What is the recommended treatment for ringworm?

Ringworm Treatment

For ringworm (tinea corporis), the recommended first-line treatment is topical antifungal therapy with clotrimazole 1% cream or miconazole 2% cream applied twice daily for 2-4 weeks. 1

First-Line Topical Treatment Options

• Clotrimazole 1% cream applied twice daily for 2-4 weeks is effective for treating ringworm infections 1, 2
• Miconazole 2% cream applied twice daily for 2-4 weeks is another effective first-line option 1, 2
• Terbinafine 1% cream has shown significantly higher clinical cure rates compared to placebo (RR 4.51,95% CI 3.10 to 6.56) 2
• Naftifine 1% cream is also effective with superior mycological cure rates compared to placebo (RR 2.38,95% CI 1.80 to 3.14) 2

Treatment Duration

• Treatment should continue for 2-4 weeks for tinea corporis 1, 2
• Therapy must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical examination 3
• If no improvement is seen after 2 weeks of appropriate therapy, consider switching to a different class of antifungal agent 1

Oral Therapy Options

• Oral antifungal therapy is indicated for extensive, widespread, or resistant cases of ringworm 4, 5
• For extensive tinea corporis, oral options include:
  • Fluconazole: 150 mg once weekly for 2-3 weeks 5
  • Itraconazole: 100 mg daily for 2 weeks or 200 mg daily for 7 days 5
  • Terbinafine: 250 mg daily for 1-2 weeks 5
  • Griseofulvin: 500 mg daily for adults or 10 mg/kg daily for children for 2-4 weeks 3

Special Considerations

• Griseofulvin is FDA-approved specifically for dermatophyte infections including tinea corporis when topical therapy is inadequate 3
• Prior to initiating treatment, appropriate specimens for laboratory testing (KOH preparation or fungal culture) should be obtained to confirm the diagnosis 3
• General hygiene measures should be observed to control sources of infection or reinfection 3
• A combination of topical and oral antifungal drugs can shorten the treatment period in extensive cases, improving patient adherence 4

Monitoring and Follow-up

• Clinical relapse will occur if medication is not continued until the infecting organism is eradicated 3
• For widespread or chronic infections, follow-up examination is recommended to ensure complete resolution 6
• Patient education on proper hygiene is an important component of effective therapy 6

Treatment Selection Algorithm

1. For localized, mild to moderate ringworm: Use topical antifungals (clotrimazole 1% or miconazole 2%) twice daily for 2-4 weeks 1, 2
2. For extensive, severe, or treatment-resistant ringworm: Consider oral therapy with fluconazole, itraconazole, terbinafine, or griseofulvin 4, 5
3. For ringworm in areas difficult to treat with topicals (face near eyes, ears, or mouth): Oral antifungal therapy is preferred 4
4. For immunocompromised patients: Consider longer duration of therapy and closer monitoring 6