From the Guidelines
For tinea corporis (ringworm of the body) that is refractory to topical treatments, oral antifungal therapy with terbinafine 250 mg daily for 2-4 weeks is the recommended next step, due to its high efficacy and favorable safety profile, as supported by the study 1. When considering treatment options, it's essential to prioritize the most recent and highest quality evidence. In this case, the study 1 provides guidance on the efficacy of oral antifungal agents, including itraconazole and terbinafine, in treating tinea corporis. Some key points to consider when treating tinea corporis with oral antifungals include:
- Confirming the diagnosis with a KOH preparation or fungal culture to rule out conditions that mimic tinea, as suggested by the study 1.
- Continuing good hygiene practices, including keeping the affected area clean and dry, using separate towels, and washing clothes and bedding in hot water to prevent reinfection, as recommended by the study 1.
- Monitoring for potential side effects, including headache, gastrointestinal disturbances, and rarely, liver toxicity, and considering liver function tests before and during treatment, especially for extended courses, as noted in the study 1.
- Considering alternative treatments, such as itraconazole 200 mg daily for 1-2 weeks, or fluconazole 150-300 mg weekly for 2-4 weeks, if the initial treatment is not effective, as suggested by the study 1. It's also important to note that the study 1 provides guidance on the treatment of tinea capitis, which may not be directly applicable to tinea corporis, but can still inform treatment decisions. Overall, the goal of treatment is to achieve mycological cure, and oral antifungal therapy with terbinafine is a effective and safe option for treating tinea corporis that is refractory to topical treatments, as supported by the study 1.
From the Research
Treatment Options for Refractory Tinea Corporis
For tinea corporis that is refractory to topical treatments, several oral antifungal options are available:
- Terbinafine, itraconazole, and fluconazole are commonly used for the systemic treatment of severe dermatophytoses, including tinea corporis 2, 3, 4
- In cases of terbinafine resistance, itraconazole may be considered as an alternative treatment option 2, 3
- Combination therapy of oral terbinafine and itraconazole may be an effective and safe therapeutic strategy for the management of dermatophytosis, including tinea corporis 3
Considerations for Treatment
When selecting a treatment option, the following factors should be considered:
- Identification of the species and genotype of the dermatophyte, as well as resistance testing, may be necessary to guide treatment decisions 2
- The use of oral antifungals should always be combined with topical antifungal therapy 2
- Therapy monitoring should be carried out culturally and, if possible, using molecular methods (polymerase chain reaction) 2
- Alternative treatment options, such as laser application and photodynamic therapy (PDT), may be considered in individual cases 2