What is the recommended treatment for ringworm?

Recommended Treatment for Ringworm

For ringworm (tinea corporis), apply terbinafine cream twice daily for 1 week as first-line treatment. 1

Treatment Options Based on Location

Tinea Corporis (Ringworm)

• First-line treatment: Terbinafine cream applied twice daily for 1 week 1
• Alternative options:
  • Clotrimazole cream applied daily for 7-14 days 2
  • Other topical azoles (miconazole, econazole) applied for 2-4 weeks 3

Special Considerations

• For extensive disease or treatment failures:
  • Oral terbinafine 250 mg daily for 1-2 weeks 4, 5
  • Oral fluconazole 150 mg once weekly for 2-3 weeks 6
  • Oral itraconazole 100 mg daily for 2 weeks or 200 mg daily for 7 days 6

Evidence Quality and Treatment Selection

Terbinafine has demonstrated superior efficacy compared to placebo with a Number Needed to Treat (NNT) of 3 3. The FDA-approved labeling specifically recommends terbinafine for ringworm with a simple once-daily application for 1 week 1, making it the most convenient and effective option.

Clotrimazole has also shown efficacy against dermatophytes with a similar NNT of 2-3 3, but typically requires a longer treatment duration of 7-14 days 2.

Treatment Pitfalls and Practical Tips

• Common errors to avoid:

  • Insufficient treatment duration leading to recurrence
  • Failure to confirm diagnosis in atypical presentations (tinea can mimic eczema)
  • Not treating all affected areas, including seemingly unaffected surrounding skin

• Practical recommendations:

  • Continue treatment for the full recommended duration even if symptoms improve quickly
  • Keep affected areas clean and dry
  • For tinea corporis on covered areas, wear loose-fitting clothing
  • Wash clothing, bedding, and towels in hot water to prevent reinfection

When to Consider Oral Therapy

Oral antifungal therapy should be considered in the following situations:

• Extensive disease involving large body surface areas
• Failure of topical treatment after 2-4 weeks
• Immunocompromised patients
• Deep or inflammatory lesions

Oral terbinafine (250 mg daily for 1-2 weeks) is the most effective oral option for tinea corporis with high cure rates and excellent tolerability 4, 5.

Treatment in Children

• For children under 12 years: Consult a physician before using topical terbinafine 1
• Terbinafine has been shown to be effective and safe in children for treating superficial fungal infections 7

Monitoring and Follow-up

• Clinical response should be evaluated within 3-5 days of treatment initiation 2
• If no improvement after 1-2 weeks of appropriate therapy, reconsider diagnosis or consider switching treatments
• For recurrent infections, investigate potential sources of reinfection (household members, pets)