Treatment of Ringworm (Tinea Corporis/Cruris)
For ringworm of the body or groin, apply topical clotrimazole 1% or miconazole 2% cream twice daily for 2-4 weeks as first-line therapy. 1
Topical Antifungal Therapy (First-Line)
Topical therapy is the preferred initial approach for localized ringworm infections. 2, 3
Recommended Topical Agents
- Clotrimazole 1% cream applied twice daily for 2-4 weeks is highly effective 1, 3
- Miconazole 2% cream applied twice daily for 2-4 weeks is equally effective 1, 3
- Terbinafine cream (allylamine class) applied once or twice daily for 1-2 weeks offers shorter treatment duration with fungicidal activity 2, 3
- Naftifine 1% demonstrates superior efficacy compared to placebo (NNT 3) and requires fewer applications 3
Treatment Duration by Site
- Tinea corporis (body): 2 weeks of treatment 2
- Tinea cruris (groin): 2 weeks of treatment 2
- Continue treatment for at least 1 week after clinical clearing to prevent relapse 2
Oral Antifungal Therapy (Second-Line)
Systemic therapy is indicated for extensive disease, treatment failure, or when topical therapy is impractical. 1, 4
Oral Treatment Options
- Fluconazole 150-200 mg weekly for 2-4 weeks for extensive or resistant cases 1
- Griseofulvin 500 mg daily (or 10 mg/kg/day in children) for 2-4 weeks for tinea corporis 4
- Terbinafine oral formulation is FDA-approved for dermatophyte infections with shorter treatment courses 5, 6
Key Clinical Considerations
Diagnosis Confirmation
- Confirm diagnosis with KOH preparation or fungal culture before initiating systemic therapy 4
- Clinical appearance alone may guide topical therapy initiation 2
When to Switch to Oral Therapy
- If no improvement after 2 weeks of appropriate topical therapy, consider switching to a different antifungal class or oral therapy 1
- Extensive body surface area involvement 4, 2
- Resistant infections 1
Fungicidal vs. Fungistatic Agents
- Allylamines (terbinafine, naftifine) are fungicidal and kill organisms, allowing shorter treatment duration 7
- Azoles (clotrimazole, miconazole) are fungistatic and require epidermal turnover to shed organisms, necessitating longer treatment 7
- Fungicidal agents have lower recurrence rates when patients stop treatment prematurely 7
Common Pitfalls to Avoid
- Do not use topical steroid-antifungal combinations as first-line therapy - while they may provide faster symptom relief, guidelines do not recommend them initially, and evidence quality is very low 3
- Do not stop treatment when skin appears healed - continue for at least 1 week after clinical clearing 2
- Griseofulvin is ineffective against Candida - ensure dermatophyte infection is confirmed 4
- Address exacerbating factors such as skin moisture and hygiene to prevent reinfection 4, 2