What is the treatment for tinea corporis?

Treatment of Tinea Corporis

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

Diagnosis Before Treatment

• Accurate diagnosis is essential before initiating treatment
• Obtain specimens from affected areas using:
  • Plucking
  • Scalpel scraping
  • Brushing techniques
• Send for microscopy and culture to identify the causative organism 1
• KOH preparation can provide rapid confirmation of fungal elements 2

Treatment Algorithm

First-Line Treatment: Topical Antifungals

For localized, uncomplicated tinea corporis:

• Terbinafine 1% cream: Apply once daily for 1 week 1, 3

  • Highly effective with 84.2% mycological cure rate 3
  • Fungicidal properties allow for shorter treatment duration
  • Clinical improvement should be seen within 1-2 weeks 1

• Alternative topical options:

  • Azole antifungals (clotrimazole, miconazole): Apply for 2 weeks 4
  • Continue treatment for at least one week after clinical clearing 4

Second-Line Treatment: Oral Antifungals

For extensive disease, treatment failure, or immunocompromised patients:

1. Griseofulvin:

   • Adult dosage: 500 mg daily (can be divided as 125 mg four times daily or 250 mg twice daily)
   • Pediatric dosage: 10 mg/kg daily
   • Treatment duration: 2-4 weeks for tinea corporis 2

2. Terbinafine (oral):

   • Adult dosage: 250 mg daily
   • Treatment duration: 2-4 weeks 1

3. Itraconazole:

   • First choice for oral therapy per American Academy of Pediatrics
   • Options: 100 mg daily for 2 weeks or 200 mg daily for 1 week 1
   • Higher dose, shorter duration regimen has faster onset of clinical and mycological cure

4. Fluconazole:

   • 150 mg once weekly for 2-4 weeks 5
   • Convenient dosing schedule with good efficacy

Special Considerations

• For inflammatory lesions: Consider agents with anti-inflammatory properties or combination antifungal/steroid agents (use with caution due to potential for atrophy) 4

• Treatment should continue until mycological cure is achieved, not just clinical improvement 1

• Obtain repeat mycology sampling at the end of treatment period 1

• If initial treatment fails:

  • Consider alternative diagnosis
  • Consider resistant organism
  • Switch antifungal class (e.g., from terbinafine to itraconazole or from azole to terbinafine) 1

Prevention of Recurrence

• Keep affected areas clean and dry
• Wear loose-fitting cotton clothing
• Screen family members for asymptomatic carriage
• Treat positive cases even if asymptomatic
• Use separate towels for affected areas
• Disinfect contaminated items with bleach solution 1

Common Pitfalls

1. Inadequate diagnosis: Failure to confirm diagnosis through KOH preparation or culture before starting treatment 2

2. Premature discontinuation: Stopping treatment based solely on clinical improvement rather than complete eradication 1

3. Misdiagnosis: Tinea corporis can mimic other annular lesions, especially with prior use of calcineurin inhibitors or corticosteroids 6

4. Inappropriate use of topical steroids: Can lead to tinea incognito, making diagnosis more difficult 6

5. Overlooking environmental factors: Failure to address sources of reinfection 1