What is the treatment for tinea corporis in a 14-year-old?

Treatment of Tinea Corporis in a 14-Year-Old

For tinea corporis in a 14-year-old, first-line treatment is topical antifungal therapy for 2-4 weeks, with oral antifungals reserved for extensive or resistant cases. 1, 2

Diagnostic Confirmation

• Accurate diagnosis should be confirmed through microscopy using potassium hydroxide preparation or culture to identify the causative organism 2, 3
• Treatment should begin immediately when clinical features strongly suggest tinea corporis 4

First-Line Treatment: Topical Therapy

• Apply topical antifungal cream once or twice daily for 2-4 weeks 1, 5, 3
• Continue treatment for at least one week after clinical clearing of infection 3
• Effective topical options include:
  • Azole antifungals (clotrimazole, miconazole): Apply twice daily for 2-4 weeks 3
  • Allylamine antifungals (terbinafine 1% cream): Apply once daily for 1-2 weeks 6
  • Ciclopirox olamine 0.77% cream: Apply twice daily for 4 weeks 1

Second-Line Treatment: Oral Therapy

• Indicated when infection is extensive, resistant to topical treatment, or in immunocompromised patients 2, 7
• Oral options include:
  • Itraconazole 100 mg daily for 15 days (87% mycological cure rate) 1, 2
  • Terbinafine 250 mg daily for 1-2 weeks (particularly effective against T. tonsurans) 1, 2, 8
  • Griseofulvin 10 mg/kg daily (250-500 mg for patients over 50 lbs) for 2-4 weeks 5
  • Fluconazole 50-100 mg daily or 150 mg once weekly for 2-3 weeks 8

Special Considerations

• For inflammatory lesions, consider a combination antifungal/steroid agent for short-term use (5-7 days) to reduce inflammation, followed by antifungal monotherapy 9
• Caution with steroid combinations due to potential for atrophy and other steroid-associated complications 3
• For atopic children with severe pruritus, combination therapy with isoconazole-diflucortolone may reduce risk of bacterial superinfection 9

Prevention and Follow-up

• Implement preventive measures:
  • Avoid skin-to-skin contact with infected individuals 1, 2
  • Don't share towels and other personal items 1, 7
  • Keep skin dry and cool 7
  • Screen and treat family members if infection is caused by anthropophilic species 4
• Follow-up should include both clinical and mycological assessment until clearance is documented 2, 4
• Treatment failure may require extending treatment duration or switching to oral therapy 2

Treatment Algorithm

1. Confirm diagnosis with KOH preparation or culture
2. For localized lesions: Start with topical antifungal for 2-4 weeks
3. For extensive, resistant, or recurrent lesions: Use oral antifungal therapy
4. Continue treatment until at least one week after clinical clearing
5. Implement preventive measures to avoid recurrence