From the Guidelines
Ringworm, specifically tinea capitis, should be treated with oral antifungal medications, with griseofulvin and terbinafine being the most widely used first-line treatments, as they have good evidence of efficacy 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1. Some key points to consider in the treatment of ringworm include:
- Topical therapy alone is not recommended for the treatment of tinea capitis, but may be used to reduce transmission of spores 1
- Oral therapy is generally indicated to achieve both clinical and mycological cure, with the end point of treatment being mycological rather than clinical cure 1
- The dose of griseofulvin and terbinafine should be based on body weight, with griseofulvin dosed at 15-20 mg/kg/day for children under 50 kg and 1 g/day for adults, and terbinafine dosed at 625 mg/day for children under 20 kg, 125 mg/day for children 20-40 kg, and 250 mg/day for adults 1
- Treatment should continue for at least 6-8 weeks for griseofulvin and 2-4 weeks for terbinafine, with repeat mycology sampling recommended until mycological clearance is achieved 1
- In cases of treatment failure, second-line therapy with itraconazole may be considered, with a dose of 50-100 mg/day for 4 weeks or 5 mg/kg/day for 2-4 weeks 1
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. Identification should be made either by direct microscopic examination of a mounting of infected tissue in a solution of potassium hydroxide or by culture on an appropriate medium Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination. Representative treatment periods are tinea capitis, 4 to 6 weeks; tinea corporis, 2 to 4 weeks; tinea pedis, 4 to 8 weeks; tinea unguium-depending on rate of growth-fingernails, at least 4 months; toenails, at least 6 months General measures in regard to hygiene should be observed to control sources of infection or reinfection. Concomitant use of appropriate topical agents is usually required, particularly in treatment of tinea pedis. In some forms of tinea pedis, yeasts and bacteria may be involved as well as dermatophytes. Griseofulvin will not eradicate these associated bacterial or yeast infections. INDICATIONS AND USAGE Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: Epidermophyton floccosum Microsporum audouinii Microsporum canis Microsporum gypseum Trichophyton crateriform Trichophyton gallinae Trichophyton interdigitalis Trichophyton megnini Trichophyton mentagrophytes Trichophyton rubrum Trichophyton schoenleini Trichophyton sulphureum Trichophyton tonsurans Trichophyton verrucosum
The etiology of ringworm is a dermatophyte infection. The treatment for ringworm includes:
- Griseofulvin oral suspension, USP
- Accurate diagnosis of the infecting organism
- Medication must be continued until the infecting organism is completely eradicated
- Concomitant use of appropriate topical agents
- General measures in regard to hygiene should be observed to control sources of infection or reinfection. The guidelines for treatment are:
- Representative treatment periods are tinea capitis, 4 to 6 weeks; tinea corporis, 2 to 4 weeks; tinea pedis, 4 to 8 weeks; tinea unguium-depending on rate of growth-fingernails, at least 4 months; toenails, at least 6 months
- Dosage should be individualized, as with adults
- Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate
- Clinical relapse will occur if the medication is not continued until the infecting organism is eradicated 2 2.
From the Research
Ringworm Etiology and Treatment
- Ringworm, also known as tinea, is a fungal infection that can affect various parts of the body, including the scalp, skin, and nails 3, 4, 5.
- The etiology of ringworm is typically caused by dermatophytes, a type of fungus that feeds on keratin, a protein found in skin, hair, and nails 5.
Treatment Options
- Treatment for ringworm typically involves the use of antifungal medications, which can be topical or systemic 3, 4, 5, 6, 7.
- Common antifungal medications used to treat ringworm include griseofulvin, terbinafine, itraconazole, and fluconazole 3, 4, 6, 7.
- The choice of treatment depends on the severity and location of the infection, as well as the patient's age and medical history 4, 6.
Guidelines for Treatment
- For tinea capitis, a fungal infection of the scalp, treatment with griseofulvin or terbinafine is typically recommended for 6-8 weeks 3, 4, 6.
- For other types of ringworm, such as tinea corporis or tinea cruris, treatment with topical antifungal medications is often effective, but may need to be continued for several weeks 5.
- In cases where the infection is severe or resistant to treatment, systemic antifungal medications may be necessary 7.
Efficacy of Treatment Options
- Studies have shown that griseofulvin, terbinafine, and itraconazole are effective in treating tinea capitis, with cure rates ranging from 84-96% 3, 6.
- However, a recent study found that the effectiveness of these medications may be limited in certain cases, such as in areas with high levels of drug resistance 7.
- Itraconazole was found to be the most effective treatment option in this study, with a cure rate of 66% at 8 weeks 7.