What is the treatment for tinea glutealis?

Treatment for Tinea Glutealis

The first-line treatment for tinea glutealis (ringworm of the buttocks) is topical antifungal medication applied once daily for 1-2 weeks, with oral antifungal therapy reserved for extensive disease, immunocompromised patients, or cases that fail topical treatment. 1

Diagnosis

Before initiating treatment, confirm the diagnosis through:

• Clinical examination of the affected area
• Mycological confirmation by obtaining specimens using scalpel scraping, plucking, or brushing techniques
• Sending specimens for microscopy and culture to identify the causative organism 1

Treatment Algorithm

First-Line Treatment:

1. Topical antifungal medications:
   • Azoles (clotrimazole 1%, miconazole, econazole)
   • Allylamines (terbinafine 1%, naftifine 1%)
   • Apply once daily for 1-2 weeks 1, 2

For Extensive Disease or Treatment Failures:

1. Oral antifungal therapy options:
   • Terbinafine: 250 mg daily for adults for 2 weeks 1
   • Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 1 week 1
   • Fluconazole: 150 mg once weekly for 2-4 weeks 3, 4

Treatment Duration:

• Continue treatment for at least one week after clinical clearing of infection 5
• The endpoint should be mycological cure, not just clinical improvement 1

Special Considerations

For Inflammatory Lesions:

• Consider using an agent with inherent anti-inflammatory properties
• Combination antifungal/steroid agents may be used short-term, but with caution due to potential for skin atrophy 5

For Treatment Failures:

1. Consider:

   • Lack of compliance
   • Suboptimal absorption of medication
   • Relative insensitivity of the organism
   • Reinfection
   • Alternative diagnosis 6

2. If there is clinical improvement but ongoing positive mycology:

   • Continue current therapy for an additional 2-4 weeks 6

3. If no initial clinical improvement:

   • Switch antifungal class (e.g., from azole to terbinafine or vice versa) 1

Prevention of Recurrence

• Keep affected areas clean and dry
• Wear loose-fitting cotton underwear
• Change underwear daily or more frequently if sweating
• Use separate towels for drying the affected area
• Apply antifungal powders to susceptible areas to prevent reinfection 1

Evidence Quality and Considerations

The evidence for topical treatments shows that most antifungal agents are effective for tinea infections, with clinical cure rates significantly higher than placebo 2. Topical terbinafine and naftifine have demonstrated particularly strong evidence of efficacy 2.

For oral therapy, studies show that fluconazole (150 mg weekly) achieved 95% cure rates for tinea corporis/cruris 3, while terbinafine and itraconazole also demonstrate high efficacy rates 7.

It's worth noting that while combination antifungal/steroid medications may provide faster symptomatic relief, they should be used cautiously and for short durations due to potential steroid-related side effects 5.