What is the treatment for ringworm?

Medical Treatment for Ringworm

For ringworm (tinea corporis/cruris), topical antifungal therapy with clotrimazole 1% or miconazole 2% cream applied twice daily for 2-4 weeks is the first-line treatment, with oral therapy reserved for extensive disease, treatment failure, or scalp/nail involvement. 1, 2

Topical Therapy (First-Line for Body and Groin)

Topical antifungals are highly effective for uncomplicated tinea corporis and tinea cruris:

• Clotrimazole 1% cream applied twice daily for 2-4 weeks is an effective first-line option 1
• Miconazole 2% cream applied twice daily for 2-4 weeks is equally effective 1, 2
• Terbinafine cream demonstrates superior efficacy compared to placebo (RR 4.51, NNT 3), requiring fewer applications and shorter treatment duration 3
• Naftifine 1% shows strong mycological cure rates (RR 2.38, NNT 3) and clinical cure (RR 2.42, NNT 3) 3

Treatment duration: Continue for 2-4 weeks even after lesions appear resolved to prevent relapse 1, 3

Oral Therapy (For Extensive or Resistant Cases)

Oral antifungals are indicated when:

• Extensive body surface area involvement 4
• Failure of topical therapy after 2 weeks 1
• Involvement of hair follicles, scalp (tinea capitis), or nails 5, 4
• Lesions near eyes, ears, mouth, or complex skin folds where topical application is difficult 4

Oral treatment options:

• Fluconazole 150-200 mg weekly for 2-4 weeks for extensive or resistant cases 1
• Terbinafine (oral) is considered first-line for tinea capitis and onychomycosis due to effectiveness, tolerability, and cost 5
• Griseofulvin remains FDA-approved for dermatophyte infections: adults 500 mg daily (or 125 mg four times daily), children >2 years: 10 mg/kg daily 6

Duration for griseofulvin: Tinea corporis requires 2-4 weeks of treatment 6

Important Clinical Considerations

Diagnostic confirmation is essential before treatment:

• Direct microscopic examination with KOH preparation or fungal culture should confirm dermatophyte infection 6, 5
• Clinical diagnosis alone is unreliable—tinea corporis mimics eczema, and other conditions can appear similar 5

Common pitfalls to avoid:

• Never use combination antifungal-corticosteroid creams as first-line therapy despite higher initial clinical cure rates, as this promotes antifungal resistance and is not recommended in guidelines 5, 3
• Do not stop treatment when lesions appear resolved—continue full course to eradicate organism and prevent relapse 6
• Griseofulvin is ineffective against Candida, bacteria, and other non-dermatophyte infections 6

Adjunctive measures:

• Address hygiene and sources of reinfection 6
• Topical therapy may be needed alongside oral treatment for tinea pedis 6

Adverse effects are generally minimal with topical agents—mainly irritation and burning reported infrequently 3

If no improvement after 2 weeks of appropriate therapy, switch to a different antifungal class 1