From the Guidelines
The best treatment for dermatophyte (ringworm) infection is oral antifungal therapy with either terbinafine or griseofulvin, depending on the causative dermatophyte and local epidemiology, as recommended by the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 1.
Treatment Options
- For mild to moderate cases, topical antifungals like clotrimazole, miconazole, or terbinafine may be effective, but 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, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1.
Dosage and Duration
- The dosage and duration of treatment vary depending on the medication and the patient's weight, with terbinafine requiring a shorter course of treatment (2-4 weeks) compared to griseofulvin (6-8 weeks) 1.
- For example, the recommended dose of terbinafine for children weighing less than 20 kg is 625 mg per day for 2-4 weeks, while for children weighing more than 40 kg, the recommended dose is 250 mg per day for 2-4 weeks 1.
Additional Measures
- Keeping the affected area clean and dry, avoiding sharing personal items, and washing bedding and clothing in hot water can help prevent reinfection 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 plan accordingly 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: Epidermophyton floccosum Microsporum audouinii Microsporum canis Microsporum gypseum Trichophyton crateriform Trichophyton gallinae Trichophyton interdigitalis Trichophyton megnini Trichophyton mentagrophytes Trichophyton rubrum Trichophyton schoenleini Trichophyton sulphureum Trichophyton tonsurans Trichophyton verrucosum
The best treatment for dermatophyte (ringworm) infection is Griseofulvin when the infection is not adequately treated by topical therapy, as stated in the drug label 2.
- It is effective against various species of fungi, including Epidermophyton floccosum, Microsporum, and Trichophyton.
- The drug should only be used when a dermatophyte has been identified as the cause of the infection and laboratory testing confirms the diagnosis.
- Griseofulvin is not effective against bacterial infections, Candidiasis, or other types of fungal infections.
From the Research
Treatment Options for Dermatophyte Infection
The treatment of dermatophyte infection, also known as ringworm, typically requires a systemic anti-fungal approach rather than topical treatment 3, 4. The following are some of the treatment options available:
- Griseofulvin (Grifulvin): an FDA-approved medication for the treatment of tinea capitis, with a treatment duration of 6 to 8 weeks 3, 4
- Terbinafine (Lamisil Granules): an FDA-approved medication for the treatment of tinea capitis, with a treatment duration of 6 weeks 3, 4
- Itraconazole: a newer antifungal agent that has been shown to be effective in the treatment of tinea capitis, with a shorter treatment duration compared to griseofulvin 5
- Fluconazole: another newer antifungal agent that may be effective in the treatment of tinea capitis, although supporting data is limited 5
- Topical antifungal treatments: such as terbinafine, naftifine, and clotrimazole, which have been shown to be effective in the treatment of tinea cruris and tinea corporis 6
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for dermatophyte infection:
- Terbinafine has been shown to have higher clinical cure rates compared to placebo 6
- Naftifine has been shown to have higher mycological cure rates compared to placebo 6
- Clotrimazole has been shown to have higher mycological cure rates compared to placebo 6
- There is no significant difference in mycological cure rates between azoles and benzylamines 6
- Azoles may be slightly less effective in achieving clinical cure compared to azole and steroid combination creams 6
Considerations for Treatment
When selecting a treatment option for dermatophyte infection, the following factors should be considered: