What is the treatment for tinea corporis?

Tinea Corporis Treatment

Topical antifungal medications are the first-line treatment for tinea corporis, with terbinafine cream 1% applied once daily for 1 week being highly effective for most cases. 1

Diagnosis Before Treatment

• Accurate diagnosis is essential before initiating treatment:
  • Direct microscopic examination using potassium hydroxide (KOH) preparation
  • Culture on appropriate medium to identify the causative organism 1, 2
  • Skin scrapings should be obtained from the active border of the lesion 3

Treatment Algorithm

First-Line Treatment: Topical Antifungals

1. For localized, uncomplicated tinea corporis:

   • Terbinafine cream 1% applied once daily for 1 week 1, 4
   • Clinical studies show this short regimen provides high cure rates (84.2%) and low relapse rates 4
   • Continue treatment for at least one week after clinical clearing of infection 5

2. Alternative topical options:

   • Azole antifungals (clotrimazole, miconazole, econazole) applied for 2 weeks 5
   • These agents are fungistatic and generally require longer treatment duration than allylamines like terbinafine 5

Second-Line Treatment: Oral Antifungals

Indicated when:

• Infection is extensive or covers a large area
• Topical therapy has failed
• Patient is immunocompromised
• Infection is resistant to initial therapy 1, 3

Oral options:

1. Terbinafine: 250 mg daily for adults (weight-based dosing for children) for 2-4 weeks 1
2. Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 1 week 1
3. Griseofulvin: 0.5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg once daily) for 2-4 weeks 2
   • Pediatric dosing: 10 mg/kg daily 2
4. Fluconazole: 150 mg once weekly for 2-4 weeks 6

Treatment Duration and Follow-up

• Clinical improvement should be seen within 1-2 weeks, with complete resolution taking 2-4 weeks 1
• Treatment should continue until mycological cure is achieved, not just clinical improvement 1
• Consider repeat mycology sampling at the end of treatment period 1
• For extensive disease or immunocompromised patients, longer therapy may be required 1

Management of Treatment Failure

If initial treatment fails:

1. Consider alternative diagnosis or resistant organism
2. Switch antifungal class (e.g., from terbinafine to itraconazole, or from azole to terbinafine) 1
3. Obtain fungal culture to identify specific pathogen and sensitivities 1, 3
4. Consider combination therapy for resistant cases 1

Prevention of Recurrence

• Keep affected areas clean and dry
• Wear loose-fitting cotton clothing
• Change underwear daily or more frequently if sweating
• Use separate towels for affected and unaffected areas
• Disinfect contaminated items with bleach solution
• Consider prophylactic topical antifungals in areas prone to recurrence 1

Important Caveats

• Prior use of corticosteroids or calcineurin inhibitors can alter the clinical presentation, making diagnosis difficult 3
• Topical steroids should be avoided as they can worsen the infection or lead to tinea incognito 3
• Griseofulvin is not effective against non-dermatophyte infections such as candidiasis 2
• Treatment should not be discontinued prematurely even if symptoms improve, as this may lead to recurrence 1, 2
• Screen family members for asymptomatic carriage, especially for T. tonsurans infections 1