News and Events

Ringworm on the Increase: Rambam Joint Study

Publication Date: 5/11/2023 11:00 AM

Ringworm, so-called due to one of its symptoms, a circular ring-shaped rash that causes redness and itching, is on the increase. Rambam Health Care Campus (Rambam), in Haifa, Israel, is part of a collaborative research effort to tackle this phenomenon.

Dr. Emily Avitan-Hersh.
 Photography: Rambam HCC.Dr. Emily Avitan-Hersh. Photography: Rambam HCC.

Ringworm is a fungal infection that thrives in warm and human environments, affects the skin, nails, and scalp, and is highly contagious. Particularly prevalent in the 1950s, it has now reappeared. The past 10 years have seen a 500 percent increase in the fungus causing this condition. Preventing ringworm is critical for avoiding its spread. Fortunately, the condition is easily treatable. However, and more concerning, there has been a significant global increase in reported ringworm cases in medical centers. The reasons are multifactorial: poor hygiene, increased international travel, and a rise in the number of immunocompromised individuals.

A three-year collaborative study between two medical centers, Rambam and Schneider Children’s Medical Center, and two universities, the Ruth and Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology in Haifa and the Sackler Faculty of Medicine, at Tel Aviv University, have been researching this increased occurrence of ringworm.

The joint study examined a total of 456 cases from the two participating medical centers. Dr. Emily Avitan-Hersh, director of Rambam’s Department of Dermatology and principal investigator at the Avitan Laboratory on the Rambam Campus, together with Dr. Rivka Fridland, director of Schneider’s Dermatology Unit, led the research. This both point out that ringworm has become the most common scalp fungus in children aged 11–18, which seems to be a national trend.

Their research, “Pediatric Tinea Capitis: A Retrospective Cohort Study from 2010 to 2021“, recently published in the Journal of Fungi reports that the drug terbinafine led to a complete recovery in 95% of patients with this fungal infection. Additionally, the treatment duration was shorter than with alternative treatments. Their study also found that while the incidence of ringworm in children was stable between 2010 and 2018, it increased markedly from 2019–2021. This is particularly concerning since ringworm can negatively impact the quality of life of children.

Hence, the researchers advise that this reported increase in cases is a red flag to the medical community. The number of patients receiving in-hospital treatment for this condition is an indication of a much higher infection rate within the community. Dr. Hiba Za’arura, senior attending physician at Rambam’s Department of Dermatology, comments, “In light of the ease with which the fungus spreads, it is clear: there is a greater prevalence of infection in the community.”

One of the researchers Dr. Joel Dascalu, resident at the Department of Dermatology at Rambam, explains, “If the chances are high that a certain contaminant will appear within a specific age range, treatment with the most effective drug, one for the most common strain, can begin before the lab tests are received. This will stop the disease from progressing, and prevent complications and pre-diagnosis anxiety.”

Despite the data presented in their study, the experts are reassuring and explain that there is nothing to fear – the disease is treatable. Their study recommends that the Ministry of Health conduct epidemiological investigations and manage outbreaks based on their geographical locations. “Proper hygiene should be maintained, and a specialist should be consulted when a lesion is small. Treatment time will be shorter and more effective,” concludes Dr. Avitan-Hersh.