Nummular eczema vs ringworm: What is the right treatment for each?

Table of Content:
Similarities | Differences | What is eczema? | Causes | Symptoms | Treatment | What is ringworm? | Causes | Symptoms | Treatment | Conditions that resemble ringworm and eczema

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Dr. Patrick Mahar, dermatologist explained that ringworm and a type of eczema (called nummular eczema, dermatitis, discoid eczema, discoid dermatitis) are two skin conditions that are commonly confused by patients since both have a coin-shaped appearance and they both have similar symptoms. 

However, eczema and ringworm have very different causes (since the first one is a type of skin inflammation and the second one is caused by a fungus) and are treated very differently.

Author’s Note: For the purposes of this article, please consider the words nummular and discoid to be interchangeable, as with the terms eczema and dermatitis.

Similarities between ringworm and nummular eczema

• Both nummular eczema and ringworm can form round or oval-shaped lesions on the skin
• They can both cause redness in the affected areas
• They can both cause itching
• They can both cause scaling or flaking around the affected areas
• Scratching in both conditions can cause secondary bacterial infections

Differences between nummular eczema and ringworm

• Nummular eczema is a type of eczema (skin inflammation) while ringworm is caused by fungal infection (usually tinea)
• Ringworm is contagious and eczema is not
• Nummular eczema tends to appear primarily on the limbs, hands and feet, whereas ringworm can occur on various parts of the body, including the scalp, groin, and nails
• The treatment for eczema typically involves topical corticosteroids, while ringworm is treated with antifungal medications, either topically or orally, depending on the severity and location of the infection.
• One of the difficulties is that using topical corticosteroids on ringworm may help alleviate symptoms briefly, but just tends to perpetuate the problem.

Do I need a prescription for ringworm?

Not necessarily. You can try an over the counter anti-fungal cream first, but if it doesn’t work, you will probably then need a prescription as you may need a stronger medication or the skin rash is not caused by a fungal skin infection.

Do I need a prescription for nummular eczema?

Yes, if you have been diagnosed with nummular eczema or you think your skin problem is eczema, it is likely you will need prescription treatment to manage your symptoms.

How can I get a prescription for ringworm, eczema or another skin problem?

You can have a photo-consultation with a board-certified dermatologist who will evaluate your photos and clinical questionnaire for an appropriate diagnosis and treatment. You will get a prescription in 1-2 days.

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Are ringworm and nummular eczema contagious?

According to Dr. Mahar, ringworm is contagious since it is a fungal infection, while nummular eczema is not because it is a chronic condition. 

What is nummular eczema?

Nummular eczema (often called discoid eczema or nummular dermatitis) is a chronic skin condition characterized by the presence of coin-shaped or oval-shaped skin lesions or patches on the skin. It causes itchy, round-shaped patches on the skin. This condition can be linked to other skin conditions like atopic dermatitis, asteatotic eczema, or stasis dermatitis. However, most people with this condition can be successfully treated with simple measures and topical corticosteroid creams¹. 

Causes of nummular eczema

The exact cause of eczema is unknown, however, it is believed that several factors may cause this condition

• Dry skin
• Allergies to certain substances
• Reactions to allergens in the air
• Staphylococcus bacteria on the skin
• Harsh soaps
• Frequent hot baths
• Low humidity in the environment
• Skin injuries
• Exposure to rough fabrics like wool
• Breast implants
• Some medications
• Chronic venous stasis (a condition affecting blood flow) could also increase the risk of developing this condition on the lower legs². 

Location of this type of nummular eczema

This type of eczema typically occurs on legs, forearms, or backs of the hands, and less commonly on the trunk³. 

Symptoms of nummular eczema

• Inflamed coin-shaped spots
• Blister-like sores and bumps
• Spot color may vary from skin tone
• Very itchy
• Dry skin⁴  

Nummular eczema treatment

To keep at bay the symptoms of nummular eczema, your dermatologist may recommend and prescribe the following:

• Lifestyle changes
• Avoidance of known triggers
• Stress management techniques
• Moisturizers
• Wet dressings
• Topical corticosteroids
• Topical calcineurin Inhibitors
• Oral antihistamines
• Phototherapy
• Certain oral medications

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What is ringworm (Tinea)?

Tinea corporis (commonly known as ringworm) is a skin rash caused by a fungal infection. Typically, it presents as an itchy, circular rash with a clearer center. The term “ringworm” describes its appearance, but it is important to note that no actual worm is responsible for the condition. Ringworm is closely related to athlete’s foot (tinea pedis), jock itch (tinea cruris), and ringworm of the scalp (tinea capitis). It usually spreads through direct skin-to-skin contact with an infected individual or animal⁵. 

Causes of ringworm

Ringworm is a fungal infection caused by various dermatophyte fungi. It is contagious and can spread through direct contact with an infected person or contaminated objects like clothing and towels.

Location of ringworm

Ringworm can affect various parts of the body, including the feet (athlete’s foot), groin, inner thighs, or buttocks (jock itch), scalp, beard, hands, and even toenails or fingernails (onychomycosis). It can also appear on other areas like the arms or legs⁶. 

Symptoms of ringworm

• Scaly, ring-shaped lesions often found on the buttocks, torso, arms, and legs
• Mild itching sensation
• A clear or scaly area inside the circular rash, sometimes accompanied by clusters of bumps, which can appear red on fair skin or exhibit shades of reddish, purplish, brown, or gray on darker skin tones
• Expanding rings that are slightly raised
• Circular, flat patches of itchy skin
• Instances of overlapping rings⁷  

Ringworm treatment

• Clotrimazole 
• Miconazole 
• Griseofulvin
• Terbinafine 
• Ketoconazole
• Itraconazole
• Fluconazole
• Good hygiene
• Avoid using harsh soaps or irritating products on the affected area⁸