From the Guidelines
Ringworm treatment should involve oral antifungal medications, with terbinafine being a preferred option 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 British Association of Dermatologists' guidelines, oral therapy is generally indicated to achieve both clinical and mycological cure 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
Key Considerations
- Terbinafine is more efficacious against Trichophyton species, while griseofulvin is more effective against Microsporum species 1.
- The dose of terbinafine and griseofulvin varies by 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 1.
- Second-line therapy options, such as itraconazole, may be considered in cases of treatment failure 1.
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery 1.
- Index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
- Asymptomatic carriers with a high spore load may require systemic treatment 1.
Prevention
- Avoiding skin-to-skin contact with people known to have lesions, not sharing towels and other fomites, and limiting exposure to swimming pools that have recently been associated with known outbreaks can help prevent the spread of ringworm 1.
From the FDA Drug Label
Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium) The FDA drug label does not answer the question.
From the Research
Ringworm Treatment Options
- Terbinafine is an effective treatment for ringworm, with a fungicidal activity against a wide variety of dermatophytes, moulds, and certain dimorphic fungi 2
- Oral terbinafine 250 mg/day is effective in treating superficial dermatophyte infections, including tinea pedis, tinea corporis/cruris, and onychomycosis, with mycological cure rates of over 80% 2
- Topical terbinafine 1% formulations are also effective in treating tinea pedis, tinea corporis/cruris, cutaneous candidiasis, and pityriasis versicolor, with mycological cure rates of over 80% 2
Comparison of Terbinafine with Other Treatments
- Terbinafine is more effective than griseofulvin in treating dermatophyte onychomycosis, tinea pedis, and tinea corporis/cruris 2
- Terbinafine is as effective as itraconazole 400 mg/day in treating tinea pedis 2
- A study comparing oral terbinafine 250 mg/day with 500 mg/day found no significant difference in efficacy between the two doses 3
- Another study found that itraconazole is more effective than terbinafine in treating chronic and chronic relapsing dermatophytosis in India 4
Treatment Duration and Dosage
- A study found that oral terbinafine 250 mg/day for 1 week is as effective as 1% clotrimazole cream applied twice daily for 4 weeks in treating interdigital tinea pedis 5
- A randomized controlled trial found that itraconazole containing groups showed significantly higher cure rates than terbinafine only groups, and that there is no benefit in increasing the dose or using a combination regimen in the treatment of tinea 6
- The same study found that prolonged duration of treatment is required for complete cure, with cure rates at 8 weeks being greater than those at 4 weeks for all groups 6