What is the treatment for dermatophytosis (ringworm)?

From the Guidelines

The treatment for dermatophytosis (ringworm) typically involves oral antifungal medications, with terbinafine and griseofulvin being the most widely used first-line treatments, as they have good evidence of efficacy 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1. Some key points to consider when treating dermatophytosis include:

• Oral therapy is generally indicated to achieve both clinical and mycological cure, and topical therapy alone is not recommended for the treatment of tinea capitis 1.
• The dose of griseofulvin or terbinafine should be determined based on the patient's body weight, with specific dosing regimens outlined in the guidelines 1.
• Treatment failure should be addressed by considering lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and second-line therapy with itraconazole may be necessary 1.
• Additional measures, such as keeping the affected area clean and dry, avoiding sharing personal items, and washing bedding and clothes in hot water, can help prevent the spread of the infection.
• The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.

From the FDA Drug Label

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 Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: Epidermophyton floccosum Microsporum audouinii Microsporum canis Microsporum gypseum Trichophyton crateriform Trichophyton gallinae Trichophyton interdigitalis Trichophyton megnini Trichophyton mentagrophytes Trichophyton rubrum Trichophyton schoenleini Trichophyton sulphureum Trichophyton tonsurans Trichophyton verrucosum 2

The treatment for dermatophytosis (ringworm) is griseofulvin oral suspension.

• It is indicated for the treatment of dermatophyte infections of the skin, hair, and nails.
• The treatment should be initiated after confirming the diagnosis of dermatophytosis through laboratory testing (KOH preparation, fungal culture, or nail biopsy).

From the Research

Treatment Options for Dermatophytosis (Ringworm)

• Systemic anti-fungal treatment is required for dermatophytosis, with options including griseofulvin and terbinafine 3
• Griseofulvin treatment typically lasts 6 to 8 weeks, while terbinafine treatment requires 6 weeks 3
• Other medications, such as itraconazole and fluconazole, may also be effective in treating dermatophytosis, although they are not FDA-approved for this indication 4, 5, 6
• Topical antifungals, including amorolfine, allylamines, azoles, ciclopiroxolamine, and tolnaftate, may be used to treat less extensive mycoses 7
• Combination therapy with oral and topical antifungals may be recommended in some cases 7

Specific Treatment Regimens

• Terbinafine 250 mg/day is effective in treating superficial dermatophyte infections, including onychomycosis, tinea pedis, and tinea corporis/cruris 4
• Itraconazole and fluconazole may be used to treat severe yeast infections of the skin and mucous membranes 7
• Griseofulvin, itraconazole, and terbinafine are currently available for the systemic treatment of severe dermatophytoses, tinea capitis, and onychomycosis 7

Considerations for Treatment

• Identification of the species and genotype of the dermatophyte and resistance testing may be necessary to guide treatment 7
• Therapy monitoring should be carried out culturally and, if possible, using molecular methods (polymerase chain reaction) 7
• Alternative treatment options, such as laser application and photodynamic therapy (PDT), may be considered in individual cases 7