What is the treatment for ringworm under the axilla?

Treatment of Ringworm Under the Axilla

For ringworm (tinea corporis) under the axilla, topical antifungal treatment with terbinafine 1% cream applied twice daily for 1-2 weeks is the most effective first-line therapy. 1, 2

First-Line Treatment Options

• Terbinafine 1% cream applied twice daily for 1-2 weeks is highly effective for tinea corporis with superior mycological and clinical cure rates compared to other agents 2, 3
• Clotrimazole 1% cream applied twice daily for 2-4 weeks is an effective alternative 4, 3
• Miconazole 2% cream applied twice daily for 2-4 weeks is another effective option 4

Treatment Duration and Application

• For tinea corporis (ringworm), treatment should continue for at least 1-2 weeks after clinical clearing of the infection 5
• Apply a thin layer of the antifungal cream to the affected area and surrounding 1-2 cm of normal skin 3
• The axilla presents a warm, moist environment that can promote fungal growth, so thorough drying after bathing is recommended 5

Alternative Treatment Options

• For cases unresponsive to first-line therapy, consider:
  • Naftifine 1% cream applied twice daily for 2-4 weeks 3
  • Oral fluconazole 150-200 mg weekly for 2-4 weeks for extensive or resistant cases 4
  • Oral terbinafine 250 mg daily for 2 weeks may be necessary for extensive or resistant infections 6

Special Considerations for Axillary Location

• The axillary region's warm, moist environment may require:
  • More frequent application of antifungal agents 5
  • Longer duration of treatment than other body areas 5
  • Keeping the area clean and dry to prevent recurrence 3

Monitoring and Follow-up

• Clinical improvement should be seen within 1-2 weeks of starting treatment 3
• If no improvement after 2 weeks of appropriate therapy, consider:
  • Confirming diagnosis with microscopy or culture 5
  • Switching to a different class of antifungal agent 4
  • Evaluating for potential terbinafine resistance, which has been increasingly reported 7

Common Pitfalls to Avoid

• Discontinuing treatment prematurely once symptoms improve, which can lead to recurrence 5
• Using combination antifungal/steroid preparations in the axilla, which can cause skin atrophy and other steroid-related complications 5
• Failing to address predisposing factors such as excessive sweating or tight clothing 3
• Not considering the possibility of resistant strains, particularly in cases that don't respond to initial therapy 7

Prevention of Recurrence

• Keep the axillary region clean and dry 3
• Wear loose-fitting clothing that allows air circulation 5
• Change clothes and undergarments daily, especially after sweating 3
• Avoid sharing personal items like towels or clothing with infected individuals 5