From the Guidelines
The best oral treatment for recurrent ringworm is typically terbinafine, taken at a dose of 250 mg once daily for 2-4 weeks, as it has been shown to be more efficacious against Trichophyton species, which are common causes of ringworm 1. When considering treatment options, it's essential to take into account the causative dermatophyte and local epidemiology, as this can impact the effectiveness of the treatment 1.
- The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more effective against Trichophyton species and griseofulvin more effective against Microsporum species 1.
- The dose of terbinafine varies by body weight, with doses ranging from 125 mg per day for 2-4 weeks for children weighing 20-40 kg, to 250 mg per day for 2-4 weeks for adults and children weighing over 40 kg 1.
- In cases of treatment failure, it's essential to consider lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and to adjust the treatment plan accordingly 1.
- Itraconazole is a suitable alternative for patients who do not respond to terbinafine or griseofulvin, with a dose of 50-100 mg per day for 4 weeks or 5 mg kg-1 per day for 2-4 weeks 1.
- To prevent recurrence, it's crucial to complete the full course of medication, even if symptoms improve early, and to take measures to prevent reinfection, such as avoiding sharing personal items, keeping skin clean and dry, and washing bedding and clothing in hot water 1.
From the Research
Oral Treatment Options for Recurrent Ringworm
The best oral treatment for recurrent ringworm is a subject of ongoing research, with various studies comparing the efficacy of different antifungal medications.
- Itraconazole has been shown to be effective in treating recurrent ringworm, with cure rates ranging from 66% to 91.8% in different studies 2, 3, 4.
- Terbinafine, on the other hand, has been found to be less effective, with cure rates ranging from 28% to 74.3% 2, 3, 4.
- Griseofulvin and fluconazole have also been studied, but their effectiveness is limited, with cure rates of 14% and 42%, respectively 2.
- The emergence of terbinafine-resistant dermatophytes, such as Trichophyton indotineae, has highlighted the need for alternative treatment strategies, including the use of itraconazole, voriconazole, and posaconazole 5, 6.
Treatment Strategies
The choice of oral treatment for recurrent ringworm depends on various factors, including the severity of the infection, the presence of antifungal resistance, and the patient's medical history.
- Itraconazole is generally considered a first-line treatment option, due to its high efficacy and relatively low risk of adverse effects 2, 3, 4.
- Terbinafine may still be effective in some cases, but its use should be guided by susceptibility testing and careful monitoring of the patient's response to treatment 5, 6.
- Combination therapy, using multiple antifungal medications, may be considered in cases where the infection is severe or resistant to treatment 6.
- Topical non-allylamine antifungals may be an option for small areas of involvement, either as monotherapy or in combination with oral therapy 6.