What is the treatment for a tinea lesion?

Treatment of Tinea Lesions

For tinea lesions, oral antifungal therapy is generally required, with the specific regimen depending on the type of tinea and causative organism. 1

Diagnosis Before Treatment

• Accurate diagnosis is essential before initiating treatment, ideally confirmed through microscopy using potassium hydroxide preparation or culture to identify the causative organism 2, 3
• Specimens should be collected using scalpel scraping, hair pluck, brush, or swab as appropriate to the lesion 2
• While ideally one should wait for confirmation of fungus, treatment may be started immediately in high-risk populations or when clinical features strongly suggest tinea 1

Treatment Options by Type of Tinea

Tinea Corporis (Body)

• First-line: Topical antifungal agents for 2-4 weeks 3, 4
• For extensive or resistant cases: Oral therapy with griseofulvin 0.5g daily (adults) or 10mg/kg daily (children) for 2-4 weeks 3
• Alternative oral options:
  • Terbinafine 250mg daily for 1-2 weeks (particularly effective for T. tonsurans infections) 2, 5
  • Itraconazole 100mg daily for 15 days (87% mycological cure rate) 2, 5

Tinea Capitis (Scalp)

• Oral therapy is required; topical therapy alone is not recommended 1
• First-line: Griseofulvin 20mg/kg daily for 6-8 weeks 1, 3
• For resistant cases: May need to increase griseofulvin to 25mg/kg daily for more prolonged periods 1
• Alternative options based on causative organism:
  • For Trichophyton species: Terbinafine is more effective 1, 6
  • For Microsporum species: Griseofulvin is more effective (88.5% vs 67.9% response rate) 1
• Adjunctive topical therapy with povidone-iodine, ketoconazole 2%, or selenium sulfide 1% shampoos helps reduce transmission of spores 1, 6

Tinea Pedis (Feet)

• Topical therapy for 4 weeks with azole antifungals or 1-2 weeks with allylamine medications 4, 7
• For extensive or resistant cases: Oral therapy with griseofulvin for 4-8 weeks 3
• Alternative oral options:
  • Terbinafine 250mg daily for 2 weeks 5, 8
  • Itraconazole 100mg daily for 2 weeks or 400mg daily for 1 week 5
  • Fluconazole 150mg once weekly (pulse dosing) 5

Special Considerations

• Treatment should continue for at least one week after clinical clearing of infection 4
• The definitive endpoint for treatment should be mycological cure, not just clinical response 2
• Newer medications require fewer applications and shorter duration of use 4
• Presence of inflammation may require agents with anti-inflammatory properties or combination antifungal/steroid agents (use with caution due to potential for atrophy) 4

Prevention and Management of Recurrence

• Implement preventive measures including proper hygiene 3
• Clean contaminated combs and brushes with disinfectant 2
• Screen and treat family members if infection is caused by anthropophilic species 2
• Avoid skin-to-skin contact with infected individuals and sharing of personal items 2
• Follow-up should include both clinical and mycological assessment until clearance is documented 9, 2

Common Pitfalls to Avoid

• Discontinuing treatment too early (before mycological cure) leads to relapse 3, 8
• Failing to identify the causative organism can lead to ineffective treatment selection 1, 3
• Griseofulvin is not effective for tinea versicolor and other non-dermatophyte infections 3
• Using topical therapy alone for tinea capitis is ineffective 1
• Neglecting adjunctive measures such as proper hygiene and decontamination of personal items 2, 3