What is the treatment for dermatophytosis (ringworm)?

From the Guidelines

Oral antifungal therapy with either griseofulvin or terbinafine is the recommended treatment for ringworm, with the choice of medication directed by the causative dermatophyte and/or local epidemiology. When considering treatment options, it's essential to note that 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 dosage of griseofulvin and terbinafine varies by body weight, with griseofulvin dosed at 15-20 mg/kg/day for 6-8 weeks for patients under 50 kg, and 1 g/day for 6-8 weeks for patients over 50 kg, while terbinafine is dosed at 625 mg/day for 2-4 weeks for patients under 20 kg, 125 mg/day for 2-4 weeks for patients between 20-40 kg, and 250 mg/day for 2-4 weeks for patients over 40 kg 1. Some key points to consider when treating ringworm include:

• The importance of laboratory diagnosis to guide treatment choices, with scalp lesions sampled via scalpel scraping, hair pluck, brush, or swab, and processed for microscopy and culture 1
• The need to consider lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection in cases of treatment failure 1
• The use of second-line therapy, such as itraconazole, in cases where first-line therapy is not effective, with dosing at 50-100 mg/day for 4 weeks, or 5 mg/kg/day for 2-4 weeks 1
• The importance of repeat mycology sampling to ensure mycological clearance is achieved, as the end point of treatment is mycological rather than clinical cure 1.

From the FDA Drug Label

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 (also known as Tinea corporis) is griseofulvin (2).

From the Research

Treatment Options for Ringworm

• The treatment for ringworm, also known as tinea corporis, typically involves the use of antifungal medications, either topical or oral 3, 4, 5, 6, 7.
• Oral antifungal agents such as griseofulvin, terbinafine, itraconazole, and fluconazole have been shown to be effective in treating ringworm, with varying degrees of efficacy and safety profiles 3, 4, 5, 6.
• Topical antifungal treatments, including terbinafine, naftifine, and clotrimazole, have also been found to be effective in treating ringworm, with minimal adverse effects 7.

Efficacy of Antifungal Agents

• A study comparing the efficacy of griseofulvin, terbinafine, itraconazole, and fluconazole in treating tinea capitis found that all four agents were effective, with terbinafine and itraconazole showing similar efficacy to griseofulvin 3.
• Another study found that terbinafine was more effective than griseofulvin in treating tinea capitis caused by Trichophyton tonsurans, but less effective in treating Microsporum infections 4.
• Itraconazole was found to be the most effective treatment for chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and griseofulvin 5.

Safety and Adverse Effects

• The safety profiles of the antifungal agents varied, with griseofulvin being associated with gastrointestinal effects and discontinuation due to adverse effects 3.
• Terbinafine, itraconazole, and fluconazole were found to have favorable adverse-effect profiles, with mild and reversible adverse effects 3, 4, 5.
• Topical antifungal treatments were generally well-tolerated, with minimal adverse effects such as irritation and burning 7.