Treatment of Ringworm on the Wrist
For ringworm (tinea corporis) on the wrist, start with a topical antifungal agent applied once or twice daily for 2-4 weeks, reserving oral therapy for resistant cases or extensive involvement. 1
Topical Therapy (First-Line)
- Apply topical azole or allylamine antifungals once or twice daily for 2-4 weeks 1, 2
- Topical agents are the primary treatment for localized tinea corporis when the infection is not extensive 1, 2
- Continue treatment for at least one week after clinical clearing to ensure complete eradication 1
- Newer topical agents (luliconazole, efinaconazole, sertaconazole) require fewer applications and shorter treatment duration 3
Common Pitfalls to Avoid
- Do not stop treatment when lesions appear clinically resolved—continue for at least one additional week to prevent relapse 1
- Confirm diagnosis with potassium hydroxide preparation or fungal culture before initiating therapy, as accurate identification of the causative organism is essential 4, 5
Oral Therapy (Second-Line)
Oral antifungals are indicated when the infection is resistant to topical treatment, covers an extensive area, or when topical application is not feasible 4, 1, 2
Oral Treatment Options
- Terbinafine 250 mg daily for 1-2 weeks is particularly effective against Trichophyton tonsurans 6, 4, 7
- Itraconazole 100 mg daily for 15 days achieves an 87% mycological cure rate, superior to griseofulvin's 57% 6, 4
- Fluconazole 50-100 mg daily or 150 mg once weekly for 2-3 weeks is an alternative option 7
- Griseofulvin 0.5 g daily (500 mg/day) for 2-4 weeks is FDA-approved but less commonly used due to inferior efficacy compared to newer agents 5
Selecting the Right Oral Agent
- Choose terbinafine for T. tonsurans infections based on superior efficacy data 6, 4
- Itraconazole offers broader coverage and once-daily dosing with proven superiority over griseofulvin 6, 4
Treatment Monitoring
- The definitive endpoint is mycological cure, not just clinical response 4
- Follow-up with repeat mycology sampling is recommended until mycological clearance is documented 4
- Clinical relapse will occur if medication is discontinued before the infecting organism is completely eradicated 5