What are the discharge instructions for a patient with ringworm (tinea infection)?

Discharge Instructions for Ringworm (Tinea Infection)

Apply topical antifungal cream to the affected area and 2 cm beyond the visible lesion borders twice daily for 2-4 weeks, continuing for at least one week after the rash has cleared to ensure complete eradication of the fungus. 1

Treatment Regimen

Topical Treatment (First-Line)

• For body/groin ringworm (tinea corporis/cruris):

  • Apply one of the following twice daily:
    • Clotrimazole 1% cream for 2-4 weeks 1
    • Miconazole 2% cream for 2 weeks (jock itch) or 4 weeks (body/feet) 2
    • Terbinafine 1% cream for 1-2 weeks 3

• Application technique:

  • Apply a thin layer to affected area and 2 cm beyond visible borders
  • Wash hands thoroughly before and after application
  • Keep the area clean and dry 1

Oral Treatment (For Severe Cases)

• Required for extensive skin involvement, hair/nail involvement, failure of topical therapy, or immunocompromised patients 1
• Options include:
  • Itraconazole: Most effective for chronic/relapsing cases 4
  • Fluconazole: Alternative if unable to tolerate other options 4
  • Terbinafine: Effective for dermatophyte infections 5

Prevention of Reinfection

Personal Hygiene

• Keep skin clean and dry, especially in skin folds and between toes
• Change underwear, socks, and clothing daily
• Thoroughly dry body after bathing, especially between toes and in skin folds 1

Clothing and Footwear

• Wear loose-fitting cotton clothing to reduce moisture
• Avoid sharing personal items (towels, clothing, hairbrushes)
• Wear flip-flops or sandals in public showers, locker rooms, and pool areas 6

Home Measures

• Wash bedding, towels, and clothing in hot water with detergent
• Disinfect combs, brushes, and other personal items
• Consider applying antifungal powder to shoes to eliminate fungal elements 6

Follow-up Care

When to Seek Medical Attention

• If the rash doesn't improve after 2 weeks of treatment
• If the rash spreads or worsens despite treatment
• If you develop signs of secondary bacterial infection (increased pain, swelling, warmth, pus, or red streaks)
• If you develop fever or other systemic symptoms 1

Common Treatment Mistakes to Avoid

• Stopping treatment too early: Continue treatment for at least one week after the rash has disappeared
• Using topical steroids: These can worsen fungal infections and create "tinea incognito"
• Inadequate application: Ensure complete coverage of affected areas plus surrounding skin
• Neglecting to treat all infected family members: All household members with symptoms should be treated simultaneously
• Poor hygiene practices: Maintain good hygiene to prevent reinfection 1

Remember that ringworm is contagious, so avoid direct skin contact with others until the infection clears. Complete the full course of treatment even if symptoms improve before it's finished to prevent recurrence.