What is the treatment for tinea corporis?

Treatment of Tinea Corporis

For tinea corporis (ringworm), topical antifungal therapy is the first-line treatment for localized infections, while oral antifungal therapy is indicated for extensive, resistant, or recurrent cases. 1, 2

First-Line Treatment: Topical Antifungals

• Topical antifungals are effective for most cases of tinea corporis when the infection is localized and not extensive 3
• Terbinafine 1% cream applied once daily for 1-2 weeks is highly effective, with cure rates of 92% in children 1, 4
• Azole antifungals (such as clotrimazole, miconazole) applied twice daily for 2 weeks are also effective first-line options 3
• Treatment should continue for at least one week after clinical clearing of the infection to ensure complete eradication 3

Oral Antifungal Therapy (For Extensive or Resistant Cases)

• Oral therapy is indicated when the infection:

  • Covers an extensive area
  • Is resistant to topical treatment
  • Is recurrent or chronic 2, 3

• Oral treatment options include:

  • Terbinafine 250 mg daily for 1-2 weeks (particularly effective against Trichophyton species) 2, 5
  • Itraconazole 100 mg daily for 15 days (87% mycological cure rate) 6, 5
  • Fluconazole 50-100 mg daily or 150 mg once weekly for 2-3 weeks 5

Treatment Selection Based on Causative Organism

• Terbinafine is superior for Trichophyton tonsurans infections 6, 2
• Itraconazole has shown superior efficacy compared to griseofulvin (87% vs 57% mycological cure rate) 6
• Accurate diagnosis through microscopy (potassium hydroxide preparation) or culture is recommended to identify the causative organism and guide treatment 2, 3

Special Considerations

• For inflammatory lesions, consider agents with anti-inflammatory properties or short-term use of combination antifungal/steroid agents (use with caution due to potential for skin atrophy) 3
• For immunocompromised patients, systemic therapy may be required even for limited disease 7
• Treatment failure may be due to:
  • Incorrect diagnosis
  • Poor compliance
  • Reinfection from untreated contacts or fomites 2, 8

Prevention and Management of Recurrence

• Avoid skin-to-skin contact with infected individuals 6
• Do not share towels, clothing, or other personal items 6, 7
• Keep skin dry and cool 7
• Screen and treat family members if infection is caused by anthropophilic species 8
• Practice good personal hygiene 7

Treatment Monitoring and Follow-up

• The definitive endpoint for treatment should be both clinical and mycological cure 2, 8
• Follow-up should include assessment until clearance is documented 8
• For recurrent infections, consider extending treatment duration or switching to an alternative antifungal agent 9