What is the treatment for ringworm (tinea infection)?

From the Guidelines

Ringworm (tinea infection) should be treated with oral antifungal medications, such as terbinafine or griseofulvin, as topical therapy alone is not recommended for the treatment of tinea capitis 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1. Some key points to consider when treating ringworm include:

• The dose of griseofulvin or terbinafine should be determined based on the patient's body weight, with griseofulvin dosed at 15-20 mg/kg/day for 6-8 weeks and terbinafine dosed at 250 mg/day for 2-4 weeks for patients over 40 kg 1.
• Treatment failure should be addressed by considering lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and second-line therapy with itraconazole may be necessary 1.
• 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. It is essential to note that 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

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; tinea unguium-depending on rate of growth-fingernails, at least 4 months; toenails, at least 6 months 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 infection) is griseofulvin (PO), with the following dosage:

• Adults: 0.5 g daily
• Pediatric patients (older than 2 years): 10 mg/kg daily The treatment period varies depending on the type of infection:
• Tinea capitis: 4 to 6 weeks
• Tinea corporis: 2 to 4 weeks
• Tinea pedis: 4 to 8 weeks
• Tinea unguium: at least 4 months for fingernails, at least 6 months for toenails 2 2

From the Research

Treatment Options for Ringworm (Tinea Infection)

• The treatment for ringworm (tinea infection) can be either topical or oral, depending on the severity and location of the infection 3, 4.
• Topical antifungal agents such as terbinafine, clotrimazole, and naftifine are effective in treating tinea corporis and tinea cruris, with cure rates ranging from 80% to 90% 5, 6.
• Oral antifungal agents such as fluconazole, itraconazole, and terbinafine can be used to treat more severe or extensive infections, with cure rates ranging from 80% to 95% 7, 4.
• The duration of treatment varies from 1 to 6 weeks, depending on the type of infection and the antifungal agent used 3, 6, 4.

Topical Treatment

• Terbinafine 1% cream applied twice daily for 1 week has been shown to be more effective than clotrimazole 1% cream applied twice daily for 4 weeks in the treatment of tinea pedis 6.
• Naftifine 1% cream has been shown to be effective in achieving clinical and mycological cure in the treatment of tinea corporis and tinea cruris 5.
• Clotrimazole 1% cream is also effective in treating tinea corporis and tinea cruris, with mycological cure rates ranging from 70% to 80% 5, 6.

Oral Treatment

• Griseofulvin, terbinafine, itraconazole, and fluconazole are effective oral antifungal agents for the treatment of tinea capitis, with cure rates ranging from 80% to 95% 7.
• Fluconazole, itraconazole, and terbinafine are effective in treating tinea corporis, tinea cruris, and tinea pedis, with cure rates ranging from 80% to 90% 4.
• The choice of oral antifungal agent depends on the type of infection, the severity of the infection, and the patient's medical history 7, 4.