Steroid Creams Can Make Ringworm Worse

Photo credit: Dr. Shyam Verma, India

Do not use steroid creams to treat rashes that may be ringworm

Ringworm is a very common cause of skin rashes. People might have a skin rash that they do not realize is caused by ringworm. For this reason, people sometimes apply over-the-counter creams or ointments containing medications called corticosteroids (or “steroids” for short) to their rash. Steroid creams can be helpful for some skin problems and can even temporarily reduce ringworm symptoms like itching and redness. However, steroid creams don’t kill the fungus that causes ringworm.

Steroid creams can make ringworm worse because they weaken the skin’s defenses. Steroid creams can allow ringworm infections to spread to cover more of the body. Ringworm that has been treated with steroid creams can have an unusual appearance, making it hard for healthcare providers to diagnose. In rare cases, steroid creams can allow the fungus that causes ringworm to invade deeper into the skin and cause a more serious condition.

An emerging international problem

In the United States, over-the-counter steroid creams are not very powerful, which is why they’re called “low potency.” But in some other countries, people can buy creams containing strong steroids without a prescription. Many of these steroid creams also contain antifungal and antibacterial medicines, and the labels say that the cream can be used to treat fungal infections. However, healthcare providers in India report seeing more cases of severe ringworm in people who have used these combination medications.^1-6 These infections have been reported to cover large parts of the body, last for months or longer, and spread to family members.⁴

If you travel internationally, develop a rash, and think it might be ringworm, be aware that strong over-the-counter steroid creams containing combinations of antifungal and antibacterial medicines can make ringworm worse and can cause other health problems. If a healthcare provider in another country recommends a cream for a rash that might be ringworm, ask what medications are in the cream and whether it contains strong steroids.¹

Information for healthcare professionals

Topical corticosteroid use without an antifungal agent is not recommended for ringworm infections (also called “tinea” or “dermatophytosis”). However, patients may have already applied corticosteroids on their own. For example, patients may have applied over-the-counter low-potency topical corticosteroids before seeking medical care. Others may have used higher-potency corticosteroids from:

• A prescription given because ringworm was misdiagnosed as another condition.
• Treatment for an unrelated condition.
• A previous prescription for a different problem.
• Purchase of high-potency steroids abroad.

Use of topical corticosteroids on ringworm can lead to:

• More or larger ringworm lesions.
• Atypical appearance, called tinea incognito, which may involve less erythema (redness), less scale, and indistinct lesion borders. Unusual shapes or patterns can mimic other conditions like atopic dermatitis (eczema).^7,8
• Majocchi’s granuloma, in which the dermatophytes invade deeper than the epidermis (into the dermis or subcutaneous tissue).⁹

These conditions resulting from topical corticosteroid use on ringworm are sometimes referred to as steroid-modified tinea.¹ Use of topical corticosteroids for ringworm also has led to thinning of the skin, striae (stretch marks), and pigment changes when applied to sensitive regions or through excessive or high-potency corticosteroid use.¹⁰

Combination antifungal and mid-potency corticosteroid creams are available by prescription in the United States. Healthcare providers should be aware that treatment failure has been reported with use of combination therapy for ringworm and the use of certain formulations is not recommended in children.^11,12,15

The overuse of steroids to treat ringworm may contribute to antimicrobial-resistant ringworm infections, an emerging public health concern.