What is the treatment for Tinea corporis?

Treatment of Tinea Corporis

For tinea corporis, first-line treatment is topical antifungal therapy for 2-4 weeks, while oral antifungals are recommended for extensive, resistant, or recurrent infections. 1, 2, 3

Diagnosis

• Confirm diagnosis through:
  • Clinical appearance: well-demarcated, circular or oval, erythematous patches with raised borders and central clearing
  • Microscopic examination with potassium hydroxide (KOH) preparation
  • Fungal culture when diagnosis is uncertain 1, 3

Treatment Algorithm

First-Line Treatment: Topical Antifungals

• Apply for 2-4 weeks and continue for at least 1 week after clinical clearing 1, 4
• Effective options include:
  • Azoles (miconazole, clotrimazole) - apply twice daily 1, 5
  • Allylamines (terbinafine 1%) - apply once daily 5, 6
  • Naftifine 1% - apply once daily 5

Second-Line Treatment: Oral Antifungals

• Indications for oral therapy:

  • Extensive infection
  • Treatment-resistant cases
  • Recurrent infections
  • Immunocompromised patients 1, 3

• Recommended oral regimens:

  • Itraconazole: 100-200 mg daily for 2-4 weeks 1
  • Terbinafine: 250 mg daily for 1-2 weeks 1, 7
  • Fluconazole: 150 mg once weekly for 2-3 weeks 7
  • Griseofulvin: 500 mg daily (adults) or 10 mg/kg daily (children) for 2-4 weeks 1, 2

Comparative Efficacy

• Topical terbinafine 1% has shown superior efficacy (94% mycological cure) compared to ketoconazole 2% cream (69% cure) in a one-week treatment course 6
• For oral therapy in resistant cases, itraconazole has demonstrated superior efficacy (66% cure rate) compared to fluconazole (42%), terbinafine (28%), and griseofulvin (14%) 1

Special Considerations

• Inflamed lesions: Consider agents with anti-inflammatory properties or short-term combination antifungal/steroid agents (use with caution due to risk of atrophy) 4
• Children: Griseofulvin is generally well-tolerated with extensive safety data in children 1
• Treatment duration: Continue treatment until at least one week after clinical resolution 1, 4

Prevention and Control

• Screen and treat all household members for anthropophilic infections 1
• Avoid sharing personal items (combs, brushes, clothing) 1
• Apply antifungal powders to prevent reinfection 1
• Maintain good hygiene to control sources of reinfection 2

Common Pitfalls

1. Misdiagnosis: Tinea corporis can mimic other annular lesions like pityriasis rosea, leading to inappropriate treatment 1, 3
2. Inadequate treatment duration: Stopping treatment too early can lead to recurrence; continue for at least one week after clinical clearing 1, 4
3. Prior steroid use: Can modify clinical appearance and make diagnosis difficult 3
4. Failure to address reinfection sources: All infected family members should be treated simultaneously 1
5. Inappropriate use of oral therapy: Reserve for extensive or resistant cases, as topical therapy is usually sufficient for localized infections 4, 3