Management of Tinea Corporis
For localized tinea corporis, topical antifungal therapy with terbinafine 1% cream once daily for 1-2 weeks is the first-line treatment, while extensive or treatment-resistant infections require oral therapy with terbinafine 250 mg daily for 1-2 weeks. 1, 2
Diagnostic Confirmation Before Treatment
- Accurate diagnosis is mandatory before initiating therapy through potassium hydroxide (KOH) preparation microscopy or fungal culture to identify the causative dermatophyte 1, 3
- Collect specimens via scalpel scraping from the active border of lesions 1, 2
- Mycological cure, not just clinical improvement, is the definitive treatment endpoint 1, 2
First-Line Treatment: Topical Therapy
For Localized Disease
- Terbinafine 1% cream applied once daily for 1-2 weeks is highly effective and requires the shortest treatment duration 2, 4
- Alternative topical options include:
- Continue treatment for at least one week after clinical clearing to prevent relapse 4
When Topical Therapy is Insufficient
- Extensive body surface area involvement 2, 3
- Treatment failure after appropriate topical therapy 1, 2
- Immunocompromised patients 2, 7
- Severe inflammation or secondary bacterial infection 4, 7
Second-Line Treatment: Oral Antifungal Therapy
Terbinafine (Preferred for Most Cases)
- 250 mg daily for 1-2 weeks 1, 8
- Particularly effective against Trichophyton tonsurans, the most common causative organism 1, 2
- Shorter treatment duration compared to other oral agents 8
Itraconazole (Alternative)
- 100 mg daily for 15 days achieves 87% mycological cure rate 1
- Alternative dosing: 200 mg daily for 7 days 8
- Important drug interactions: enhanced toxicity with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin 1
- Licensed for children over 12 years in the UK 1
Griseofulvin (Generally Not Recommended as First-Line)
- Requires longer treatment duration (2-4 weeks) and has lower efficacy than terbinafine 1, 3
- Dosing: 500 mg daily for adults, or 10 mg/kg daily for children over 2 years 3
- More effective for Microsporum species if identified 2
- Contraindicated in lupus erythematosus, porphyria, and severe liver disease 2
Fluconazole (Third-Line)
- 50-100 mg daily or 150 mg once weekly for 2-3 weeks 1, 8
- Less cost-effective than terbinafine with limited comparative efficacy data 1
Treatment Failure Management
If Clinical Improvement but Positive Mycology Persists
- Continue current therapy for an additional 2-4 weeks 9, 2
- Reassess with repeat mycological sampling 1, 2
If No Clinical Improvement
- Assess compliance with medication regimen 2
- Evaluate for poor drug absorption or organism resistance 9, 2
- Switch to alternative oral agent (e.g., from azole to terbinafine or vice versa based on organism) 2
- Consider extending treatment duration 1
Prevention and Management of Recurrence
Essential Preventive Measures
- Avoid skin-to-skin contact with infected individuals 1
- Do not share towels, clothing, or personal items 1, 7
- Keep skin dry and cool at all times 7
- Cover active lesions to prevent transmission 1
Household and Environmental Management
- Screen and treat all family members, as over 50% may be affected with anthropophilic species like T. tonsurans 1, 2
- Clean all contaminated combs, brushes, and fomites with disinfectant or 2% sodium hypochlorite solution 1, 2
- Use separate towels for different body areas 9
Special Considerations and Common Pitfalls
Combination Steroid-Antifungal Products
- May provide faster clinical improvement due to anti-inflammatory properties 4, 5
- Use with caution and for short duration only due to risk of skin atrophy and steroid-related complications 4
- Do not use as first-line therapy 1
Monitoring and Follow-Up
- Follow-up should include both clinical assessment and repeat mycological sampling until clearance is documented 1, 2
- Treatment failure often results from poor compliance, inadequate medication absorption, or reinfection from untreated contacts 9, 2