What is the recommended treatment for ringworm?

Treatment of Ringworm

For ringworm (tinea corporis), topical antifungal therapy applied once or twice daily for 1 week is the recommended first-line treatment. 1

First-Line Treatment Options

Topical Therapy

• Terbinafine cream/gel: Apply once daily for 1 week 1

  • Highly effective with clinical cure rates significantly higher than placebo (RR 4.51,95% CI 3.10 to 6.56) 2
  • Requires fewer applications than some alternatives

• Azole creams (e.g., clotrimazole, miconazole):

  • Apply once or twice daily for 1-2 weeks
  • Clotrimazole shows good efficacy compared to placebo (RR 2.87,95% CI 2.28 to 3.62 for mycological cure) 2

• Naftifine 1%:

  • Apply once daily for 1 week
  • Demonstrated superior mycological cure rates compared to placebo (RR 2.38,95% CI 1.80 to 3.14) 2

Application Instructions

• Wash affected skin with soap and water and dry completely before applying
• For ringworm (tinea corporis), apply once daily (morning or night) for 1 week 1
• Wash hands after each use

Special Considerations

Extensive Disease or Treatment Failure

For extensive disease, immunocompromised patients, or cases that fail topical therapy:

• Oral terbinafine:

  • Adults: 250 mg daily for 1-2 weeks 3, 4
  • Children: Dosing based on weight 5:
    • <20 kg: 62.5 mg daily
    • 20-40 kg: 125 mg daily

    • 40 kg: 250 mg daily

• Alternative oral options:

  • Fluconazole: 50-100 mg daily or 150 mg once weekly for 2-3 weeks 3
  • Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 7 days 3

Treatment Failure

If initial treatment fails, consider:

1. Confirming diagnosis with microscopy or culture
2. Evaluating compliance with treatment
3. Switching to a different antifungal class
4. Extending treatment duration
5. Switching to oral therapy

Prevention of Recurrence

• Keep affected areas clean and dry
• Avoid sharing personal items (towels, clothing)
• Treat all infected family members simultaneously
• Wash clothing and bedding in hot water

Monitoring

• Most cases resolve with appropriate topical therapy within 1-2 weeks
• If no improvement after 2 weeks of treatment, reevaluate diagnosis and consider oral therapy

Pitfalls to Avoid

• Using topical steroids alone (can worsen infection - "tinea incognito")
• Inadequate treatment duration
• Failure to treat all affected areas
• Failure to identify and treat the source of infection (pets, family members)
• Not addressing predisposing factors (excessive moisture, occlusive clothing)

While both topical azoles and allylamines (terbinafine, naftifine) are effective, allylamines may provide faster clinical improvement and require shorter treatment duration, potentially improving compliance 2.