What is the recommended treatment for Tinea (ringworm) of the chest wall?

Treatment of Tinea Corporis (Chest Wall)

For tinea corporis of the chest wall, topical antifungal therapy applied once daily for 2 weeks is the recommended first-line treatment for localized disease. 1, 2

First-Line Topical Therapy

• Apply topical azole antifungals (such as econazole 1% cream) once daily to affected areas for 2 weeks minimum. 2, 3
• Econazole is FDA-approved specifically for tinea corporis caused by Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis, M. audouini, M. gypseum, and Epidermophyton floccosum. 2
• Continue treatment for at least one week after clinical clearing to prevent recurrence. 3
• Other effective topical options include other azoles (clotrimazole, miconazole) or allylamines (terbinafine, naftifine), all showing similar efficacy. 4

When to Use Oral Therapy Instead

• Reserve oral antifungal therapy for extensive infections covering large body surface areas, treatment failures with topical therapy, or immunocompromised patients. 1, 3
• For oral therapy when needed, terbinafine 250 mg daily for 2-4 weeks is highly effective. 1, 4
• Griseofulvin remains an alternative oral option, though it requires longer treatment duration (6-8 weeks). 1

Diagnostic Confirmation

• Obtain potassium hydroxide (KOH) preparation or fungal culture before initiating treatment when feasible to confirm dermatophyte infection. 5, 3
• However, if clinical features strongly suggest tinea corporis (characteristic annular scaly plaques with central clearing), treatment can be started immediately while awaiting results. 5

Important Treatment Considerations

• Avoid topical steroid-antifungal combination products as first-line therapy - while they may provide faster symptom relief, they should be used with caution due to potential for skin atrophy and other steroid-related complications. 3, 4
• If inflammation is prominent, consider using an antifungal agent with inherent anti-inflammatory properties rather than adding steroids. 3
• Address exacerbating factors such as excessive skin moisture, tight clothing, and poor hygiene to improve treatment success. 3

Monitoring and Follow-Up

• Clinical improvement should be evident within 2 weeks; if no improvement occurs, reassess the diagnosis and consider switching to oral therapy. 2, 3
• Mycological cure (negative KOH or culture) is the definitive treatment endpoint, not just clinical appearance. 1, 6

Prevention of Recurrence and Transmission

• Clean all contaminated clothing, towels, and bedding with disinfectant or 2% sodium hypochlorite solution. 1
• Avoid skin-to-skin contact with infected individuals and sharing of personal items. 6
• Screen and treat household contacts if anthropophilic species like T. tonsurans are identified. 1, 7

Common Pitfalls to Avoid

• Do not use topical therapy alone for tinea capitis (scalp) - this requires oral therapy. 5, 6, 7
• Do not stop treatment when symptoms resolve; complete the full 2-week course to prevent relapse. 2, 3
• Adverse effects from topical antifungals are minimal (mainly mild irritation or burning) and should not deter appropriate treatment. 4