Ringworm and fungal skin infections – how to treat them
Ringworm, athlete's foot, jock itch and fungal nails: how to recognise them, how long treatment really takes, and why the wrong cream makes it worse.
Ringworm is a fungus, not a worm
Ringworm is a fungal infection of the skin. The name comes from the shape: a round or oval patch with a raised, scaly, often redder edge and a clearer centre. It spreads by contact — with another person, with a pet, or with shared towels, bedding, combs, clippers and changing-room floors.
- On the body: round scaly patches that slowly widen.
- Between the toes: soggy, cracked, itchy skin. This is athlete's foot.
- In the groin: an itchy rash spreading from the crease outward, usually sparing the scrotum.
- On the scalp: scaly patches with hair loss, common in children. Scalp ringworm needs tablets — creams do not reach the hair root.
- In the nails: thickened, crumbly, discoloured nails. Slow to treat and often needs tablets.
Treatment, and the part people get wrong
Most skin ringworm responds to an antifungal cream such as clotrimazole (Canesten) or terbinafine from a pharmacy. The mistake is stopping when it stops itching.
- Apply the cream to the patch and about two centimetres of normal-looking skin around it — the fungus is already there before it shows.
- Keep going for the full course on the pack, and usually for one to two weeks after the skin looks normal.
- Keep the area clean and dry. Dry between the toes properly after washing.
- Wash towels, socks and bedding hot, and do not share them while you are being treated.
- Treat athlete's foot at the same time as a groin rash — the foot is very often the source, carried up by underwear pulled on over it.
Antifungal treatments used in South Africa:
Clotrimazole — Canesten, Candid, Trimysten, Mycelex
Vaginal candidiasis; dermatophyte infections; oral candidiasis
Terbinafine — Lamisil
Dermatophyte infections (tinea); onychomycosis (fungal nail infections)
Ketoconazole (Topical) — Nizoral, Sebizole
Seborrhoeic dermatitis; dandruff; tinea versicolor; cutaneous candidiasis
Fluconazole (Single-dose OTC) — Diflucan One, Flucazole Once
Single-dose treatment of vaginal candidiasis (thrush) and associated candidial balanitis
When creams are not enough
- Scalp ringworm and fungal nails need oral antifungal treatment, which is prescription-only and takes weeks to months.
- Widespread patches, or patches that keep coming back after proper treatment.
- Anyone with diabetes, HIV or a weakened immune system who has a fungal infection, especially on the feet.
- Any foot infection in someone with diabetes — a crack between the toes is a common entry point for a much more serious infection.
Common questions
- How long does ringworm take to clear?
- Skin ringworm usually improves within two weeks of proper cream use, but keep treating for one to two weeks after it looks normal. Nails and scalp need oral treatment and take weeks to months.
- Can I use a steroid cream on ringworm?
- No. A steroid calms the itch while the fungus spreads underneath, producing a wider and harder-to-treat patch. Use an antifungal, and go back to the clinic if a rash treated as eczema is getting bigger.
- Is ringworm contagious?
- Yes, by skin contact and by shared towels, bedding, combs, clippers and floors. Treat it, wash shared items hot, and do not share them until it has cleared.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Medicines Online Directory and approved patient information leafletsSouth African Health Products Regulatory Authority
- Adult Primary Care guide: symptom-based integrated approach to the adult in primary careNational Department of Health, South Africa
Last reviewed 11 August 2026.