What is the treatment for tinea corporis?

Treatment of Tinea Corporis

Topical antifungal medications are the first-line treatment for tinea corporis, with application once daily for 1-2 weeks being highly effective for most cases. 1

First-Line Treatment

Topical Antifungals

• Preferred agents:

  • Terbinafine cream 1% - apply once daily for 1-2 weeks
  • Azole antifungals (clotrimazole, miconazole, econazole) - apply 1-2 times daily for 2-4 weeks
  • Naftifine cream 1% - apply once daily for 2 weeks

• Application instructions:

  • Apply to affected area and 2 cm beyond visible lesion borders
  • Continue treatment for at least one week after clinical clearing of infection
  • Wash hands thoroughly after application

• Efficacy evidence:

  • Terbinafine shows significantly higher clinical cure rates compared to placebo (NNT 3) 2
  • Naftifine 1% is more effective than placebo in achieving both mycological cure (NNT 3) and clinical cure (NNT 3) 2
  • Clotrimazole 1% demonstrates superior mycological cure rates compared to placebo (NNT 2) 2

Second-Line Treatment (For Extensive or Resistant Cases)

Oral Antifungals

When topical treatment fails or for extensive disease, oral therapy is indicated:

1. Itraconazole:

   • 100 mg daily for 2 weeks OR 200 mg daily for 1 week
   • Provides faster onset of clinical and mycological cure with the higher dose, shorter duration regimen 1
   • Clinical symptoms significantly reduce within 2 weeks of treatment 3

2. Fluconazole:

   • 150 mg once weekly for 2-4 weeks
   • Effective for extended or multiple infection sites 4
   • May require 2-4 doses for complete cure 5

3. Griseofulvin:

   • Adults: 500 mg daily (or 250 mg twice daily)
   • Children: 10 mg/kg daily
   • Treatment duration: 2-4 weeks 6
   • Continue until the infecting organism is completely eradicated

Diagnostic Confirmation

• Accurate diagnosis is essential before initiating treatment
• Confirm through:
  • Direct microscopic examination of skin scrapings in potassium hydroxide solution
  • Fungal culture on appropriate medium when diagnosis is uncertain
• Identify the causative organism to guide treatment selection

Follow-up and Monitoring

• Clinical improvement should be seen within 1-2 weeks
• Complete resolution typically takes 2-4 weeks
• Treatment should continue for at least one week after clinical clearing
• For resistant cases, obtain repeat mycology sampling to ensure mycological cure 1

Environmental Management and Prevention

• Keep affected areas clean and dry
• Wear loose-fitting cotton clothing
• Change clothes and underwear daily, especially after sweating
• Use separate towels for affected and unaffected areas
• Disinfect contaminated items (combs, brushes) with bleach solution or 2% sodium hypochlorite 7

Common Pitfalls and Considerations

1. Treatment failure causes:

   • Inadequate treatment duration
   • Concurrent steroid use without antifungal
   • Misdiagnosis (bacterial infection, contact dermatitis)
   • Inadequate environmental management

2. Special considerations:

   • For inflammatory lesions: Consider combination antifungal/steroid agents for short-term use only
   • For immunocompromised patients: Longer therapy duration may be required
   • For extensive disease: Oral therapy is preferred over topical

3. Contraindications:

   • Avoid oral antifungals in patients with liver disease
   • Avoid combination steroid/antifungal products for long-term use due to risk of skin atrophy

Remember that mycological cure, not just clinical improvement, should be the goal of treatment, with therapy tailored according to individual response 1.