What is the best treatment for multiple large lesions of tinea corporis (ringworm) on an adult female's arms?

From the Guidelines

For multiple large lesions of tinea corporis (ringworm) on an adult female's arms, oral antifungal therapy is recommended as the best treatment. The provided evidence, although focused on sporotrichosis, highlights the effectiveness of oral antifungals like itraconazole and terbinafine in treating fungal infections [ 1 ]. Given the context of tinea corporis, which is a dermatophyte infection, the preferred treatment would align with guidelines that recommend oral antifungals for extensive or severe cases. Terbinafine 250 mg once daily for 2-4 weeks is often considered a first-line option due to its high efficacy and favorable safety profile for dermatophyte infections. Alternatively, itraconazole 200 mg daily for 1-2 weeks could be considered, especially in cases where terbinafine is not suitable.

Key Considerations:

• Oral antifungals are preferred for multiple large lesions because they work systemically to eliminate the infection more effectively than topical treatments alone.
• Topical antifungal creams such as terbinafine 1%, clotrimazole 1%, or miconazole 2% should be applied twice daily to the affected areas and extending 1-2 cm beyond the visible border of the lesions.
• Treatment should continue for 1-2 weeks after the lesions have cleared to prevent recurrence.
• Good hygiene practices, including keeping the affected areas clean and dry, wearing loose-fitting clothing, avoiding sharing personal items, and washing clothing and bedding in hot water, are crucial to prevent reinfection.

Treatment Approach:

• Initiate oral antifungal therapy with terbinafine 250 mg once daily for 2-4 weeks as the first-line treatment.
• Consider itraconazole 200 mg daily for 1-2 weeks as an alternative, taking into account the patient's medical history and potential interactions.
• Combine oral treatment with topical antifungal creams to enhance efficacy and prevent recurrence.
• Educate the patient on the importance of hygiene and preventive measures to avoid reinfection.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... tinea corporis, 2 to 4 weeks; ... Adults: 0. 5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg/day). Patients with less severe or extensive infections may require less, whereas those with widespread lesions may require a starting dose of 0.75 g to 1.0 g/day.

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 treatment for multiple large lesions of tinea corporis (ringworm) on an adult female's arms is griseofulvin (PO), with a recommended dosage of 0.5 g daily for 2 to 4 weeks. However, patients with widespread lesions may require a starting dose of 0.75 g to 1.0 g/day 2. It is essential to note that prior to therapy, a dermatophyte should be identified as responsible for the infection 2.

• Key points:
  • Griseofulvin is indicated for the treatment of tinea corporis.
  • The recommended treatment period is 2 to 4 weeks.
  • The dosage should be individualized, with a starting dose of 0.5 g daily for adults.
  • Patients with widespread lesions may require a higher starting dose. 2 2

From the Research

Treatment Options for Tinea Corporis

The treatment of tinea corporis, also known as ringworm, typically involves the use of antifungal agents. For multiple large lesions on an adult female's arms, the following options are available:

• Topical antifungal treatments, such as terbinafine, naftifine, and clotrimazole, have been shown to be effective in treating tinea corporis 3
• Oral antifungal agents, such as terbinafine, itraconazole, and fluconazole, may be necessary for more extensive or resistant infections 4, 5, 6
• Treatment duration varies from one to several weeks, depending on the severity of the infection and the chosen treatment regimen 7, 4, 6

Considerations for Treatment

When selecting a treatment option, the following factors should be considered:

• The size and number of lesions, as well as the presence of any underlying health conditions 7
• The potential for side effects, such as skin irritation or gastrointestinal symptoms 5
• The need for ongoing treatment to prevent relapse, as well as the importance of completing the full treatment course 7, 3

Efficacy of Treatment Options

Studies have demonstrated the efficacy of various antifungal agents in treating tinea corporis, including:

• Terbinafine, which has been shown to be highly effective in achieving clinical and mycological cure 4, 3
• Naftifine and clotrimazole, which have also been found to be effective in treating tinea corporis 3
• Oral antifungal agents, such as itraconazole and fluconazole, which may be necessary for more severe or resistant infections 5, 6