What is the treatment for ringworm (tinea corporis) in an infant?

Treatment of Ringworm in Infants

For ringworm (tinea corporis) in infants, topical antifungal therapy with an azole cream such as clotrimazole or miconazole applied twice daily for 2-4 weeks is the recommended first-line treatment. 1

Diagnosis and Assessment

• Ringworm (tinea corporis) typically presents as circular, erythematous, scaly patches with central clearing and raised borders
• Diagnosis can be confirmed by microscopic examination of skin scrapings with potassium hydroxide (KOH) or fungal culture, though treatment may begin based on clinical appearance 2
• Assess the severity and extent of the infection:
  • Localized lesions (most common in infants)
  • Widespread lesions
  • Presence of inflammation or secondary bacterial infection

Treatment Algorithm

First-line Treatment: Topical Therapy

• For localized, non-severe tinea corporis in infants:
  • Apply topical azole antifungal (clotrimazole, miconazole) twice daily for 2-4 weeks 1, 3
  • Continue application for at least one week after clinical resolution to ensure complete eradication
  • These agents are effective, well-tolerated, and have minimal systemic absorption

Second-line/Severe Cases: Oral Therapy

• For severe, extensive, or treatment-resistant infections:
  • Griseofulvin: 10 mg/kg/day for 2-4 weeks 2
  • For infants under 2 years: safety not established at higher doses than recommended 2

Special Considerations for Infants

• Ringworm is rare in infants, especially neonates, but can occur 4, 5
• Treatment duration should continue until the infection is completely eradicated as indicated by clinical examination 2
• General hygiene measures should be observed to control sources of infection or reinfection 2
• Family members and close contacts should be examined and treated if infected to prevent reinfection 1

Monitoring and Follow-up

• Assess response to treatment after 2 weeks
• If no improvement is seen with topical therapy after 2 weeks, consider:
  • Confirming diagnosis with culture
  • Switching to a different topical agent
  • Escalating to oral therapy if extensive or severe

Common Pitfalls and Caveats

• Failure to treat for an adequate duration is a common cause of recurrence
• Failure to identify and treat infected family members or pets can lead to reinfection
• Misdiagnosis is common - other conditions such as nummular eczema, seborrheic dermatitis, or contact dermatitis can mimic tinea corporis
• Topical steroids should be avoided as monotherapy as they can worsen the infection (tinea incognito)
• Oral antifungal agents have more potential side effects and drug interactions than topical treatments, so they should be reserved for severe or extensive cases

While oral griseofulvin has historically been the standard systemic treatment for dermatophyte infections in children 6, 7, topical therapy is sufficient and preferred for most cases of tinea corporis in infants due to its safety profile and effectiveness 1, 3.