What is the treatment for ringworm (tinea infection)?

Treatment for Ringworm (Tinea Infection)

Topical antifungal medications are the first-line treatment for localized ringworm infections, with terbinafine 1% cream applied once daily for 1-2 weeks being the most effective option. 1

Diagnosis Confirmation

• Diagnosis can be confirmed through:
  • Direct microscopic examination with potassium hydroxide (KOH) preparation
  • Fungal culture if diagnosis is uncertain or treatment fails
  • PCR testing in specialized settings (90.9% sensitivity, 94.1% specificity)

Treatment Algorithm

1. Localized Tinea Infections (Tinea Corporis/Cruris)

First-line treatment:

• Topical antifungals:
  • Terbinafine 1% cream once daily for 1-2 weeks (highest efficacy with 93.5% mycological cure rate) 1, 2
  • Clotrimazole 1% cream twice daily for 2-4 weeks 1, 3
  • Miconazole 2% cream twice daily for 2-4 weeks 1, 4

For extensive or resistant infections:

• Oral antifungals:
  • Terbinafine 250mg daily for 1-2 weeks 1, 5
  • Itraconazole 100mg daily for 2 weeks or 200mg daily for 7 days 1, 5
  • Fluconazole 150mg once weekly for 2-3 weeks 5
  • Griseofulvin 500mg daily for 2-4 weeks (adults) or 10mg/kg/day (children) 6

2. Tinea Pedis (Athlete's Foot)

• Topical therapy: Same agents as above but for longer duration (4 weeks with azoles, 1-2 weeks with terbinafine) 7
• Oral therapy for resistant cases:
  • Terbinafine 250mg daily for 2 weeks
  • Itraconazole 100mg daily for 2 weeks or 400mg daily for 1 week
  • Fluconazole 150mg once weekly for 2-4 weeks 5

3. Tinea Capitis (Scalp Ringworm)

• Always requires oral therapy:
  • Griseofulvin 15-20mg/kg/day for 6-8 weeks (first-line for children) 1
  • Terbinafine 250mg daily for 2-4 weeks (for Trichophyton species)
  • Itraconazole 100mg daily for 4 weeks 1
  • Adjunctive antifungal shampoo (ketoconazole 2% or selenium sulfide 1%) 1

Treatment Duration and Follow-up

• Continue treatment for at least one week after clinical resolution 1, 7
• Clinical improvement typically expected within 1-2 weeks
• If no improvement after 2-4 weeks, consider:
  • Confirming diagnosis with fungal culture
  • Identifying specific dermatophyte species
  • Adjusting treatment based on species identification 1

Prevention of Recurrence

• Apply antifungal powders to shoes and socks for foot infections
• Avoid sharing personal items like towels and clothing
• Keep skin clean and dry, especially in skin folds
• Wear breathable cotton clothing and socks
• Examine and treat all household members for anthropophilic infections 1

Special Considerations

• Taking oral griseofulvin with fatty food improves absorption 1
• For inflammatory lesions, short-term use of combination antifungal/steroid preparations may provide faster symptomatic relief, but should be used cautiously due to potential for steroid-related side effects 3, 7
• Oral antifungals may have drug interactions and side effects; monitor for gastrointestinal disturbances, headache, and rarely hepatotoxicity 1

Ringworm treatment should be tailored to the specific type of infection, its location, and extent. Topical therapy is highly effective for most localized infections, while oral therapy is reserved for extensive, resistant cases or scalp infections.