What is the treatment for tinea corporis?

Treatment of Tinea Corporis

Topical antifungal agents are the first-line treatment for tinea corporis (ringworm of the body) and are highly effective for localized, uncomplicated infections.

Diagnosis

Before initiating treatment, proper diagnosis is essential:

• Look for characteristic well-demarcated, circular or oval, erythematous patches or plaques with raised, scaly borders and central clearing
• Confirm diagnosis through direct microscopy of skin scrapings with potassium hydroxide (KOH) preparation 1
• Culture is rarely needed unless the diagnosis is uncertain or treatment has failed 2

Treatment Algorithm

First-Line Treatment: Topical Antifungals

For localized, uncomplicated tinea corporis:

1. Azole antifungals (apply once or twice daily for 2-4 weeks):

   • Clotrimazole 1%
   • Miconazole 2%
   • Econazole 1%
   • Ketoconazole 2%

2. Allylamine antifungals (more expensive but require shorter treatment duration):

   • Terbinafine 1% cream (once daily for 1-2 weeks) 3, 4
   • Naftifine 1% cream (once daily for 2 weeks) 4

Second-Line Treatment: Oral Antifungals

For extensive, severe, or treatment-resistant infections:

1. Griseofulvin (FDA-approved):

   • Adults: 375 mg daily (single dose or divided) for 2-4 weeks 5
   • Children: ~7.3 mg/kg/day of ultramicrosize griseofulvin 5
     • 16-27 kg: 125-187.5 mg daily

     • 27 kg: 187.5-375 mg daily

2. Alternative oral agents (for resistant cases):

   • Itraconazole 100 mg daily for 2-4 weeks 6
   • Terbinafine (oral) - based on weight

Treatment Duration and Follow-up

• Continue treatment for at least one week after clinical clearing of infection 2
• For topical treatment: 2-4 weeks is typically sufficient 2
• For oral treatment: 2-4 weeks for tinea corporis 5

Special Considerations

1. Inflammatory lesions: Consider short-term use of combination antifungal/steroid preparations for highly inflammatory lesions, but use with caution due to risk of steroid-related side effects 2, 4

2. Treatment failure: Consider the following factors:

   • Poor adherence to treatment
   • Incorrect diagnosis
   • Reinfection from untreated contacts or fomites
   • Need for systemic therapy

3. Prevention of recurrence:

   • Maintain good personal hygiene
   • Avoid sharing personal items (towels, clothing)
   • Keep skin dry, especially in skin folds

Common Pitfalls

1. Misdiagnosis: Tinea corporis can mimic other annular lesions such as nummular eczema, psoriasis, or granuloma annulare 1

2. Tinea incognito: Modified presentation due to inappropriate use of topical steroids without antifungal therapy, making diagnosis more difficult 1

3. Inadequate treatment duration: Stopping treatment too early can lead to recurrence; continue for at least one week after clinical clearing 2

4. Failure to address predisposing factors: Underlying conditions like diabetes or immunosuppression may require longer treatment courses

5. Overlooking household contacts: Consider screening family members for asymptomatic infection, especially with anthropophilic dermatophytes