What is the recommended treatment for tinea corporis in pediatric patients?

Treatment of Tinea Corporis in Pediatric Patients

Topical terbinafine 1% cream applied once daily for 1-2 weeks is the recommended first-line treatment for tinea corporis in pediatric patients. 1

Diagnosis Confirmation

• Confirm diagnosis through microscopic examination (KOH preparation) or fungal culture before treatment
• Treatment can be initiated while awaiting confirmatory mycology if clinical signs are present
• Key clinical signs: circular lesions with raised, scaly borders and central clearing

Treatment Algorithm

First-Line Treatment: Topical Therapy

• Terbinafine 1% cream applied once daily for 1-2 weeks 1, 2

  • Highly effective with 92% cure rates in children 2
  • Fungicidal action provides high cure rates with short treatment duration
  • Continue treatment for at least one week after clinical resolution 1

• Alternative topical options if terbinafine is unavailable:

  • Clotrimazole 1% cream applied twice daily for 2 weeks 1
  • Miconazole 2% cream applied twice daily for 2 weeks 1

Second-Line Treatment: Systemic Therapy

Indicated for:

• Extensive disease
• Failed topical treatment
• Immunocompromised patients

Systemic Options:

1. Griseofulvin:

   • Dosage: 10-15 mg/kg/day 3
   • Duration: 2-4 weeks for tinea corporis 1, 3
   • Particularly effective for Microsporum species infections 1
   • Well-tolerated in children with extensive safety data 1

2. Terbinafine (oral):

   • Dosage: Weight-based (typically 62.5-250 mg daily) 1, 4
   • Duration: 1-2 weeks 1
   • More effective for Trichophyton species infections 1
   • Generally well-tolerated with primarily gastrointestinal side effects 4

3. Itraconazole:

   • Dosage: 5 mg/kg/day 1
   • Duration: 2-4 weeks 1
   • Effective against both Trichophyton and Microsporum species 1
   • Higher efficacy (66%) compared to other systemic options in resistant cases 1

Monitoring and Follow-up

• Clinical improvement typically expected within 1-2 weeks 1
• Continue treatment until mycological cure is achieved 1
• Follow-up mycological examination recommended for resistant or recurrent cases 1

Prevention of Reinfection

• Screen and treat all household members for anthropophilic infections 1
• Cleanse personal items with disinfectant and avoid sharing 1
• Apply antifungal powders to prevent reinfection 1

Important Considerations

• Topical therapy is generally sufficient for localized tinea corporis 5, 6
• Systemic therapy should be reserved for extensive disease or when topical treatment fails 6
• Treatment should continue for at least one week after clinical clearing of infection 5
• The presence of inflammation may necessitate an agent with anti-inflammatory properties 5

Cautions

• Avoid combination antifungal/steroid agents due to potential for causing atrophy and other steroid-associated complications 5
• Terbinafine, while generally well-tolerated, can rarely cause Stevens-Johnson syndrome and hepatic toxicity 1
• Accurate diagnosis is essential as tinea corporis can be confused with eczema and other skin conditions 6