What is the treatment for tinea corporis?

Treatment of Tinea Corporis

For limited tinea corporis, use topical terbinafine 1% cream once daily for 1-2 weeks as first-line therapy; for extensive disease, treatment failure, or immunocompromised patients, use oral terbinafine 250 mg daily for 1-2 weeks. 1, 2

Topical Therapy (First-Line for Limited Disease)

Topical antifungals are appropriate for localized infections without extensive involvement. 3, 2

• Terbinafine 1% cream applied once daily for 1-2 weeks is the preferred topical agent due to high efficacy and convenient dosing 1, 3
• Butenafine cream applied twice daily for 2 weeks is an effective over-the-counter alternative 4, 2
• Clotrimazole 1% cream applied twice daily for 2-4 weeks has demonstrated superior mycological cure compared to placebo (RR 2.87, NNT 2) 5
• Continue treatment for at least one week after clinical clearing to prevent relapse 3

Oral Therapy (For Extensive or Resistant Disease)

Oral antifungals are indicated when infection is resistant to topical treatment, covers extensive areas, or occurs in immunocompromised patients. 1, 2

Preferred Oral Agents:

• Terbinafine 250 mg once daily for 1-2 weeks is first-line oral therapy, particularly effective against Trichophyton tonsurans 6, 1, 7, 2
• Itraconazole 100 mg once daily for 15 days achieves 87% mycological cure rate, superior to griseofulvin (87% vs 57%) 6, 1
• Fluconazole 50-100 mg daily for 2-3 weeks or 150 mg once weekly for 2-3 weeks is an alternative option 7

Alternative Agent:

• Griseofulvin 500 mg daily for 2-4 weeks (adults) or 10 mg/kg daily (pediatrics >2 years) is FDA-approved but less effective than newer agents 8

Treatment Selection Based on Causative Organism

Terbinafine demonstrates superior efficacy for Trichophyton tonsurans infections compared to other agents. 6, 1

• For T. tonsurans: prioritize terbinafine 6, 1
• For other dermatophytes: azoles (itraconazole, fluconazole) or terbinafine are equally effective 5, 7

Diagnostic Confirmation

Confirm diagnosis with potassium hydroxide (KOH) preparation or fungal culture before initiating treatment, particularly for extensive disease requiring oral therapy. 1, 8, 3

• Collect specimens via scalpel scraping from the active border of lesions 1
• Culture on Sabouraud's agar media if organism identification is needed 9

Prevention and Recurrence Management

Implement preventive measures to avoid reinfection and treatment failure. 6, 1, 9

• Avoid skin-to-skin contact with infected individuals and cover active lesions 6, 1
• Do not share towels, clothing, or personal items 6, 9
• Clean and disinfect contaminated combs and brushes 1
• Screen and treat household contacts if anthropophilic species are identified 1
• Keep skin dry and cool; practice good hygiene 9

Monitoring and Follow-Up

The definitive endpoint is mycological cure, not just clinical improvement. 1

• Assess both clinical and mycological response during follow-up 1
• If clinical improvement occurs but mycology remains positive, continue current therapy for an additional 2-4 weeks 4
• Treatment failure may indicate poor compliance, inadequate absorption, or organism resistance 4

Common Pitfalls

• Avoid premature discontinuation: Continue treatment at least one week after clinical clearing to prevent relapse 3
• Do not use topical steroid-antifungal combinations as first-line: While these achieve higher clinical cure rates at end of treatment, they carry risks of skin atrophy and steroid-related complications 3, 5
• Recognize treatment failure early: Extensive disease, maceration with secondary infection, or immunocompromised status requires oral therapy 9, 2