What is the best Over-The-Counter (OTC) treatment for tinea (ringworm)?

From the Guidelines

The best Over-The-Counter (OTC) treatment for tinea (ringworm) is terbinafine (1% cream or spray) or clotrimazole (1% cream or lotion).

• These medications are effective against a wide range of dermatophytes, including Trichophyton and Microsporum species 1.
• Application of these medications should be done 2-3 times daily for a duration of 2-4 weeks, or as directed on the product label.
• Alternatively, miconazole (2% cream or powder) and tolnaftate (1% cream or powder) may also be used, following the same application frequency and duration guidelines.
• It is essential to note that treatment should continue for at least 7-10 days after symptoms have resolved to ensure complete eradication of the fungal infection.
• Terbinafine is particularly effective against Trichophyton species, which are common causes of ringworm 1.
• Clotrimazole is a broad-spectrum antifungal that is effective against a variety of fungal infections, including ringworm.
• It is crucial to follow the instructions on the product label and to complete the full treatment course to ensure effective treatment of the infection.

From the FDA Drug Label

Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions Principal Display Panel TopCare Miconazorb AF ANTIFUNGAL POWDER MICONAZOLE NITRATE 2%/ ANTIFUNGAL Cures Most Athlete's Foot, Jock Itch & Ringworm Relieves Itching, Burning, Scaling & Chafing Comforts & Refreshes Absorbs Moisture Talc-Free NET WT 2.5 OZ (71 g) Uses cures most athlete's foot, jock itch, and ringworm relieves itching, burning, cracking, scaling, redness, soreness, irritation and discomfort

The best Over-The-Counter (OTC) treatment for tinea (ringworm) is terbinafine (TOP), miconazole (TOP), or tolnaftate (TOP), as they all cure most ringworm and relieve symptoms such as itching, burning, and scaling 2, 3, 4.

• Key benefits of these treatments include:
  • Curing most ringworm infections
  • Relieving itching, burning, and scaling
  • Comforting and refreshing the affected area It is essential to follow the instructions and consult a doctor if symptoms persist.

From the Research

Treatment Options for Tinea Infections

• Terbinafine 1% cream has been shown to be a highly effective short-duration therapy for dermatophytosis of the skin, with mycological cure rates of 93.5% compared to 73.1% for clotrimazole 1% cream 5.
• Topical therapy is generally successful for tinea corporis and cruris infections, with treatment usually lasting for two weeks, while tinea pedis is treated for four weeks with an azole or for one to two weeks with allylamine medication 6.
• Terbinafine and naftifine have been found to be effective in achieving clinical and mycological cure, with significantly higher clinical cure rates seen in participants treated with terbinafine compared to placebo 7.
• Oxiconazole nitrate 1% cream has been shown to be effective in the treatment of tinea pedis, tinea cruris, and tinea corporis, with mycologic and clinical cures in at least 80% of patients 8.
• Terbinafine cream or butenafine cream are recommended as first-line topical treatments for tinea corporis, tinea cruris, and tinea pedis, while oral antifungal agents may be indicated for extensive disease or failed topical treatment 9.

Comparison of Treatment Options

• Terbinafine has been found to be more effective than clotrimazole in achieving mycological and clinical cure 5.
• Azoles and allylamines have been found to be effective in achieving clinical and mycological cure, but there is no evidence for a difference in cure rates between tinea cruris and tinea corporis 7.
• Oxiconazole has been shown to be as effective as or more effective than other antifungal creams, including miconazole, clotrimazole, and tolnaftate creams 8.

Duration and Frequency of Treatment

• Treatment duration for tinea corporis and cruris infections is usually two weeks, while tinea pedis is treated for four weeks with an azole or for one to two weeks with allylamine medication 6.
• Oxiconazole nitrate 1% cream can be applied once daily for four weeks in the treatment of tinea pedis or for two weeks in the treatment of tinea corporis, tinea cruris, and tinea versicolor 8.