Facial Ringworm (Tinea Faciei)

Who's At Risk?

Facial ringworm may occur in people of any age, race / ethnicity, or sex. It is most frequently seen in adults aged 20-40, but it is common in children as well. In addition, it is common in people who live in warm, humid climates.

Signs & Symptoms

The most common locations for facial ringworm include the:

• Cheeks.
• Nose.
• Around the eye.
• Chin.
• Forehead.

Facial ringworm appears as one or more scaly plaques (raised areas of skin larger than a thumbnail) of any size. In lighter skin colors, the border can be pink or red, whereas in darker skin colors, it can be dark red, purple, brown, or grayish. The border of the affected skin may be bumpy and may contain papules (small, solid bumps), vesicles (fluid-filled bumps), or crust. Often, the center of the lesion has normal-appearing skin with a ring-shaped edge, leading to the nickname “ringworm,” even though it is not caused by a worm.

Facial ringworm is almost always itchy, and it may become itchier or feel like a burn after exposure to the sun.

Self-Care Guidelines

If you suspect your child has facial ringworm, you can try one of the following over-the-counter antifungal creams or lotions:

• Terbinafine
• Clotrimazole
• Miconazole

Apply the cream to each lesion and to the skin 2 cm beyond the border of the affected area until the skin completely clears. Because ringworm is very contagious, have your child avoid contact sports until lesions have been treated for at least 48 hours.

People often have tinea infections on more than one body part, so examine your child for other ringworm infections, such as in the groin (tinea cruris, or jock itch), on the feet (tinea pedis, or athlete’s foot), and anywhere else on the body (tinea corporis).

Have any household pets evaluated by a veterinarian to make sure they do not have a fungal infection. If the veterinarian discovers an infection, be sure to have the animal(s) treated.

Treatments

To confirm the diagnosis of facial ringworm, the child’s medical professional may scrape some scales onto a glass slide and examine them under a microscope. This procedure, called a KOH (potassium hydroxide) preparation, allows the medical professional to look for signs of fungal infection.

Once the diagnosis of facial ringworm is confirmed, the medical professional will likely prescribe an antifungal medication. Most infections can be treated with topical creams and lotions, such as:

• Terbinafine.
• Clotrimazole.
• Miconazole.
• Econazole.
• Oxiconazole.
• Ketoconazole.
• Ciclopirox.
• Sulconazole.
• Naftifine.

Rarely, more extensive or long-standing infections may require treatment with oral antifungal medication, such as:

• Terbinafine.
• Itraconazole.
• Fluconazole.
• Griseofulvin.

The infection should go away within 4-6 weeks after using effective treatment.

Visit Urgency

If the lesions do not improve after 1-2 weeks of applying an over-the-counter antifungal cream, see your child’s medical professional for an evaluation.

Trusted Links

• Clinical Information and Differential Diagnosis of Tinea Faciei (Ringworm of Face)

References

Bolognia J, Schaffer JV, Cerroni L. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018.

James WD, Elston D, Treat JR, Rosenbach MA. Andrew’s Diseases of the Skin. 13th ed. Philadelphia, PA: Elsevier; 2019.

Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill Education; 2019.

Paller A, Mancini A. Paller and Mancini: Hurwitz Clinical Pediatric Dermatology. 6th ed. St. Louis, MO: Elsevier; 2022.