What is the recommended treatment for tinea corporis in a child?

Treatment Recommendation for Tinea Corporis in an 8-Year-Old Child

For this 8-year-old child with tinea corporis affecting approximately 10% of the chest and back area (representing extensive disease), oral antifungal therapy is indicated rather than topical treatment alone. 1

Oral Antifungal Selection

First-line oral therapy should be either terbinafine 250 mg daily for 1-2 weeks or itraconazole 100 mg daily for 15 days. 1

Terbinafine Advantages:

• Particularly effective against Trichophyton tonsurans, the most common causative organism in North America 1, 2
• Shorter treatment duration of 1-2 weeks 1
• Superior efficacy compared to griseofulvin 1
• Most cost-effective option among newer antifungals 2
• Well-tolerated with primarily gastrointestinal side effects 2

Itraconazole Alternative:

• Achieves 87% mycological cure rate versus 57% with griseofulvin 1
• Licensed for children over 12 years in the UK, though used off-label in younger children in some countries 1
• Important drug interactions to monitor: warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin 1
• Requires 15 days of treatment 1

Why Oral Therapy is Necessary

• The infection is extensive (covering significant chest and back area) and resistant to topical treatment 1
• Topical therapy alone is generally reserved for limited, localized infections 3, 4
• Oral agents compartmentalize in skin, allowing more effective treatment of widespread disease 2

Griseofulvin Should Be Avoided

Do not use griseofulvin as first-line treatment because it requires longer treatment duration (2-4 weeks for tinea corporis), has lower cure rates than terbinafine, and is less effective overall 1, 5

Essential Adjunctive Measures

• Confirm diagnosis with potassium hydroxide preparation or fungal culture before initiating treatment 1, 5
• Clean all contaminated combs, brushes, and towels with disinfectant or 2% sodium hypochlorite solution 1
• Screen and treat all family members, as over 50% may be affected with anthropophilic species 1
• Avoid skin-to-skin contact with infected individuals and do not share personal items 1
• Cover lesions during treatment to prevent transmission 1

Monitoring and Follow-up

• The definitive endpoint should be mycological cure, not just clinical improvement 1
• Follow-up should include both clinical and mycological assessment 1
• Repeat mycology sampling is recommended until mycological clearance is documented 1
• Treatment failure may require extending treatment duration 1
• Liver enzyme monitoring is generally unnecessary if therapy is limited to ≤4 weeks 2

Common Pitfall to Avoid

Do not discontinue medication when clinical symptoms resolve—continue until the infecting organism is completely eradicated, as clinical relapse will occur if treatment is stopped prematurely 5, 3