What is the treatment for axillary ringworm?

Treatment of Axillary Ringworm

Topical terbinafine 1% cream applied twice daily for 1-2 weeks is the recommended first-line treatment for axillary ringworm (tinea axillaris). 1, 2

Diagnosis and Clinical Presentation

• Axillary ringworm (tinea axillaris) is a dermatophyte infection affecting the axillary region, which is considered a variant of tinea corporis (ringworm) occurring in an intertriginous area 3
• Clinical presentation typically includes:
  • Pruritic, erythematous, scaling patches with central clearing 4
  • Possible burning sensation and skin cracking in the affected area 1
• Diagnosis can be confirmed by microscopic examination of skin scrapings with potassium hydroxide (KOH) preparation or fungal culture 4, 5

Treatment Options

First-line Treatment

• Topical antifungal medications:
  • Terbinafine 1% cream: Apply twice daily for 1-2 weeks 1, 2
    • Provides higher cure rates with shorter treatment duration compared to azoles 2
    • Continue treatment for at least one week after clinical clearing of the infection 5
  • Azole antifungals (e.g., clotrimazole 1%): Apply twice daily for 2-4 weeks 4, 5
    • Effective but may require longer treatment duration than allylamines like terbinafine 2, 4

Alternative Treatment Options

• Naftifine 1% cream: Apply once or twice daily for 2 weeks 4
  • Demonstrated superior efficacy compared to placebo in clinical trials 4
• Combination antifungal/corticosteroid preparations: Consider for short-term use (3-7 days) if significant inflammation is present 5
  • Use with caution due to potential for skin atrophy and other steroid-related complications 5

Treatment Considerations

• Keep the affected area clean and dry, as moisture can exacerbate fungal infections 5
• Avoid applying topical corticosteroids alone to the affected area, as this can worsen the infection 3
• For extensive or resistant infections that don't respond to topical therapy, oral antifungal medications may be considered 6
  • Oral options include itraconazole 200 mg daily or fluconazole (dosing based on specific clinical scenario) 6

Follow-up and Prevention

• Treatment should continue for at least one week after clinical clearing of the infection 5
• To prevent recurrence:
  • Maintain good hygiene practices 4
  • Keep axillary region dry 5
  • Avoid sharing personal items like towels or clothing 4

Special Considerations

• Differential diagnosis should include bacterial infections such as trichomycosis axillaris, which requires different treatment (antibacterial agents) 7
• If the infection does not respond to appropriate topical therapy after 2-4 weeks, consider:
  • Confirming the diagnosis with culture 4
  • Evaluating for underlying conditions that may predispose to fungal infections 3
  • Switching to an alternative antifungal class or considering oral therapy 5