What is the recommended management for Tinea corporis?

Management of Tinea Corporis

Topical antifungal agents are the first-line treatment for tinea corporis, with oral antifungal therapy reserved for cases that are extensive, resistant to topical treatment, or in immunocompromised patients. 1

Diagnosis

• Accurate diagnosis is essential before initiating treatment, ideally confirmed through microscopy using potassium hydroxide (KOH) preparation or culture to identify the causative organism 1, 2
• Specimens should be collected using scalpel scraping, as appropriate to the lesion 1
• Direct microscopic examination showing hyphae and/or arthroconidia confirms the diagnosis 1

Treatment Algorithm

First-Line: Topical Antifungal Therapy

• Indicated for localized, uncomplicated tinea corporis 3
• Treatment options include:
  • Azole antifungals (e.g., clotrimazole, miconazole): Apply twice daily for 2 weeks 3
  • Allylamine antifungals (e.g., terbinafine): Apply once or twice daily for 1-2 weeks 3
• Continue treatment for at least one week after clinical clearing of infection 3
• In cases with inflammation, agents with anti-inflammatory properties or combination antifungal/steroid agents may be considered, though steroid combinations should be used with caution due to potential side effects 3

Second-Line: Oral Antifungal Therapy

Indicated when:

• Infection is extensive or covers a large area 1, 4
• Infection is resistant to topical treatment 1
• Patient is immunocompromised 5

Oral treatment options:

• Terbinafine: 250 mg daily for 1-2 weeks 1, 4
  • Particularly effective against Trichophyton species 1
• Itraconazole:
  • 100 mg daily for 2 weeks 4, 6, or
  • 200 mg daily for 7 days (higher dose, shorter duration with equivalent efficacy) 7
• Fluconazole: 50-100 mg daily or 150 mg once weekly for 2-3 weeks 4
• Griseofulvin: 500 mg daily (or 10 mg/kg in children) for 2-4 weeks 2
  • Dosage should be individualized based on severity of infection 2

Prevention and Management of Recurrence

• Implement preventive measures to avoid recurrence 1:
  • Avoid skin-to-skin contact with infected individuals
  • Do not share towels and other personal items
  • Cover lesions to prevent spread
  • Maintain good personal hygiene 5
  • Keep skin dry and cool 5
• Screen and treat family members if infection is caused by anthropophilic species 1

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
• For griseofulvin, clinical relapse will occur if medication is not continued until the infecting organism is eradicated 2

Special Considerations

• Prior to therapy, a dermatophyte should be identified as responsible for the infection through appropriate laboratory testing 2
• Griseofulvin is not effective for non-dermatophyte infections such as candidiasis or other fungal infections 2
• Treatment should be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination 2
• In cases with secondary bacterial infection, additional treatment may be required 5