What is the recommended treatment for Tinea corporis?

Treatment of Tinea Corporis

The recommended first-line treatment for tinea corporis is topical terbinafine 1% cream applied once daily for 1-2 weeks. 1

Diagnosis

Before initiating treatment, proper diagnosis is essential:

• Confirm diagnosis through microscopic examination (KOH preparation) or fungal culture 1, 2, 3
• Clinical presentation typically includes well-demarcated, circular or oval, erythematous, scaly patches or plaques with raised borders 3
• Dermoscopy can be a useful non-invasive diagnostic tool 3

Treatment Algorithm

Step 1: Topical Therapy (First-Line)

• Terbinafine 1% cream once daily for 1-2 weeks 1
• Alternative options:
  • Clotrimazole 1% cream twice daily for 2 weeks 1, 4
  • Miconazole 2% cream twice daily for 2 weeks 1

Step 2: Systemic Therapy (For extensive, resistant, or recurrent cases)

• Terbinafine 250mg daily for 1-2 weeks (particularly effective for Trichophyton species) 1, 5
• Itraconazole 100-200mg daily for 2-4 weeks (effective for both Trichophyton and Microsporum species) 1
• Griseofulvin 500mg daily (adults) or 10mg/kg daily (children) for 2-4 weeks 1, 2
  • Particularly effective for Microsporum species infections 1

Treatment Duration and Follow-up

• Continue treatment for at least one week after clinical resolution of symptoms 1, 6
• For topical therapy: 2 weeks is typically sufficient 6
• For systemic therapy: 2-4 weeks depending on the agent and severity 1, 2, 5
• The endpoint of treatment should be mycological cure, not just clinical improvement 1

Important Considerations

Efficacy

• Topical terbinafine and naftifine have demonstrated superior efficacy compared to placebo in achieving clinical and mycological cure 4
• Oral terbinafine, itraconazole, and fluconazole have all shown effectiveness in treating tinea corporis 5

Cautions

• Avoid combination antifungal/corticosteroid preparations, especially in children, as they may lead to persistent or recurrent infections 7
• Topical steroids can modify the clinical appearance, making diagnosis more difficult 3

Prevention of Reinfection

• Screen and treat all household members for anthropophilic infections 1
• Disinfect personal items (combs, brushes) and avoid sharing them 1
• Apply antifungal powders containing miconazole or clotrimazole to prevent reinfection 1

Special Populations

Children

• Topical agents are generally preferred as first-line therapy 1, 7
• For systemic therapy, griseofulvin (10mg/kg daily) is well-tolerated with extensive safety data in children 1, 2

Extensive or Resistant Cases

• Oral itraconazole has shown superior efficacy (66% cure rate) compared to fluconazole (42%), terbinafine (28%), and griseofulvin (14%) in treatment-resistant cases 1

Remember that accurate diagnosis is crucial before initiating treatment, and therapy should continue until complete eradication of the infecting organism as indicated by appropriate clinical or laboratory examination 2, 3.