From the Guidelines
For a 15-year-old male with tinea corporis (ringworm), the best oral medication is typically terbinafine (Lamisil) at a dose of 250 mg once daily for 2-4 weeks. This recommendation is based on the high efficacy of terbinafine against dermatophytes, particularly Trichophyton species, which are common causes of tinea corporis 1. The British Association of Dermatologists' guidelines also support the use of terbinafine as a first-line treatment for tinea capitis, which is caused by similar dermatophytes 1.
Key Considerations
- Terbinafine has a favorable safety profile in adolescents and is generally well-tolerated 1.
- Oral therapy is usually reserved for extensive disease, multiple lesions, immunocompromised patients, or cases that have failed topical treatment.
- For most uncomplicated tinea corporis cases, topical antifungals like clotrimazole, miconazole, or terbinafine applied twice daily for 2-4 weeks are the first-line treatment.
- The patient should also maintain good hygiene, keep affected areas clean and dry, avoid sharing personal items, and wash clothes and bedding regularly to prevent reinfection or spread to others.
Alternative Treatments
- Itraconazole 200 mg daily for 1-2 weeks or fluconazole 150-300 mg once weekly for 2-4 weeks may be considered as alternative treatments 1.
- However, terbinafine is generally preferred due to its high efficacy and favorable safety profile.
Mechanism of Action
- Terbinafine works by inhibiting squalene epoxidase, disrupting fungal cell membrane synthesis, which makes it particularly effective against dermatophytes that cause ringworm 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. ... Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate (pediatric patients from 30 to 50 lbs, 125 mg to 250 mg daily; pediatric patients over 50 lbs, 250 mg to 500 mg daily, in divided doses). 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 ...
The best oral medication for a 15-year-old male with tinea corporis (ringworm) is griseofulvin (PO), with a recommended dosage of 250 mg to 500 mg daily, in divided doses, as the patient is over 50 lbs 2. It is essential to note that the dosage should be individualized, and the medication must be continued until the infecting organism is completely eradicated.
- The treatment period for tinea corporis is typically 2 to 4 weeks 2.
- Griseofulvin is effective against various species of fungi, including those that cause tinea corporis 2.
From the Research
Oral Medications for Tinea Corporis (Ringworm) in a 15-Year-Old Male
The following oral medications have been studied for the treatment of tinea corporis (ringworm):
- Terbinafine
- Griseofulvin
- Itraconazole
- Fluconazole
- Ketoconazole
Efficacy of Oral Medications
The efficacy of these medications has been compared in several studies:
- A study published in 2016 3 found that terbinafine and griseofulvin had similar efficacy for the treatment of tinea capitis, with cure rates of 84.2% and 79.0%, respectively.
- A study published in 2020 4 found that itraconazole was the most effective treatment for chronic and chronic relapsing tinea corporis, with a cure rate of 66% at 8 weeks.
- A study published in 2007 5 found that terbinafine, itraconazole, and fluconazole may be similar to griseofulvin in children with tinea capitis caused by Trichophyton species.
- A study published in 2012 6 found that griseofulvin had the highest cure rate (96%) for the treatment of tinea capitis, followed by terbinafine (88%) and fluconazole (84%).
Treatment Options
Based on the available evidence, the following treatment options can be considered:
- Terbinafine: 6-8 weeks of treatment, with a cure rate of 84.2% 3
- Griseofulvin: 6-8 weeks of treatment, with a cure rate of 79.0% 3
- Itraconazole: 8 weeks of treatment, with a cure rate of 66% 4
- Fluconazole: 6-8 weeks of treatment, with a cure rate of 84% 6
Safety and Adverse Events
All of the included studies reported that the medications were well-tolerated, with mild and reversible adverse events 3, 4, 5, 6.