It’s funny how certain words elicit a predictable response on the part of listeners. Take the title of this column for example. Ringworm and scabies and lice, oh my! Ringworm and scabies and lice, oh my! Is your skin tingling yet? Do you feel an overwhelming urge to scratch? No? Okay, here’s a challenge for you. Read the entire text without scratching. Not even once. I’ll bet you can’t do it.

It’s equally funny how some diseases have earned an undeserved social stigma. Ringworm and scabies and lice fall into this category as well. Tell a mother her child has one of these conditions, and she’s sure to give you a horrified gaze that quickly turns into an indignant my-kid-is-not-dirty-there’s-no-way-he-has-ringworm-or-scabies-or-lice kind of stare. I’ve seen it many times. If you ever find yourself in this position, making this face, please remember to breathe. Relax. Don’t take it personally. Dirty conditions do not cause these disorders. They are spread by personal contact with the offending organism. Let’s take a closer look.

Despite it’s name, there’s no worm in ringworm. It’s actually a fungal infection of the skin, characterized by a ring-shaped pink patch that is mildly itchy. As it grows, the borders of the ring become raised and scaly, and the center clears. At least that’s the classic pattern. As with most disease, there is room for individual variation.

The spread of ringworm requires direct skin-to-skin contact, making it a common problem for wrestlers. Of course, little kids are rough and tumble, and since transmission doesn’t require prolonged skin-to-skin contact, ringworm spreads easily among them as well. If you haven’t seen it in your own child yet, don’t worry. It’ll visit soon enough.

Although it’s far less common, you can get ringworm from animals (especially kittens and puppies). The animal may not have a rash or any indication of a skin problem. So if ringworm is a persistent, recurring problem in your home, and if you have close contact with a kitten or puppy, consider making a trip to your veterinarian. Animal ringworm does not transmit from human to human. So if you get ringworm from your new kitten, don’t worry about passing it on to others.

We treat ringworm with anti-fungal creams and lotions. Some are available over-the-counter, while others require a prescription. After 48 hours of treatment, you won’t pass human ringworm to others. But you will have to use the cream a long time, usually 3-6 weeks. Stop treatment early and you run the risk of the rash returning. There is one place where treatment differs a bit–the scalp. Since the fungus penetrates deep into the hair root, an oral medication is required (prescription only).

Scabies is not a fungus. It’s a disease caused by tiny mites burrowing under the skin. They like skin folds best, so it’s common between fingers and toes and inside armpits. Scabies is extremely itchy and spreads easily. Like ringworm, most scabies comes from other humans. Animals get scabies too, but it’s a different type. Animal scabies can pass to humans, but it’s a very rare event.

Scabies has a 30-day incubation period (the time from contact to onset of symptoms), so you’ll have to treat everyone in the house to eliminate re-exposure. It’s important to tell your doctor about pregnant women and young infants living in your house because they require special consideration when choosing a treatment medication.

Scabies requires one application of medicine that’s left on the skin for several hours. The medicine kills mites, so the rash shouldn’t spread any more. But keep this in mind: The scabies rash is caused by the mere presence of mites in the skin. It doesn’t really matter if they are dead or alive. This means the rash will remain until your body replaces the infested skin with new layers, a process that may take several weeks. During this period, all you can do is treat the symptoms with steroid cream and antihistamines. Ask your doctor for details.

Scabies can live away from human contact for 3 days, so be sure to wash clothes and sheets in hot water and vacuum carpets and furniture to prevent reinfestation. Place unwashable objects (such as stuffed animals) in sealed plastic bags for a week. That way, when you remove the items, the mites will be dead.

Then there’s head lice. Like scabies, lice is an infestation of tiny bugs. They live on your head, suck blood from your scalp, and cement their little white eggs (nits) to your hair. Their favorite location is behind the ears and on the back of the neck. You’ll need a lice-killing shampoo to get rid of the critters. You’ll find some of these products, like Nix and Rid, available over-the-counter, while others require a prescription. These medications kill adult lice and their nits, but you still have to remove the nits by hand. It’s a tedious process best achieved with the help of a fine-tooth comb. If you’re having trouble removing the nits, try loosening them with a mixture of equal parts vinegar and water.

After killing the lice and removing nits, you’ll need to clean your house using the same process described for scabies. There is one important difference: With lice clean-up, you’ll need to keep unwashables in plastic bags for three weeks instead of one. Why? Because unhatched nits survive longer periods of time away from human contact.

Don’t mistake dandruff for nits. Dandruff is made up of little skin flakes that pull out easily.

There’s an old saying that goes, “Never share what goes in your hair.” This wisdom is based on the fact that lice spreads by direct contact. Combs, brushes, hats, and scrunchies–all of these things can spread lice from one person to another.

So how did you fare? Where you able to keep your fingers from scratching your skin? If not, you may want to inspect the itchy area for signs of ringworm or scabies or lice. Of course, plenty of other conditions cause itchy rashes as well, so if you find one, call your doctor and let him take a look.

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