What is the treatment of choice for tinea corporis in a 14-year-old patient?

Treatment of Tinea Corporis in a 14-Year-Old Patient

For tinea corporis in a 14-year-old patient, topical antifungal therapy with econazole or another azole applied once daily for two weeks is the treatment of choice. 1, 2

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis through:

• Clinical appearance: well-demarcated, circular or oval erythematous patches with raised borders and central clearing
• Microscopic examination: KOH preparation of skin scrapings from the active border
• Consider fungal culture in atypical or resistant cases 2, 3

First-Line Treatment

Topical Therapy

• Topical antifungal agents are first-line for localized tinea corporis 4, 5
• Apply once daily to cover affected areas and 2 cm beyond the border of the lesion
• Options include:
  • Econazole 1% cream once daily for two weeks 1
  • Terbinafine 1% cream once daily for one week 6
  • Other azoles (miconazole, clotrimazole) applied once daily for two weeks 2
• Continue treatment for at least one week after clinical clearing 4

Second-Line Treatment

Oral Therapy

Consider oral antifungals in cases that are:

• Extensive or widespread
• Resistant to topical therapy
• In immunocompromised patients 5

Oral options include:

• Griseofulvin: 10 mg/kg/day for 2-4 weeks 7
• Terbinafine: 250 mg daily (adult dose) for 1-2 weeks 2, 8
• Itraconazole: 5 mg/kg/day (or 100 mg daily for adult-sized adolescents) for 2-4 weeks 2
• Fluconazole: 150 mg once weekly for 2-3 weeks 8

Treatment Monitoring and Follow-up

• Clinical improvement typically occurs within 1-2 weeks 2
• Continue treatment for the full prescribed duration even if symptoms resolve earlier
• If no improvement after the treatment period, reconsider diagnosis 1
• Follow-up to confirm clinical and mycological cure 2

Prevention and Control

• Advise on general hygiene measures
• Avoid sharing personal items
• Screen and treat all household members for anthropophilic infections
• Apply absorbent powders containing antifungals to prevent reinfection 2

Important Considerations

• Avoid topical steroids as they can worsen the infection or create tinea incognito
• Combination antifungal/steroid agents should be used with caution due to potential for atrophy 4
• Differential diagnosis includes eczema, psoriasis, and pityriasis rosea 2, 3
• The British Journal of Dermatology emphasizes that treatment should continue until mycological cure is achieved 2

Special Considerations for Adolescents

• Adolescents with extensive disease may require adult dosing of oral medications
• Terbinafine 1% cream has demonstrated efficacy and good tolerability in children 6
• For oral therapy in adolescents approaching adult size, adult dosing may be appropriate 8