Treatment of Ringworm on the Trunk
For ringworm on the trunk (tinea corporis), topical antifungal agents applied twice daily for 2-4 weeks are the first-line treatment of choice. 1, 2
First-Line Topical Treatment Options
- Clotrimazole 1% cream applied twice daily for 2-4 weeks is highly effective for treating ringworm on the trunk 1, 2
- Miconazole 2% cream applied twice daily for 2-4 weeks is an equally effective alternative 1, 3
- Other effective topical azole options include ketoconazole, econazole, and oxiconazole, all applied twice daily for 2-4 weeks 2, 4
- Allylamine class agents such as terbinafine 1% cream and naftifine 1% cream applied twice daily for 2-4 weeks are also effective 2
When to Consider Oral Therapy
- For extensive or severe ringworm infections on the trunk that cover large areas 5, 6
- For infections that have not responded to appropriate topical therapy after 2 weeks 1
- For immunocompromised patients who may have more resistant infections 4
Oral Treatment Options
- Fluconazole 150-200 mg weekly for 2-4 weeks 1, 6
- Terbinafine 250 mg daily for 1-2 weeks 6
- Itraconazole 100 mg daily for 2 weeks or 200 mg daily for 7 days 6
- Griseofulvin 500 mg daily (or 10 mg/kg in children) for 2-4 weeks 7
Practical Management Tips
- Confirm diagnosis before starting treatment - look for the characteristic ring-shaped, scaly patches with central clearing and raised borders 2
- Potassium hydroxide (KOH) microscopic examination of skin scrapings can confirm the diagnosis 7, 2
- Continue treatment for the full recommended duration even if symptoms improve earlier to prevent recurrence 7
- Advise patients to keep the affected area clean and dry 4
- Recommend washing clothes, bedding, and towels that come in contact with the affected area to prevent reinfection 4
Monitoring and Follow-up
- If no improvement is seen after 2 weeks of appropriate topical therapy, consider switching to a different class of antifungal agent or initiating oral therapy 1
- Most cases of tinea corporis should resolve within 2-4 weeks of appropriate treatment 2, 4
- Recurrent infections may require investigation for underlying conditions or sources of reinfection 4
Common Pitfalls to Avoid
- Failure to treat for the full recommended duration, which can lead to recurrence 7
- Using combination products containing corticosteroids for prolonged periods, which can worsen the infection 2
- Not addressing potential sources of reinfection such as infected household members, pets, or fomites 4
- Misdiagnosis of other annular eruptions (like granuloma annulare, pityriasis rosea, or nummular eczema) as ringworm 2