What is the treatment for tinea corporis?

Treatment of Tinea Corporis

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

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis through:

• Clinical appearance: Well-demarcated, circular or oval, erythematous, scaly patches or plaques with raised borders and central clearing
• Direct microscopy: KOH preparation of skin scrapings from the active border
• Culture: Only necessary for atypical presentations or treatment failures

Treatment Algorithm

First-Line Treatment: Topical Antifungals

For localized, uncomplicated tinea corporis:

• Azole antifungals (clotrimazole, miconazole, econazole, ketoconazole)

  • Apply twice daily for 2-4 weeks 1
  • Continue for at least one week after clinical clearing

• Allylamine antifungals (terbinafine, naftifine)

  • Apply once or twice daily for 1-2 weeks 1, 2
  • Terbinafine 1% cream once daily for 7 days has shown high efficacy (84.2% mycological cure) 2

Second-Line Treatment: Oral Antifungals

Reserve for cases that are:

• Extensive or involving large body surface area
• Resistant to topical therapy
• Recurrent or chronic
• In immunocompromised patients

Options include:

• Griseofulvin

  • Adults: 500 mg daily (or 250 mg twice daily)
  • Children: 10 mg/kg daily
  • Duration: 2-4 weeks 3

• Terbinafine

  • Adults: 250 mg daily for 1-2 weeks 4
  • More effective for Trichophyton species

• Fluconazole

  • 150 mg once weekly for 2-4 weeks 5
  • Good option for patients who prefer less frequent dosing

• Itraconazole

  • 100 mg daily for 2 weeks or 200 mg daily for 7 days 4

Treatment Duration and Follow-up

• Continue treatment for at least one week after clinical clearing of infection 1
• Treatment failure may indicate:
  • Incorrect diagnosis
  • Non-compliance
  • Reinfection from untreated contacts or fomites
  • Resistant organism

Special Considerations

• Inflammatory lesions: Consider short-term use of combination antifungal/steroid preparations, but use with caution due to risk of steroid-related side effects 1
• Prevention of recurrence:
  • Maintain good hygiene
  • Keep skin dry
  • Avoid sharing personal items
  • Treat family members if infected

Pitfalls to Avoid

1. Misdiagnosis: Tinea corporis can mimic other annular lesions like nummular eczema, psoriasis, or granuloma annulare 6
2. Inadequate treatment duration: Stopping treatment too early can lead to recurrence
3. Tinea incognito: Prior use of corticosteroids can alter the clinical appearance, making diagnosis difficult 6
4. Overuse of combination steroid-antifungal preparations: Can lead to skin atrophy and other steroid-related complications 1