Oral Antifungal Treatment for Recurrent Tinea Corporis in Children and Adults
Terbinafine is the most effective oral antifungal for both children and adults with recurrent tinea corporis, given at 250 mg daily for 1-2 weeks in adults and weight-based dosing in children (62.5 mg for <20 kg, 125 mg for 20-40 kg, 250 mg for >40 kg). 1, 2, 3
Primary Treatment Recommendation
Terbinafine should be your first-line oral agent because:
- It achieves >90% mycological cure rates in tinea corporis with short treatment duration (1-2 weeks) 2, 4, 5
- It is fungicidal rather than fungistatic, providing superior cure rates and lower relapse rates—critical for recurrent infections 2, 4
- It is well-tolerated in both children (ages 2-17 years) and adults with minimal adverse effects 3, 6
- It is effective across all age groups with established pediatric dosing: 62.5 mg/day for children <20 kg, 125 mg/day for 20-40 kg, and 250 mg/day for >40 kg 3
- It is inexpensive and has low potential for drug interactions 2, 6
Alternative Option: Itraconazole
Itraconazole 100 mg daily for 15 days is an effective alternative with an 87% mycological cure rate 1:
- Superior to griseofulvin (87% vs 57% cure rate) 1
- Licensed for children >12 years in the UK, though used off-label in younger children in some countries 7
- Important drug interactions to consider: enhanced toxicity with warfarin, certain antihistamines (terfenadine, astemizole), antipsychotics, midazolam, digoxin, and simvastatin 7, 8
- More expensive than terbinafine and requires longer treatment duration 1
Fluconazole as Third-Line Option
Fluconazole can be considered but has significant limitations 7, 9:
- Not licensed for tinea in children <10 years in the UK (though licensed for mucosal candidiasis in all children) 7
- Once-weekly dosing regimens have been used and appear well-tolerated 7
- Less cost-effective than terbinafine with limited comparative efficacy data 7
- Caution in breastfeeding women as fluconazole is present in breast milk 9
Critical Management Points for Recurrent Infections
Address the underlying causes of recurrence:
- Screen and treat all family members, especially with anthropophilic species like Trichophyton tonsurans (>50% of family members may be affected) 7, 10
- Clean all fomites (hairbrushes, combs, towels) with disinfectant or 2% sodium hypochlorite solution 7, 10
- Avoid sharing personal items and maintain proper hygiene 1, 10
- Cover active lesions to prevent spread 1
Treatment Monitoring
The definitive endpoint must be mycological cure, not just clinical improvement 7, 1:
- Obtain baseline mycology (KOH preparation and culture) before treatment when possible 1
- Follow-up with repeat mycology sampling at end of treatment and monthly until clearance is documented 7
- Extend treatment duration if needed based on mycological response 1
Common Pitfalls to Avoid
- Do not rely on clinical improvement alone—mycological cure is essential to prevent recurrence 7, 1
- Do not use combination antifungal-corticosteroid preparations—this promotes resistance and treatment failure 6
- Do not ignore family screening—failure to treat household contacts leads to high recurrence rates 7, 10
- Do not use griseofulvin as first-line—it requires longer treatment (6-8 weeks), is less effective than terbinafine, and has lower cure rates 7, 1, 2