What is the treatment for tinea (ringworm)?

From the Guidelines

Ringworm treatment should involve oral antifungal medications, with terbinafine being the preferred choice for Trichophyton species and griseofulvin for Microsporum species, as indicated by the British Association of Dermatologists' guidelines 1. The treatment of ringworm, also known as tinea, typically involves the use of antifungal medications. According to the guidelines, topical therapy alone is not recommended for the treatment of tinea capitis, and oral therapy is generally indicated to achieve both clinical and mycological cure 1.

Key Considerations

• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
• Terbinafine is more efficacious against Trichophyton species, while griseofulvin is more effective against Microsporum species 1.
• The dosage of terbinafine and griseofulvin varies by body weight, with specific recommendations provided in the guidelines 1.

Treatment Options

• Terbinafine: 250mg daily for 2-4 weeks for individuals weighing over 40kg, 125mg daily for 2-4 weeks for individuals weighing 20-40kg, and 625mg daily for 2-4 weeks for individuals weighing under 20kg 1.
• Griseofulvin: 15-20 mg/kg per day for 6-8 weeks for individuals weighing under 50kg, and 1g per day for 6-8 weeks for individuals weighing over 50kg 1.

Additional Measures

• Keeping the affected area clean and dry, avoiding sharing personal items, and washing bedding and clothes in hot water can help prevent reinfection 1.
• In cases of treatment failure, it is 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.

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

• The treatment of ringworm, also known as tinea capitis, typically requires systemic anti-fungal medication rather than topical treatment 4.
• Two FDA-approved medications for the treatment of tinea capitis are griseofulvin (Grifulvin) and terbinafine (Lamisil Granules), with treatment durations of 6 to 8 weeks and 6 weeks, respectively 4.
• Other medications, such as itraconazole, fluconazole, and ketoconazole, have been studied for their efficacy in treating ringworm, with varying results 5, 6, 7.

Efficacy of Antifungal Agents

• A study comparing the efficacy of itraconazole, terbinafine, fluconazole, and griseofulvin in treating tinea imbricata found that terbinafine and griseofulvin were effective, while fluconazole was not 6.
• Another study evaluating the efficacy of oral antifungal drugs in treating chronic and chronic relapsing tinea corporis, tinea cruris, and tinea faciei found that itraconazole was the most effective, followed by fluconazole, terbinafine, and griseofulvin 7.
• The in-vitro activity of 10 antifungal agents against 320 dermatophyte strains was evaluated, with itraconazole and terbinafine showing the lowest minimum inhibitory concentration (MIC) values 5.

Considerations for Treatment

• The choice of treatment for ringworm depends on various factors, including the extent of involvement, social situation, and availability of resources such as laboratory testing and follow-up 6.
• The use of antifungal shampoos, topical antimycotic agents, and corticosteroids as adjuvant therapies may be considered in the treatment of ringworm 8.
• Further research is needed to determine the optimal treatment for ringworm and to address the issue of antifungal resistance 5, 7.