Treatment of Ringworm (Tinea Corporis) in Pregnancy
Topical antifungal medications such as clotrimazole, miconazole, and nystatin are the first-line treatments for ringworm (tinea corporis) during pregnancy, particularly in the first trimester. 1
First Trimester Treatment Recommendations
- Topical azole antifungals (clotrimazole, miconazole) and nystatin are considered safe and effective first-line treatments for tinea corporis during pregnancy 1
- Oral azole antifungals (fluconazole, itraconazole) should be avoided during the first trimester due to potential teratogenicity 2
- The FDA has issued warnings that high-dose fluconazole (400-800 mg/day) during the first trimester may be associated with birth defects 2
- If systemic treatment is absolutely necessary during the first trimester (which is rarely needed for typical ringworm), intravenous amphotericin B would be recommended instead of oral azoles 2
Second and Third Trimester Treatment Options
- Topical antifungals remain the preferred treatment throughout pregnancy 1, 3
- After the first trimester, if systemic treatment is required for severe or resistant cases, oral azole antifungals such as fluconazole or itraconazole may be considered 2
- Low-dose fluconazole (150 mg/day) appears to be safe in later stages of pregnancy for resistant cases 3
Specific Topical Agent Recommendations
- First-line agents: clotrimazole, miconazole, and nystatin 1
- Second-line agents (if first-line fails): butenafine, ciclopirox, naftifine, oxiconazole and terbinafine 1
- Econazole should be avoided during the first trimester and used sparingly during 2nd and 3rd trimesters 1
- Ketoconazole topical preparations should be employed in limited areas for brief periods 1
Treatment Duration and Application
- Apply topical antifungals to affected areas and approximately 2 cm beyond the border of the lesion 3
- Continue treatment for 1-2 weeks beyond clinical resolution to prevent recurrence 4
- Maintain good skin hygiene and keep affected areas clean and dry 4
Important Considerations and Precautions
- Systemic absorption of topical antifungals is minimal, making them safer options during pregnancy 1
- Vaginal use of imidazoles has higher systemic absorption than when applied to the skin, but is still considered relatively safe in later pregnancy stages 3
- Oral antifungals including ketoconazole, flucytosine, and griseofulvin have been shown to be teratogenic and/or embryotoxic in animals and should be avoided 3, 5
- Amphotericin B remains the drug of choice for severe systemic fungal infections during pregnancy when absolutely necessary 6