What is the treatment for tinea corporis?

Treatment of Tinea Corporis

For tinea corporis, first-line treatment should be topical antifungal agents, with oral antifungal therapy reserved for cases that are resistant to topical treatment, extensive, or in immunocompromised patients. 1, 2, 3

Diagnostic Confirmation

• Accurate diagnosis is essential before initiating treatment, ideally confirmed through microscopy using potassium hydroxide preparation or culture to identify the causative organism 1
• Specimens should be collected using scalpel scraping from the active border of the lesion 1

Treatment Algorithm

First-Line Treatment: Topical Antifungals

• Topical antifungal agents are generally successful for localized tinea corporis 3
• Treatment should continue for at least two weeks and for at least one week after clinical clearing of infection 3
• Azole antifungals (clotrimazole, miconazole) typically require two weeks of treatment 3
• Allylamine medications (terbinafine) may be effective with only 1-2 weeks of use 3

Second-Line Treatment: Oral Antifungals

When topical therapy fails, or for extensive infection, oral therapy is indicated:

• Griseofulvin:

  • FDA-approved for tinea corporis at 0.5g daily (125mg four times a day, 250mg twice a day, or 500mg once daily) for adults 4
  • For children older than 2 years: 10mg/kg daily (typically 125-250mg daily for 30-50 lbs; 250-500mg daily for over 50 lbs) 4
  • Treatment duration for tinea corporis: 2-4 weeks 4

• Itraconazole:

  • 100mg daily for 15 days (87% mycological cure rate) 1
  • Some studies show effectiveness with just 2-4 weeks of treatment 5

• Terbinafine:

  • 250mg daily for 1-2 weeks, particularly effective against T. tonsurans infections 1, 6

• Fluconazole:

  • 150mg once weekly for 2-4 weeks has shown efficacy in studies 7, 6

Treatment Selection Based on Causative Organism

• Terbinafine appears superior for Trichophyton tonsurans infections 1
• Itraconazole has shown superior efficacy compared to griseofulvin (87% vs 57% mycological cure rate) 1

Prevention and Special Considerations

• Avoid skin-to-skin contact with infected individuals 1, 2
• Do not share towels, clothing, or other personal items 1, 2
• Cover lesions to prevent spread 1
• Properly clean contaminated combs and brushes 1
• Keep skin dry and cool to prevent recurrence 2
• Screen and treat family members if infection is caused by anthropophilic species 1

Treatment Monitoring and Follow-up

• The definitive endpoint for treatment should be mycological cure, not just clinical response 1
• Follow-up should include both clinical and mycological assessment 1
• Treatment failure may require extending treatment duration 1
• Repeat mycology sampling until mycological clearance is documented 1

Common Pitfalls and Caveats

• Failure to accurately diagnose the causative organism may lead to treatment failure 1, 4
• Inadequate treatment duration is a common cause of recurrence - treatment must continue until the infecting organism is completely eradicated 4
• Concomitant bacterial or yeast infections may not respond to antifungal treatment alone 4
• Inflammation may require agents with anti-inflammatory properties, but combination antifungal/steroid agents should be used with caution due to potential for causing atrophy 3
• Griseofulvin is not effective against non-dermatophyte infections like candidiasis, tinea versicolor, or other fungal infections 4