What is the treatment for tinea corporis?

Treatment of Tinea Corporis

First-line treatment for tinea corporis is topical antifungal therapy for uncomplicated cases, while oral antifungal therapy is indicated when the infection is resistant to topical treatment. 1

Diagnostic Confirmation

• Accurate diagnosis should be confirmed through microscopy using potassium hydroxide preparation or culture to identify the causative organism before initiating treatment 1, 2
• Specimens should be collected using scalpel scraping as appropriate to the lesion 1

Topical Treatment Options

• Topical antifungals are generally successful for localized tinea corporis that isn't extensive 2
• Ketoconazole cream 2% is FDA-approved for the topical treatment of tinea corporis caused by Trichophyton rubrum, T. mentagrophytes, and Epidermophyton floccosum 3
• Treatment with topical agents should continue for at least two weeks, and should extend at least one week after clinical clearing of infection 2
• The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties, though combination antifungal/steroid agents should be used with caution due to potential for causing atrophy 2

Oral Treatment Options

• For extensive, resistant, or recurrent cases, oral antifungal therapy is indicated 1
• Itraconazole 100 mg daily for 15 days has an 87% mycological cure rate 1
• Terbinafine 250 mg daily for 1-2 weeks is particularly effective against T. tonsurans infections 1, 4
• Griseofulvin 0.5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg once daily) for 2-4 weeks is another option, with dosage individualized based on infection severity 5
• Fluconazole 150 mg once weekly for 2-3 weeks has also shown efficacy in treating tinea corporis 6, 4

Treatment Selection Based on Causative Organism

• Terbinafine appears superior for Trichophyton tonsurans infections 1
• Itraconazole has shown superior efficacy compared to griseofulvin, with an 87% vs 57% mycological cure rate 1, 7
• Treatment duration should be based on clinical response and causative organism 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 or switching to an alternative antifungal 1

Prevention and Special Considerations

• Implement preventive measures to avoid recurrence, including avoiding skin-to-skin contact with infected individuals, not sharing towels and personal items, covering lesions, and properly cleaning contaminated combs and brushes 1
• Screen and treat family members if infection is caused by anthropophilic species 1

Common Pitfalls

• Stopping treatment too early based only on clinical improvement rather than mycological cure 8
• Not considering secondary bacterial infection in inflammatory cases 8
• Using combination antifungal/steroid agents for extended periods, which can cause atrophy and other steroid-associated complications 2