What is the treatment regimen for Tinea corporis infection in adults?

Treatment Regimen for Tinea Corporis Infection in Adults

For adults with tinea corporis infection, first-line treatment is topical antifungal therapy for 2-4 weeks, with oral antifungal therapy reserved for extensive, resistant, or recurrent cases. 1, 2

Diagnostic Approach

• Accurate diagnosis is essential before initiating treatment, ideally confirmed through microscopy using potassium hydroxide preparation or culture 1, 3
• Specimens should be collected using scalpel scraping to identify the causative organism 1

Topical Therapy (First-Line)

• For localized tinea corporis infections:
  • Azole creams (clotrimazole, miconazole) applied twice daily for 2-4 weeks 3, 2
  • Allylamine creams (terbinafine 1%) applied once or twice daily for 1-2 weeks 2, 4
  • Continue treatment for at least one week after clinical clearing of infection 2

Oral Therapy (For Extensive or Resistant Cases)

• For extensive or resistant tinea corporis:
  • Itraconazole 100 mg daily for 15 days (87% mycological cure rate) 5, 1
  • Terbinafine 250 mg daily for 1-2 weeks (particularly effective against T. tonsurans) 5, 1, 6
  • Fluconazole 150 mg once weekly for 2-3 weeks 7
  • Griseofulvin 500 mg daily for 2-4 weeks (less effective than newer agents) 3

Treatment Selection Based on Causative Organism

• Terbinafine is superior for Trichophyton tonsurans infections 5, 1
• Itraconazole has shown superior efficacy compared to griseofulvin (87% vs 57% mycological cure rate) 5, 1
• Treatment should continue until the infecting organism is completely eradicated 3

Prevention and Management of Recurrence

• Avoid skin-to-skin contact with infected individuals 5, 1
• Do not share towels, clothing, or personal items 5, 1
• Cover active lesions to prevent spread 5
• Clean contaminated combs and brushes with disinfectant 1
• Screen and treat family members if infection is caused by anthropophilic species 1

Treatment 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 oral therapy 1

Important Considerations and Caveats

• Obesity and diabetes are risk factors that should be addressed 5
• Concomitant use of appropriate topical agents is usually required when using oral therapy 3
• Drug interactions should be monitored, particularly with itraconazole 8
• Clinical relapse will occur if medication is not continued until the infecting organism is eradicated 3