What is the treatment for tinea corporis?

Treatment of Tinea Corporis

The first-line treatment for tinea corporis is topical antifungal therapy, which is generally effective for most cases, with oral antifungal therapy reserved for extensive, resistant, or recurrent infections. 1, 2

Diagnostic Approach

• Accurate diagnosis is essential before initiating treatment, ideally confirmed through microscopy using potassium hydroxide preparation or culture to identify the causative organism 3, 4
• Specimens should be collected using scalpel scraping, hair pluck, brush, or swab as appropriate to the lesion 3

First-Line Treatment: Topical Antifungals

• Topical antifungal agents are effective for localized tinea corporis infections 1, 2
• Treatment options include:
  • Azoles (clotrimazole, miconazole, econazole) applied twice daily for 2-4 weeks 2
  • Allylamines (terbinafine 1%, naftifine 1%) applied once or twice daily for 1-2 weeks 2, 5
  • Terbinafine 1% cream once daily for 7 days has shown high efficacy (84.2% mycological cure) in placebo-controlled studies 5

Second-Line Treatment: Oral Antifungals

• Oral therapy is indicated when the infection:

  • Covers an extensive area
  • Is resistant to topical treatment
  • Involves hair follicles
  • Is recurrent 6, 1

• Oral treatment options include:

  • Griseofulvin: 0.5g daily (250mg twice daily) for 2-4 weeks in adults; 10mg/kg daily for children 4
  • Itraconazole: 100mg daily for 15 days (87% mycological cure rate) 6, 7
  • Fluconazole: 150mg once weekly for 2-4 weeks 6, 8
  • Terbinafine: 250mg daily for 1-2 weeks (particularly effective against T. tonsurans) 6

Treatment Algorithm

1. For localized, uncomplicated tinea corporis:

   • Start with topical antifungal (terbinafine 1% or azole) 2, 5
   • Continue treatment for at least one week after clinical clearing of infection 1

2. For extensive or resistant tinea corporis:

   • Switch to oral antifungal therapy 6, 1
   • Select based on causative organism if known (terbinafine for Trichophyton species) 6
   • Continue until complete eradication of the infecting organism 4

Prevention and Management of Recurrence

• Implement preventive measures:
  • Avoid skin-to-skin contact with infected individuals 6
  • Do not share towels, clothing, or personal items 6
  • Cover active lesions 6
  • Clean contaminated combs and brushes with disinfectant 3
• Screen and treat family members if infection is caused by anthropophilic species 3

Monitoring and Follow-up

• The definitive endpoint for treatment should be mycological cure, not just clinical response 3, 9
• Follow-up with repeat mycology sampling is recommended until mycological clearance is documented 3, 9
• Treatment failure may require extending treatment duration or switching to a different antifungal agent 6

Special Considerations

• Combination antifungal/steroid agents may be useful when inflammation is prominent but should be used with caution due to potential for steroid-associated complications 1, 2
• In cases with bacterial superinfection, appropriate antibacterial therapy may be needed in addition to antifungal treatment 4