Q) Can you suggest any alternative treatments for ring-worm? The cream Daktarin is making me feel sick and headachy. I have used urine therapy and also Aloe vera, but I think something stronger is required.-C.H., via e-mail
A) Ringworm is a fungal infection of the skin that usually shows up as raised, red patches with defined edges. In the centre of the red patch, there is often a lighter coloured circle-hence the term 'ring' in the name. Where the other half of the name comes from is not known, as no worms are involved at all, but it may be related to the serpiginous appearance of the skin lesions.
The medical name for the condition is 'tinea'. It can attack almost any part of the body, but it is rather common on the scalp (when it's known as 'tinea capitis'), whereit will often cause loss of hair. It can be very itchy. Athlete's foot ('tinea pedis') is probably the best-known example of this infection.
How do you 'catch' ringworm? Usually, it's by contact with someone else who has it, as the condition is highly contagious. Certain drugs can increase your susceptibility, particularly corticosteroids such as prednisone.
The chemical name of the anti-fungal drug Daktarin is miconazole. This agent first became available on the market more than 30 years ago, so it can now be considered 'old hat', particularly as its effectiveness is also thought to be "limited" (Clin Infect Dis, 1992; 14 [Suppl 1]: S161-9). So, it's somewhat surprising that you were prescribed it in the first place.
What's more, the drug can have serious side-effects. Fifteen years ago, Daktarin was fingered for causing thrombocytosis, a blood-platelet condition that can lead to blood clots. It can also cause severe blistering, peeling, dryness and, most ironically, itchiness and redness-two of the very symptoms it is meant to control.
A stronger drug that is often prescribed for severe tinea is fluconazole (Diflucan). However, this, too, can produce serious side-effects, including liver damage, seizures and rashes.
So what are the alternatives?
You have already tried Aloe vera. This popular houseplant is often recommended by alternative practi-tioners for tinea, as the gel derived from its cactus-like leaf naturally contains a range of amino acids, minerals, vitamins and enzymes that are especially good for the skin. However, although there is evidence that Aloe vera is useful for burns and psoriasis, there seems to be no clinical trials to support its use for ringworm.
You have also tried urine therapy-also known as urotherapy and, in India, amaroli-which has its devo-tees. Although urine is claimed to be an effective immune-booster and able to help across a wide range of diseases, including fungal skin infections, reports of its effectiveness appear to be entirely anecdotal.
However, there are other, less challenging, possible alternative treatments. At the top of this list is tea tree oil. In fact, tea tree oil is probably herbal medicine's best-known antifungal, and is backed by centuries of use for conditions such as athlete's foot, dandruff, vaginal infections and acne.
Its value has recently been con-firmed in clinical trials. Australian doctors tested it on athlete's foot in a full-scale placebo-controlled study, and found that a lotion containing 25-per-cent tea tree oil produced "a marked clinical response" in over
70 per cent of the study patients (Australas J Dermatol, 2002; 43: 175-8).
Three other clinical trials have also broadly come to the same con-clusions, which should pretty well establish tea tree oil as the most effective natural antifungal around.
However, two other herbals found to have "encouraging" supportive evidence are various species of Solanum (members of the nightshade family) and oil of bitter orange (Mycoses, 2004; 47: 87-92).
There is one caveat with tea tree, however. Some people can have an allergic reaction to the oil, resulting in itching or a rash that should improve quickly on stopping the treatment. For this reason, you may wish to first test a small amount of tea tree oil on just a patch of skin before applying it in larger amounts. It can also cause serious irritation if it gets into the eyes, nose or mouth.
Another natural product is un-decylenic acid (UA; also called undecenoic acid), which is vacuum-distilled from castor-bean oil. Widely used in the 1950s as a natural antifungal, UA is still used in products such as Blis-To-Sol Powder, Breezee Mist Foot Powder, Cruex, Desenex, Fungoid AF, Pedi-Pro, Protectol and Undelenic. In fact, a recent review of the clinical evidence from 126 trials recommended using undecylenic acid as a first-line non-drug treatment (BMJ, 1999; 319: 79-82).
An interesting and promising do-it-yourself treatment is a mixture of honey, olive oil and beeswax. Honey has a long history of use as a natural antibacterial-nurses used it to help heal wounded soldiers during World War I)-and it can also kill yeast and fungal growths. Olive oil and beeswax both contain compounds that have natural anti-inflammatory properties.
A small trial recently tested a skin cream made up of equal parts of the three ingredients-with astonishing results. Depending on the type of tinea, between 62 per cent and 78 per cent of the patients who responded (86 per cent) were considered cured of their skin problem (Complement Ther Med, 2004; 12: 45-7).
Although such a honey/olive oil/ beeswax mixture is not yet com-mercially available, making up your own cream is a relatively simple DIY job: just mix equal parts of melted beeswax with pure olive oil and raw honey. Adding a few drops of vitamin E oil will increase the mixture's shelf-life. For best results, it should be applied to the skin three times a day. Expect to see some benefit within four weeks.