Treatment of Tinea Corporis
Terbinafine 1% cream applied once daily for 1-2 weeks is the recommended first-line treatment for tinea corporis, with treatment continuing for at least one week after clinical resolution. 1
Diagnosis Before Treatment
- Confirm diagnosis through:
- Microscopic examination (KOH preparation)
- Fungal culture
- Treatment can be initiated while awaiting confirmatory mycology if clinical signs are present 1
- Accurate diagnosis is essential for effective treatment 2
Treatment Algorithm
First-Line: Topical Therapy
- Preferred option: Terbinafine 1% cream once daily for 1-2 weeks 1
- Alternatives:
- Clotrimazole 1% cream twice daily for 2 weeks
- Miconazole 2% cream twice daily for 2 weeks 1
- Continue treatment for at least one week after clinical clearing of infection 2
Second-Line: Systemic Therapy
Indicated when:
- Infection is extensive, multiple, or widespread
- Topical treatment has failed
- Patient is immunocompromised
- Infection is deep, recurrent, or chronic 3
Systemic Options:
- Terbinafine: 250mg daily for 1-2 weeks (most effective for Trichophyton species) 1, 4
- Itraconazole: 100-200mg daily for 2-4 weeks (66% cure rate in resistant cases) 1
- Griseofulvin:
- Adults: 500mg daily (can start at 750mg-1g for widespread lesions)
- Children: 10mg/kg daily
- Duration: 2-4 weeks 5
- Fluconazole: 150mg once weekly for 2-3 weeks (for exceptional circumstances) 6
Treatment Duration
- Topical therapy: 1-2 weeks plus one week after clinical clearing 1, 2
- Systemic therapy: 2-4 weeks for griseofulvin 5, 1-2 weeks for terbinafine 4
- Continue until mycological cure is achieved 1
Prevention of Reinfection
- Screen and treat all household members for anthropophilic infections
- Cleanse personal items with disinfectant
- Avoid sharing personal items
- Apply antifungal powders to prevent reinfection 1
Important Considerations
Safety Profiles
- Terbinafine: Generally well-tolerated; rare serious adverse reactions include Stevens-Johnson syndrome and hepatic toxicity (avoid in liver disease) 1
- Griseofulvin: Well-tolerated with extensive safety data in children; GI disturbances and rashes in <8% of patients 1, 5
- Itraconazole: Primarily gastrointestinal side effects, cutaneous eruptions, and occasional headache 1
Treatment Efficacy
- Topical terbinafine shows significantly higher clinical cure rates compared to placebo (NNT = 3) 7
- Oral terbinafine (250mg daily for 1 week) has demonstrated high efficacy in treating tinea corporis 4
- For stubborn cases, itraconazole has superior efficacy (66%) compared to fluconazole (42%), terbinafine (28%), and griseofulvin (14%) 1
Common Pitfalls
- Misdiagnosis between tinea corporis and pityriasis rosea can lead to inappropriate treatment 1
- Prior use of calcineurin inhibitors or corticosteroids can alter clinical appearance, making diagnosis difficult 3
- Failure to continue treatment for at least one week after clinical resolution can lead to relapse 1, 2
- Inadequate attention to potential sources of reinfection 1, 5