What is the recommended management for tinea corporis and tinea pedis?

Management of Tinea Corporis and Tinea Pedis

For tinea corporis and tinea pedis, topical antifungal therapy is the first-line treatment, with oral therapy reserved for severe, extensive, or resistant cases. 1, 2

Diagnosis

• Accurate diagnosis is essential before initiating treatment, requiring either direct microscopic examination with potassium hydroxide (KOH) preparation or culture on appropriate medium 3
• Clinical presentation varies:
  • Tinea corporis presents as circular, scaly lesions with central clearing 1
  • Tinea pedis presents as fine scaly or vesiculopustular eruptions, often itchy, commonly affecting the spaces between toes 1, 2

Treatment for Tinea Corporis

Topical Therapy

• First-line treatment for limited disease 1, 4
• Treatment options:
  • Terbinafine 1% cream applied once daily for 1-2 weeks (65% effective cure rate) 5
  • Azole creams (e.g., clotrimazole 1%) applied twice daily for 2-4 weeks 1, 4

Oral Therapy

• Reserved for extensive disease or when topical therapy fails 4
• Treatment options:
  • Itraconazole 100 mg daily for 15 days (87% mycological cure rate) 1
  • Terbinafine is superior for infections caused by T. tonsurans 1
  • Griseofulvin 500 mg daily for 2-4 weeks (adults) or 10 mg/kg daily (children) 3
  • Fluconazole 150 mg weekly for 2-3 weeks 6

Treatment for Tinea Pedis

Topical Therapy

• First-line for most cases 2, 7
• Treatment options:
  • Terbinafine 1% cream applied twice daily for 1 week (66% effective cure rate) 2, 5
  • Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks (60% cure at end of treatment, 85% two weeks after treatment) 1, 2
  • Clotrimazole 1% cream applied twice daily for 4 weeks 2

Oral Therapy

• Reserved for severe disease, failed topical therapy, concomitant onychomycosis, or immunocompromised patients 2, 7
• Treatment options:
  • Terbinafine 250 mg once daily for 1 week (faster clinical resolution than topical treatments) 1, 2
  • Itraconazole 100 mg daily for 2 weeks (similar efficacy to terbinafine but slightly higher relapse rate) 1, 2
  • Griseofulvin 500 mg daily for 4-8 weeks 3
  • Fluconazole 150 mg once weekly for multiple weeks 8, 6

Duration of Treatment

• Tinea corporis: Continue treatment for 2-4 weeks 3, 4
• Tinea pedis: Continue treatment for 4-8 weeks with azoles or 1-2 weeks with allylamines 3, 4
• Treatment should continue for at least one week after clinical clearing of infection 4

Prevention and Management of Outbreaks

• Avoid skin-to-skin contact with infected individuals 1
• Do not share towels or other personal items 1
• Thoroughly dry between toes after showering 2
• Change socks daily and clean athletic footwear periodically 2
• Apply foot powder after bathing to reduce tinea pedis rates 2
• Cover active foot lesions with socks before wearing underwear to prevent spread to groin area 2

Special Considerations

• Risk factors for tinea pedis include swimming, running, warm humid environments, male gender, obesity, and diabetes 1, 2
• Failing to treat all infected family members simultaneously can result in reinfection 2
• Neglecting to address contaminated footwear can lead to recurrence 2
• Concomitant use of appropriate topical agents is usually required for tinea pedis, as yeasts and bacteria may be involved alongside dermatophytes 3

Follow-up

• The definitive endpoint for adequate treatment should be mycological cure, not just clinical response 1
• Consider follow-up with repeat mycology sampling at the end of the standard treatment period 1