From the Guidelines
Oral antifungal therapy is the recommended treatment for ringworm, with griseofulvin and terbinafine being the most widely used first-line treatments, as they have good evidence of efficacy 1. When treating ringworm, the choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
Key Considerations
- Griseofulvin is more effective against Microsporum species, while terbinafine is more efficacious against Trichophyton species 1.
- The dosage of griseofulvin and terbinafine varies by body weight, with griseofulvin recommended at 15-20 mg/kg/day for 6-8 weeks for children under 50 kg, and terbinafine recommended at 250 mg/day for 2-4 weeks for children over 40 kg 1.
- Treatment failure should be addressed by considering lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and second-line therapy with itraconazole may be necessary 1.
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery, and index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
- The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 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 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;
The treatment for ringworm includes:
- Terbinafine (TOP): cures most ringworm (tinea corporis) 2
- Griseofulvin (PO): treatment period for tinea corporis is 2 to 4 weeks 3 Key points:
- Accurate diagnosis of the infecting organism is essential
- Medication must be continued until the infecting organism is completely eradicated
- General measures in regard to hygiene should be observed to control sources of infection or reinfection 3
From the Research
Treatment Options for Ringworm
- Systemic anti-fungal medications are required to treat ringworm, with griseofulvin and terbinafine being FDA-approved options 4
- Treatment duration for griseofulvin is usually 6 to 8 weeks, while terbinafine requires 6 weeks 4
- Other medications, such as itraconazole, ketoconazole, and fluconazole, have been used off-label to treat ringworm, with varying degrees of success 5, 6
Efficacy of Antifungal Agents
- A study comparing the efficacy of 10 antifungal agents against dermatophytes found that itraconazole and terbinafine had the lowest MIC values, while fluconazole had the highest 5
- A randomized pragmatic trial found that itraconazole was the most effective oral antifungal drug in treating chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and griseofulvin 6
- A comparative evaluation of griseofulvin, terbinafine, and fluconazole in the treatment of tinea capitis found that griseofulvin had the highest cure rate, followed by terbinafine and fluconazole 7