What are the best topical and oral treatments for Tinea (Ringworm)?

From the Guidelines

For the treatment of Tinea, I strongly recommend using oral antifungal medications, such as terbinafine or griseofulvin, as topical therapy alone is not recommended and has a lower efficacy rate 1. When it comes to treating Tinea, the goal is to achieve both clinical and mycological cure, and oral therapy is generally indicated to achieve this outcome 1.

Key Considerations

• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
• Terbinafine is more efficacious against Trichophyton species, while griseofulvin is more effective against Microsporum species 1.
• The dosage of terbinafine and griseofulvin varies by body weight, with specific recommendations outlined in the guidelines 1.

Treatment Options

• Terbinafine is a recommended first-line treatment, with a shorter course of treatment that may increase compliance 1.
• Griseofulvin is also a recommended first-line treatment, particularly for Microsporum species 1.
• Itraconazole is a safe and effective second-line therapy, with activity against both Trichophyton and Microsporum species 1.

Additional Measures

• Children receiving appropriate therapy should be allowed to attend school or nursery 1.
• Index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
• The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. Identification should be made either by direct microscopic examination of a mounting of infected tissue in a solution of potassium hydroxide or by culture on an appropriate medium Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination. Representative treatment periods are tinea capitis, 4 to 6 weeks; tinea corporis, 2 to 4 weeks; tinea pedis, 4 to 8 weeks; tinea unguium-depending on rate of growth-fingernails, at least 4 months; toenails, at least 6 months General measures in regard to hygiene should be observed to control sources of infection or reinfection. Concomitant use of appropriate topical agents is usually required, particularly in treatment of tinea pedis. INDICATIONS AND USAGE Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi:

The best oral treatment for Tinea (Ringworm) is griseofulvin 2 2.

• The dosage for adults is 0.5 g daily, and for pediatric patients, it is 10 mg/kg daily.
• The treatment period varies depending on the type of Tinea, ranging from 2 to 4 weeks for tinea corporis to at least 6 months for tinea unguium. The best topical treatment is not specified in the provided drug labels, but it is mentioned that concomitant use of appropriate topical agents is usually required, particularly in the treatment of tinea pedis 2.

From the Research

Topical Treatments for Tinea

• Terbinafine has been shown to have higher clinical cure rates compared to placebo, with a risk ratio (RR) of 4.51 and a number needed to treat (NNT) of 3 3.
• Naftifine 1% has been found to have higher mycological cure rates compared to placebo, with an RR of 2.38 and an NNT of 3 3.
• Clotrimazole 1% has been shown to have higher mycological cure rates compared to placebo, with an RR of 2.87 and an NNT of 2 3.
• Azoles, such as fluconazole and itraconazole, have been found to be effective in treating tinea, but the quality of evidence is low to very low 3.

Oral Treatments for Tinea

• Griseofulvin has been the mainstay of treatment for tinea capitis, with a treatment duration of 6-8 weeks 4, 5.
• Terbinafine has been shown to be effective in treating tinea capitis, with a treatment duration of 6 weeks 4, 5.
• Itraconazole and fluconazole have been found to be effective in treating tinea capitis, but the quality of evidence is low to very low 6, 7.
• Terbinafine and griseofulvin have been found to be effective in treating tinea imbricata, with significant remission lasting up to 8 weeks after cessation of therapy 7.

Comparison of Treatments

• There is no significant difference in cure rates between tinea cruris and tinea corporis 3.
• Azoles and benzylamines have been found to have similar mycological cure rates, with an RR of 1.01 3.
• Azoles and allylamines have been found to have similar clinical and mycological cure rates, but the quality of evidence is low to very low 3.
• Combinations of topical steroids and antifungals have been found to have higher clinical cure rates, but the quality of evidence is very low 3.