What is the treatment for Tinea corporis?

Treatment of Tinea Corporis

For tinea corporis, topical antifungal therapy applied once or twice daily for 2-4 weeks is the first-line treatment, with oral antifungals reserved for extensive, chronic, or treatment-resistant cases. 1, 2

Topical Therapy (First-Line)

Topical antifungals are the primary treatment for tinea corporis and should be continued for at least one week after clinical clearing of infection. 1

• Treatment duration: 2-4 weeks with topical azoles or allylamines applied once or twice daily 1, 2
• Newer topical agents (luliconazole, sertaconazole, efinaconazole) require fewer applications and shorter treatment courses 3
• Continue therapy for at least one week beyond visible resolution to ensure mycological cure 1

Common Pitfall

Do not stop treatment when lesions appear clinically resolved—this leads to relapse. Mycological cure, not just clinical improvement, is the endpoint. 1

Oral Therapy (For Extensive or Resistant Cases)

When topical therapy fails or infection is extensive, oral antifungals are highly effective, with multiple evidence-based regimens available. 4, 5, 2

Oral Treatment Options:

• Itraconazole 100 mg once daily for 15 days achieved 87% mycological cure in adolescents and adults, superior to griseofulvin (57% cure rate) 4
• Fluconazole 150 mg once weekly for 2-4 weeks demonstrated significant efficacy with reduction in symptom severity scores from 7.1 to 1.5 (p=0.001) 6
• Fluconazole 50-100 mg daily for 2-3 weeks is also effective 5
• Terbinafine 250 mg daily for 1-2 weeks provides rapid treatment with once-daily dosing 5
• Griseofulvin 500 mg daily for 2-4 weeks (FDA-approved dosing: 0.5g daily, individualized based on severity) 7

Choosing Between Oral Agents:

The evidence shows itraconazole and terbinafine offer superior efficacy compared to griseofulvin, with shorter treatment durations. 4, 5 Fluconazole provides convenient once-weekly dosing with favorable tolerability. 6, 5 Terbinafine is specifically noted as superior for Trichophyton tonsurans infections. 4

Diagnostic Confirmation

Accurate identification of the causative organism is essential before initiating treatment. 7

• Obtain potassium hydroxide (KOH) preparation for rapid microscopic examination 7
• Culture specimens when possible to confirm dermatophyte infection and identify species 7
• This prevents inappropriate treatment of non-dermatophyte conditions (candidiasis, bacterial infections, tinea versicolor) that will not respond to dermatophyte-directed therapy 7

Adjunctive Measures

General hygiene measures are critical to prevent reinfection and treatment failure. 7

• Avoid skin-to-skin contact with infected individuals and cover lesions 4
• Do not share towels, clothing, or other fomites 4
• Limit exposure to contaminated environments (swimming pools associated with outbreaks) 4
• Concomitant topical therapy is usually required alongside oral treatment 7

When Inflammation is Present

If significant inflammation accompanies the infection, consider agents with inherent anti-inflammatory properties or combination antifungal/steroid preparations, though use steroids cautiously due to risk of skin atrophy. 1