What is the treatment for Tinea (ringworm) infections?

Treatment for Tinea (Ringworm) Infections

The treatment for tinea infections requires oral antifungal therapy for tinea capitis, while topical antifungal agents are generally effective for other forms of tinea, with the specific regimen depending on the type of tinea and causative organism. 1

Diagnosis

• Accurate diagnosis is essential before initiating treatment, ideally confirmed through microscopy using potassium hydroxide preparation or culture to identify the causative organism 1, 2
• Clinical presentations vary by type of tinea, including scaling, pustular patterns, "black dot" variety, inflammatory kerion, or annular patches 3

Treatment by Type of Tinea

Tinea Capitis (Scalp)

• Oral therapy is required; topical therapy alone is not recommended 4, 1
• First-line treatments based on causative organism:
  • For Trichophyton species: Terbinafine is more effective 4, 1
    • Dosage by weight:
      • <20 kg: 62.5 mg daily for 2-4 weeks
      • 20-40 kg: 125 mg daily for 2-4 weeks

      • 40 kg: 250 mg daily for 2-4 weeks 4

  • For Microsporum species: Griseofulvin is more effective 4, 1
    • Dosage by weight:
      • <50 kg: 15-20 mg/kg daily for 6-8 weeks

      • 50 kg: 1 g daily for 6-8 weeks 4, 5

• Second-line therapy: Itraconazole 50-100 mg daily for 4 weeks, or 5 mg/kg daily for 2-4 weeks 4

Tinea Corporis (Body) and Tinea Cruris (Groin)

• Topical antifungal agents are generally effective unless the infection covers an extensive area 2
• Treatment options:
  • Topical azoles (e.g., clotrimazole 1%) applied twice daily for 2-4 weeks 2, 6
  • Topical allylamines (e.g., terbinafine 1%) applied once or twice daily for 1-2 weeks 7, 6
• For extensive or resistant cases, oral therapy may be required:
  • Fluconazole: 50-100 mg daily or 150 mg once weekly for 2-3 weeks 8
  • Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 7 days 8
  • Terbinafine: 250 mg daily for 1-2 weeks 8

Tinea Pedis (Feet)

• Topical therapy for 1-4 weeks depending on the agent:
  • Azoles: Apply twice daily for 4 weeks 2
  • Allylamines: Apply once or twice daily for 1-2 weeks 7
• For extensive or resistant cases, oral therapy:
  • Fluconazole: 150 mg once weekly 8
  • Itraconazole: 100 mg daily for 2 weeks or 400 mg daily for 1 week 8
  • Terbinafine: 250 mg daily for 2 weeks 8

Treatment Duration and Follow-up

• Treatment should continue for at least one week after clinical clearing of infection 2
• Follow-up should include both clinical and mycological assessment until clearance is documented 1
• Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination 5

Prevention of Recurrence

• Clean contaminated combs and brushes with disinfectant 1, 9
• Screen and treat family members if infection is caused by anthropophilic species 1
• Avoid skin-to-skin contact with infected individuals and sharing of personal items 1
• Observe general hygiene measures to control sources of infection or reinfection 5

Common Pitfalls and Caveats

• Failure to identify the causative organism may lead to inappropriate treatment selection 4, 1
• Treatment failure may result from:
  • Lack of compliance
  • Suboptimal absorption of drug
  • Relative insensitivity of the organism
  • Reinfection 4
• Topical steroids should be used with caution as they can cause atrophy and other steroid-associated complications 2
• Griseofulvin is not effective for tinea versicolor 5
• Children receiving appropriate therapy for tinea capitis should be allowed to attend school or nursery 4