What is the diagnosis and treatment for Tinea (Ringworm)?

From the Guidelines

Ringworm, also known as tinea capitis, should be treated with oral antifungal medications, with terbinafine and griseofulvin 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 when treating ringworm include:

• 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
• The dose of terbinafine and griseofulvin should be determined by the patient's body weight, with specific dosing regimens outlined in the guidelines 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
• 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

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; 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: The treatment of ringworm (also known as tinea corporis) with griseofulvin typically lasts for 2 to 4 weeks 2. The dosage for adults is usually 0.5 g daily 2, and for pediatric patients, it is 10 mg/kg daily 2. Griseofulvin is indicated for the treatment of dermatophyte infections, including tinea corporis 2.

• Key points:
  • Accurate diagnosis is essential
  • Treatment duration: 2 to 4 weeks for tinea corporis
  • Dosage: 0.5 g daily for adults, 10 mg/kg daily for pediatric patients
  • Griseofulvin is indicated for dermatophyte infections, including tinea corporis 2 2

From the Research

Ringworm Treatment

• Ringworm, also known as tinea, is a fungal infection that can be treated with various oral antifungal medications 3, 4, 5.
• The effectiveness of these medications can vary depending on the type of fungus causing the infection and the individual patient's response to treatment 5.

Common Antifungal Medications

• Griseofulvin is an older antifungal medication that has been used to treat ringworm, but it may not be as effective as newer medications like itraconazole and terbinafine 3, 4.
• Itraconazole and terbinafine have been shown to be effective in treating ringworm, including cases caused by non-dermatophyte molds like Scopulariopsis brevicaulis 4.
• Fluconazole is another antifungal medication that can be used to treat ringworm, but its effectiveness may vary depending on the type of fungus causing the infection 3, 5.

Potential Side Effects

• Oral antifungal medications can cause side effects, including gastrointestinal symptoms, allergic reactions, and liver damage 4, 6.
• In some cases, oral antifungal medications can exacerbate inflammatory reactions, particularly in patients with zoophilic fungi infections 6.
• Topical and systemic corticosteroids may be helpful in reducing inflammatory reactions caused by oral antifungal medications 6.

Treatment Outcomes

• The outcome of ringworm treatment can vary depending on the effectiveness of the medication and the individual patient's response to treatment 3, 4, 5.
• In some cases, treatment may need to be discontinued or modified due to side effects or lack of effectiveness 3, 4, 5.
• Further research is needed to determine the most effective treatment options for ringworm and to minimize the risk of side effects and treatment failures 5.