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 should be 15-20 mg/kg per day for 6-8 weeks for patients weighing less than 50 kg, and 1 g per day for 6-8 weeks for patients weighing more than 50 kg 1.
• The dose of terbinafine should be 250 mg per day for 2-4 weeks for patients weighing more than 40 kg, 125 mg per day for 2-4 weeks for patients weighing 20-40 kg, and 625 mg per day for 2-4 weeks for patients weighing less than 20 kg 1.
• In cases of treatment failure, it is essential to consider lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and to adjust the treatment regimen accordingly 1.
• Itraconazole can be used as a second-line therapy, with a dose of 50-100 mg per day for 4 weeks, or 5 mg/kg per day for 2-4 weeks 1. It is crucial 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. Additionally, 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.

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 tinea 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, also known as tinea infection, typically involves the use of antifungal medications. The choice of treatment depends on the severity and location of the infection, as well as the patient's overall health.

• Systemic Antifungal Agents: For tinea capitis, which affects the scalp, systemic antifungal agents such as griseofulvin 3, 4, 5, 6 and terbinafine 3, 4, 5, 6 are commonly used. Griseofulvin is usually administered for 6 to 8 weeks, while terbinafine requires 6 weeks of treatment.
• Topical Treatment: For superficial tinea infections, such as tinea corporis, tinea cruris, and tinea pedis, topical antifungal agents are often effective 7. Treatment typically lasts for 2 to 4 weeks, depending on the location and severity of the infection.
• Comparison of Treatments: Studies have compared the efficacy of different antifungal agents, including griseofulvin and terbinafine, in the treatment of tinea capitis 3, 5, 6. These studies have shown that both agents are effective, but terbinafine may have a shorter treatment duration and fewer side effects.

Efficacy and Safety of Treatments

The efficacy and safety of antifungal agents in the treatment of ringworm have been evaluated in several studies.

• Griseofulvin: Griseofulvin has been shown to be effective in the treatment of tinea capitis, with cure rates ranging from 84% to 96% 3, 5. However, it can cause gastrointestinal side effects in some patients 3.
• Terbinafine: Terbinafine has also been shown to be effective in the treatment of tinea capitis, with cure rates ranging from 84% to 94% 3, 5. It may have a shorter treatment duration and fewer side effects compared to griseofulvin 3, 6.
• Other Antifungal Agents: Other antifungal agents, such as itraconazole and fluconazole, have also been used to treat ringworm, although their efficacy and safety may vary depending on the specific infection and patient population 3, 5.