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 should be confirmed through:
  • Direct microscopic examination using potassium hydroxide (KOH) preparation
  • Fungal culture when necessary (especially for resistant cases)
  • Clinical appearance (circular, scaly patches with raised borders)

Treatment Algorithm

1. Localized Ringworm (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 resistant or extensive cases:

• Oral antifungals:
  • Terbinafine 250mg daily for 1-2 weeks 1, 5
  • Fluconazole 150mg once weekly for 2-3 weeks 5
  • Itraconazole 100mg daily for 2 weeks or 200mg daily for 7 days 1, 5

2. Tinea Capitis (Scalp Ringworm)

• Requires oral therapy:
  • Griseofulvin 15-20mg/kg/day for 6-8 weeks (first-line for children) 1, 6
  • Terbinafine 250mg daily for adults (1-2 weeks for Trichophyton species) 1
  • Itraconazole 100mg daily for 4 weeks 1

3. Tinea Pedis (Athlete's Foot)

• Topical therapy:

  • Terbinafine 1% cream once daily for 1-2 weeks 1, 2
  • Clotrimazole 1% cream twice daily for 4 weeks 2, 3

• For severe or resistant cases:

  • Terbinafine 250mg daily for 2 weeks 5
  • Itraconazole 100mg daily for 2 weeks or 400mg daily for 1 week 5
  • Fluconazole 150mg once weekly for 2-4 weeks 5

4. Tinea Unguium (Nail Ringworm)

• Requires oral therapy:
  • Terbinafine 250mg daily for at least 6 weeks (fingernails) or 12 weeks (toenails) 6
  • Itraconazole 200mg twice daily for 1 week per month, for 2 months (fingernails) or 3 months (toenails) 1

Treatment Duration

• Continue treatment for at least one week after clinical resolution of symptoms 1, 7
• The endpoint of treatment should be mycological cure, not just clinical improvement 1

Adjunctive Measures

• Keep affected areas clean and dry
• Avoid sharing personal items like towels, combs, or clothing
• For tinea pedis: wear cotton socks and change them daily, use antifungal powders in shoes
• For tinea capitis: consider antifungal shampoo (ketoconazole 2%) as adjunctive therapy 1

Special Considerations

• Combination antifungal/steroid creams may provide faster symptom relief for inflammatory lesions but should be used cautiously and for short durations only 1, 3
• For widespread or highly inflammatory lesions, oral therapy may be preferred over topical treatment 7
• Treatment failure may occur due to incorrect diagnosis, non-adherence, or reinfection from untreated sources 1

Follow-up

• If no improvement is seen after 2-4 weeks, reconsider diagnosis and consider fungal culture to identify specific dermatophyte species 1
• For recurrent infections, investigate potential sources of reinfection (household members, pets) 1