What is the treatment for bilateral groin and under bilateral breast tinea (ringworm)?

From the Guidelines

For the treatment of bilateral groin and under bilateral breast tinea, I strongly recommend using topical antifungal medications such as terbinafine 1% cream, applied to the affected areas twice daily for 2-4 weeks, as it has shown good efficacy against dermatophytes 1. The treatment of tinea infections in these areas requires a combination of antifungal medication and proper hygiene measures to prevent recurrence.

• Apply topical antifungals such as clotrimazole 1% cream, miconazole 2% cream, or terbinafine 1% cream to the affected areas twice daily for 2-4 weeks.
• Continue application for at least one week after the rash has cleared to prevent recurrence.
• For more severe or extensive infections, oral antifungal therapy may be necessary, such as fluconazole 150mg once weekly for 2-4 weeks or terbinafine 250mg daily for 2 weeks, as suggested by the British Association of Dermatologists' guidelines for the management of tinea capitis 1.

Key Considerations

• Keep the affected areas clean and dry, as fungi thrive in warm, moist environments.
• After bathing, thoroughly dry the groin and under-breast areas with a clean towel.
• Wear loose-fitting, breathable cotton clothing and consider using absorbent powders like talcum powder to reduce moisture.
• Change underwear and bras daily, and avoid sharing personal items. These infections are caused by dermatophyte fungi that feed on keratin in the skin, and they spread easily in warm, moist skin folds.

Treatment Failure

In cases of treatment failure, consider lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, as suggested by the guidelines 1.

Second-Line Therapy

If there is no initial clinical improvement, proceed to second-line therapy, such as itraconazole 50–100 mg per day for 4 weeks, or 5 mg kg−1 per day for 2–4 weeks, as recommended by the British Association of Dermatologists' guidelines 1.

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 The treatment for bilateral groin tinea is likely terbinafine (TOP), as it cures most jock itch (tinea cruris). However, for under bilateral breast tinea, the FDA drug label does not directly support the use of terbinafine (TOP), as it only mentions tinea corporis (ringworm) in general, without specifying the breast area.

• Key points:
  • Terbinafine (TOP) is effective for jock itch (tinea cruris).
  • The label does not explicitly address tinea under the breast. 2

From the Research

Treatment of Bilateral Groin and Under Bilateral Breast Tinea

• The treatment of tinea infections, including those affecting the groin (tinea cruris) and other parts of the body, typically involves the use of antifungal agents 3.
• Topical therapy is generally successful for treating tinea corporis and tinea cruris, unless the infection covers an extensive area or is resistant to initial therapy, in which case systemic therapy may be required 3.
• Treatment duration for tinea corporis and cruris infections is usually two weeks, and treatment should continue for at least one week after clinical clearing of the infection 3.
• Terbinafine has been shown to be effective in treating tinea pedis, with a cure rate of 78% achieved in patients with tinea pedis after a single application of 1% terbinafine cream 4.
• A comparison of terbinafine 1% cream given for one week with clotrimazole 1% cream given for four weeks in the treatment of tinea pedis found that terbinafine was more effective in terms of both mycological cure and effective treatment 5.
• A review of topical antifungal treatments for tinea cruris and tinea corporis found that terbinafine and naftifine were effective, with significantly higher clinical cure rates seen in participants treated with terbinafine compared to placebo 6.
• The treatment of tinea imbricata with griseofulvin, terbinafine, itraconazole, and fluconazole found that griseofulvin and terbinafine were effective in achieving significant remission, lasting up to 8 weeks after cessation of therapy 7.

Antifungal Agents

• Azoles, allylamines, and benzylamines are classes of antifungal agents used to treat tinea infections 6.
• Terbinafine is a synthetic allylamine antifungal that has been shown to be fungicidal against dermatophytes and a number of yeasts and moulds 4, 5.
• Clotrimazole is an azole antifungal that has been used to treat tinea pedis, but has been found to be less effective than terbinafine in some studies 4, 5.

Treatment Considerations

• The choice of antifungal agent and treatment duration should be based on the severity and extent of the infection, as well as the patient's medical history and potential for drug interactions 3, 6.
• Treatment should continue for at least one week after clinical clearing of the infection to ensure complete cure 3.
• Patients with tinea infections should be advised to keep the affected area clean and dry, and to avoid sharing personal items to prevent the spread of the infection 3.