Treatment of Ringworm (Tinea Infection)

Topical antifungal agents are the first-line treatment for tinea corporis (ringworm) and are generally effective for localized infections. 1

First-Line Treatment

Apply topical antifungal medication to affected areas and 2 cm beyond the border of the lesion 1
Continue treatment for at least one week after clinical clearing of infection 2
Effective topical agents include:
- Azoles: clotrimazole 1%, miconazole 2% - apply twice daily for 2-4 weeks 1, 2
- Allylamines: terbinafine 1%, naftifine 1% - apply once or twice daily for 1-2 weeks 1
Allylamines may require fewer applications and shorter treatment duration compared to azoles 1
Pooled data shows both terbinafine and naftifine are effective with low rates of adverse effects 1

Oral antifungal therapy should be considered in the following situations:

Extensive or widespread tinea corporis 3
Infection adjacent to eyes, ears, or mouth where topical application is difficult 3
Infection involving complex skin folds 3
Failure of topical therapy 3, 4

Griseofulvin:
- Adults: 500 mg daily for 2-4 weeks 5
- Children: 10 mg/kg daily for 2-4 weeks 5
- FDA-approved for tinea corporis 5
Terbinafine:
- Adults: 250 mg daily for 1-2 weeks 4
- Children: dosing based on weight (62.5-250 mg daily) for 2-4 weeks 6
Fluconazole:
- 50-100 mg daily or 150 mg once weekly for 2-3 weeks 4
Itraconazole:
- 100 mg daily for 2 weeks or 200 mg daily for 7 days 4

For lesions with significant inflammation, consider:
- Topical agents with inherent anti-inflammatory properties 2
- In severe cases, short-term use of combination antifungal/steroid agents may be beneficial, but use with caution due to potential for skin atrophy 2

General hygiene measures should be observed to control sources of infection or reinfection 5, 7
Cleanse personal items like combs and brushes with disinfectant 7
Consider screening family members, especially for highly contagious infections 7

Treatment should continue until the infecting organism is completely eradicated 5
For tinea corporis, typical treatment duration is 2-4 weeks for topical therapy 5, 2
Continue treatment for at least one week after clinical clearing 2
Clinical relapse will occur if medication is not continued until the infection is eradicated 5

Failure to accurately diagnose the infection before starting treatment 5
Discontinuing treatment too early (before complete eradication) 5
Not treating a wide enough area around the visible lesion 1
Neglecting to address potential sources of reinfection 7, 5
Using topical steroids alone without antifungal agents, which can worsen the infection ("tinea incognito") 2