What is the treatment for Tinea corporis?

Treatment of Tinea Corporis

The first-line treatment for tinea corporis is topical terbinafine 1% cream applied once daily for 1-2 weeks, which offers faster clinical resolution than other topical agents with mycological cure rates of 84.2% compared to 23.3% for placebo. 1

Diagnosis Confirmation

• Accurate diagnosis is essential before initiating treatment
• Confirm diagnosis through:
  • Direct microscopic examination with potassium hydroxide (KOH) preparation
  • Fungal culture on appropriate medium
  • Treatment can begin while awaiting confirmatory mycology if clinical signs are present 1, 2

Treatment Algorithm

1. Localized Tinea Corporis (First-Line)

• Topical antifungal agents:
  • Terbinafine 1% cream: Apply once daily for 1-2 weeks 1, 3
  • Clotrimazole 1% cream: Apply twice daily for 2-4 weeks 1, 4
  • Miconazole 2% cream: Apply twice daily for 2-4 weeks 1
  • Ciclopirox olamine 0.77% cream/gel: Apply twice daily for 4 weeks (clinical and mycological cure rates ~60% at end of treatment) 1

2. Extensive or Resistant Tinea Corporis (Second-Line)

• Oral antifungal agents:
  • Terbinafine: 250 mg once daily for 1-2 weeks (especially effective for Trichophyton species) 1
  • Itraconazole: 100 mg once daily for 2 weeks (87% mycological cure rate) 1
  • Griseofulvin:
    • Adults: 0.5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg once daily)
    • Children (>2 years): 10 mg/kg daily for 2-4 weeks 2
  • Fluconazole: 150 mg once weekly for 2-4 weeks 5, 6

Duration of Treatment

• Continue treatment for at least one week after clinical resolution 1, 7
• Treatment endpoint should be mycological cure, not just clinical improvement 1
• For tinea corporis, typical treatment duration is:
  • Topical therapy: 2-4 weeks 7
  • Oral therapy: 1-2 weeks for terbinafine/itraconazole; 2-4 weeks for griseofulvin 1, 2

Prevention and Hygiene Measures

• Apply antifungal powders containing miconazole or clotrimazole to prevent reinfection 1
• Avoid sharing towels and personal items 1
• Examine and treat all household members for anthropophilic infections 1

Follow-up Recommendations

• Clinical improvement typically expected within 1-2 weeks 1
• Return for follow-up if symptoms persist or recur within 2 months 1
• Consider follow-up mycological examination in resistant or recurrent cases 1

Important Considerations

• Topical therapy is preferred for localized infection, while oral therapy is reserved for extensive, resistant, or multiple-site infections 1, 6
• Unnecessary or inappropriate use of OTC preparations can delay proper treatment 1
• The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties, but combination antifungal/steroid agents should be used with caution due to potential for causing atrophy 7
• Oral antifungals may have side effects including gastrointestinal disturbances, rashes, and rarely more serious adverse reactions like Stevens-Johnson syndrome and hepatic toxicity 1