From the Guidelines
Oral antifungal therapy is generally indicated to achieve both clinical and mycological cure for ringworm, with griseofulvin and terbinafine being the most widely used first-line treatments. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
Key Considerations
- Topical therapy alone is not recommended for the treatment of ringworm, as it is not effective in achieving mycological cure 1.
- Griseofulvin is more effective against Microsporum species, while terbinafine is more efficacious against Trichophyton species 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 children under 50 kg, and terbinafine dosed at 125-250 mg/day for 2-4 weeks depending on body weight 1.
Treatment Failure and Second-Line Therapy
- In cases of treatment failure, consider lack of compliance, suboptimal absorption of drug, relative insensitivity of the organism, and reinfection 1.
- Second-line therapy options include itraconazole, which is safe and effective against both Trichophyton and Microsporum species 1.
Additional Measures
- 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
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).
- Key points:
- Griseofulvin is indicated for the treatment of dermatophyte infections of the skin, including ringworm.
- Prior to therapy, a dermatophyte should be identified as responsible for the infection.
- Griseofulvin is not effective in bacterial infections, candidiasis, or other non-dermatophyte fungal infections.
From the Research
Treatment Options for Ringworm
- Topical application of terbinafine 1% cream has been shown to be a highly effective short-duration therapy for dermatophytosis of the skin 3
- Terbinafine and itraconazole have been found to have the lowest MIC values for the most fungi tested, indicating their effectiveness against dermatophytes 4
- Oral antifungal drugs such as fluconazole, griseofulvin, itraconazole, and terbinafine have been found to have limited effectiveness in the treatment of altered dermatophytosis in India, with itraconazole being the most effective 5
- Griseofulvin and terbinafine have been found to be effective in the treatment of tinea imbricata, with significant remission achieved in patients treated with these medications 6
Antifungal Medications
- Terbinafine, itraconazole, fluconazole, and griseofulvin are commonly used oral antifungal medications for the treatment of ringworm 5, 6, 7
- Topical antifungal agents such as clotrimazole and terbinafine can be used as adjuvant therapy to systemic antifungals, but are not recommended as sole treatment for tinea capitis due to their inability to penetrate the root of the hair follicles 3, 7
Treatment Considerations
- The choice of treatment depends on the extent of involvement, social situation, and availability of resources such as laboratory testing and follow-up 6
- Combined therapy with topical and oral antifungals may increase the cure rate for tinea capitis 7
- Dermoscopy is a highly sensitive tool for the diagnosis of tinea capitis, and mycologic confirmation is desirable before beginning a treatment regimen 7