immune deficiency.A possible complication of erythema infectiosum is joint involvement. It becomes noticeable through painful joint inflammations, which occur especially in the small joints. Young women and girls are particularly affected by this effect. The duration of the symptoms varies from two weeks to several months. In the further course, they also regress without therapy. Some complications of ringworm occur because the viruses specifically target erythrocytes (red blood cells) and their precursor cells. If a patient suffers from hemolytic anemia (anemia) at the same time, aplastic crises are imminent. In the course of these crises, the bone marrow of the affected person is temporarily no longer able to produce red blood cells. The parvovirus B19 is responsible for this. The aplastic crisis is often the first indication of spherocytic anemia. If congenital or in the course of life acquired immune system defects are present, this results in a disturbance in the eradication of the ringworm virus. The effect of this is often chronic recurrent anemia. A typical indication is that no specific antibodies directed against parvovirus B19 can be detected in affected individuals. Danger also exists during pregnancy. Thus, in one third of all pregnancies, the virus infects the placenta, so that its transmission to the unborn child occurs and a severe anemia threatens.
When should you go to the doctor?
Ringworm often does not require treatment. The symptoms resolve on their own within seven to fourteen days, with no further complications to worry about. If fever and flu-like symptoms such as joint pain or nausea develop, a visit to the doctor is recommended. If the characteristic rash appears two to five days after these symptoms, a doctor must be consulted the same day. Ringworm infection during pregnancy requires medical evaluation. The doctor will perform an ultrasound examination and check whether the child is affected by the disease. People with hemolytic anemia or immune deficiency are also among the risk groups and should involve the doctor if the described signs of the disease occur. Ringworm can only occur once, as the body forms long-term antibodies during the first infection. If similar symptoms occur again, there may be another underlying disease that needs to be clarified by a doctor. Ringworm is treated by the family doctor or pediatrician. If the condition occurs in connection with an existing disease, the appropriate specialist is the right contact.
Treatment and therapy
Since ringworm is a relatively harmless disease, a visit to the doctor is usually not necessary when the disease occurs in childhood. In this case, self-treatment of ringworm at home is sufficient and primarily serves to relieve symptoms. Since childhood illnesses bring with them an important developmental boost, it should be ensured that the child drinks enough and gets plenty of rest. In case of higher fever or pain, lukewarm calf compresses or the administration of paracetamol will help. If the child or someone in the family suffers from a serious underlying illness that can increase the risk of complications as a result of ringworm, a doctor must be consulted at short notice. Because the viruses that cause ringworm primarily affect the precursor cells of red blood cells, people with anemia are particularly at risk. In the worst case, an aplastic crisis can be triggered. These patients may need to be hospitalized and receive blood transfusions. Sick people with a weakened immune system (e.g., AIDS or after organ transplants) receive antibodies via immunoglobulin injections to treat ringworm. Infection with ringworm in the first half of pregnancy can be treated with a direct blood transfusion to the fetus or drugs that cross the placenta.
Prevention
As a result of infection with ringworm, lifelong immunity is acquired. Because there is no preventive vaccination against ringworm, standard hygiene measures such as washing hands or using unused tissues are indicated for prevention.
Follow-up
A ringworm infection usually heals completely within a few days and therefore does not require special aftercare measures.Once the rash and other typical symptoms such as fever, muscle pain, headache and joint pain have subsided after approximately seven to ten days, patients can resume their usual activities without hesitation. To prevent overloading the body, the patient’s general condition should be taken into account. Sporting activities should be gradually increased again. Longer-lasting after-effects are usually to be expected at most as a result of the receding skin rash. If there is increased itching or if affected persons suffer from scaly skin, ordinary skin care products can alleviate these complaints. However, these skin reactions also usually disappear on their own after a short time. If serious complications arise in the course of the disease, which were treated with medication according to medical instructions, special measures may also be necessary. Patients with a weakened immune system or anemia should follow the individual instructions of their physician. They may need to allow for longer recovery periods with physical rest. Pregnant women, as high-risk patients, should also strictly follow their doctor’s recommendations. Once the ringworm infection has healed, patients cannot become infected again. They are immune to the disease for life.
Here’s what you can do yourself
Ringworm cannot yet be specifically treated, but it usually heals on its own. The most important self-help measure is to take it easy and take the medication prescribed by a doctor. If the child suffers from ringworm infection, parents must provide the child with sufficient fluids and gentle food. A proven home remedy for the itching is cooling compresses. Greasy creams from the pharmacy are an alternative. In addition, the sufferer should not come into contact with healthy people. It is advisable to observe the child closely so that the necessary measures can be taken immediately in the event of any complications. High fever, severe itching and persistent gastrointestinal complaints require medical clarification. If the ringworm does not subside within two weeks, a visit to the doctor is also necessary. If the ringworm infection occurs during pregnancy, regular follow-up examinations are required. The physician determines by ultrasound examination whether the pathogen has passed to the unborn child and can initiate appropriate therapy if necessary. Patients with a disturbed immune system must be provided with special antibodies, insofar as chronic anemia is present.
