What is the treatment for Tinea (Ringworm) infection?

From the Guidelines

Ringworm treatment should always 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. When it comes to treating ringworm, the goal is to achieve both clinical and mycological cure.

• The treatment approach depends on the causative dermatophyte and local epidemiology.
• Topical therapy alone is not recommended, and oral therapy is generally indicated. Some key points to consider when treating ringworm include:
• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
• Terbinafine requires a shorter course of treatment, which may increase compliance, and is more efficacious against Trichophyton species 1.
• Griseofulvin is more effective against Microsporum species, but its use is limited in children due to licensing issues in some countries 1.
• Itraconazole is a safe and effective alternative, but its use should be considered on a case-by-case basis 1. In terms of specific treatment regimens, the following doses are recommended:
• Terbinafine: 250 mg per day for 2-4 weeks for patients over 40 kg, 125 mg per day for 2-4 weeks for patients between 20-40 kg, and 625 mg per day for 2-4 weeks for patients under 20 kg 1.
• Griseofulvin: 15-20 mg kg-1 per day for 6-8 weeks for patients under 50 kg, and 1 g per day for 6-8 weeks for patients over 50 kg 1. It's also important to note that treatment failure should be addressed by considering lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and that second-line therapy with itraconazole or other agents may be necessary in some cases 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 for ringworm (tinea corporis) is griseofulvin (PO), with a treatment period of 2 to 4 weeks 2. The dosage for adults is 0.5 g daily, and for pediatric patients, it is 10 mg/kg daily 2. It is essential to continue medication until the infecting organism is completely eradicated 2.

• Key points:
  • Accurate diagnosis of the infecting organism is essential
  • Treatment period: 2 to 4 weeks for tinea corporis
  • Dosage: 0.5 g daily for adults, 10 mg/kg daily for pediatric patients
  • Medication must be continued until the infecting organism is completely eradicated 2 2

From the Research

Ringworm Treatment Options

• The treatment of ringworm, also known as tinea, can be achieved through the use of various antifungal medications, including griseofulvin, terbinafine, itraconazole, and fluconazole 3, 4, 5, 6.
• According to a study published in 2004, terbinafine and griseofulvin were found to be effective in the treatment of tinea imbricata, with significant remission achieved in both groups 3.
• However, a more recent study published in 2020 found that itraconazole was the most effective treatment for chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and then griseofulvin 4.
• Another study published in 2013 evaluated the in-vitro activity of 10 antifungal agents against 320 dermatophyte strains and found that itraconazole and terbinafine showed the lowest MIC values, while fluconazole had the greatest MIC values 5.
• A randomized controlled trial published in 2020 compared the efficacy of terbinafine and itraconazole in different doses and in combination in the treatment of tinea infection and found that itraconazole-containing groups showed significantly higher cure rates than terbinafine-only groups 6.

Antifungal Medications

• Griseofulvin: an antifungal medication that has been used to treat ringworm for decades, but its effectiveness has been found to be limited in some studies 3, 4.
• Terbinafine: an antifungal medication that has been found to be effective in the treatment of ringworm, but its effectiveness can vary depending on the specific type of infection and the dose used 3, 5, 6.
• Itraconazole: an antifungal medication that has been found to be effective in the treatment of ringworm, particularly in the treatment of chronic and chronic relapsing dermatophytosis 4, 5, 6.
• Fluconazole: an antifungal medication that has been found to be less effective in the treatment of ringworm compared to other antifungal medications, but it can still be used in certain cases 4, 5.