What is the treatment for tinea corporis?

Treatment of Tinea Corporis

For limited tinea corporis, use topical terbinafine 1% cream once daily for 1-2 weeks as first-line therapy; for extensive disease, treatment failure, or immunocompromised patients, use oral terbinafine 250 mg daily for 1-2 weeks. 1, 2

Topical Therapy (First-Line for Limited Disease)

Topical antifungals are appropriate for localized infections without extensive involvement. 3, 2

• Terbinafine 1% cream applied once daily for 1-2 weeks is the preferred topical agent, offering the advantage of shorter treatment duration and once-daily dosing 1, 3
• Alternative topical options include azole creams (clotrimazole, miconazole) applied twice daily for 2-4 weeks, though these require longer treatment courses 3, 4
• Butenafine cream is another effective option requiring twice-daily application for 2 weeks 2
• Continue treatment for at least one week after clinical clearing to prevent relapse 3

Oral Therapy (For Extensive or Resistant Disease)

Oral antifungals are indicated when infection is extensive, resistant to topical treatment, or in immunocompromised patients. 1, 2

Terbinafine (Preferred Oral Agent)

• Terbinafine 250 mg once daily for 1-2 weeks is first-line oral therapy, particularly effective against Trichophyton tonsurans 5, 1, 6
• Offers advantages of once-daily dosing and shorter treatment duration compared to alternatives 5

Itraconazole (Alternative Oral Agent)

• Itraconazole 100 mg once daily for 15 days achieves 87% mycological cure rate, superior to griseofulvin (57% cure rate) 5, 1
• Alternative dosing: 200 mg daily for 7 days 6
• Important drug interactions: enhanced toxicity with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin 1
• Licensed for children over 12 years in the UK, though used off-label in younger children in some countries 1

Fluconazole (Third-Line Option)

• Fluconazole 50-100 mg daily for 2-3 weeks or 150 mg once weekly for 2-3 weeks 6
• Less cost-effective than terbinafine with limited comparative efficacy data 1
• Not licensed for tinea in children under 10 years in the UK 1

Griseofulvin (Not Recommended as First-Line)

• Griseofulvin is not recommended as first-line treatment due to longer treatment duration (2-4 weeks), lower efficacy than terbinafine, and lower cure rates 1, 7
• Dosing: 0.5 g daily in adults (may increase to 0.75-1.0 g daily for extensive infections); 10 mg/kg daily in children over 2 years 7
• May be considered when other agents are contraindicated 7

Combination Antifungal/Steroid Preparations

Azole-steroid combination creams achieve higher clinical cure rates at end of treatment but similar mycological cure rates compared to azoles alone. 4

• Use with caution due to potential for skin atrophy and other steroid-associated complications 3
• May be appropriate when significant inflammation is present 3
• Not currently recommended in clinical guidelines despite some evidence of benefit 4

Diagnostic Confirmation

Confirm diagnosis with potassium hydroxide (KOH) preparation or fungal culture before initiating treatment. 1, 7, 2

• Specimens should be collected using scalpel scraping from the active border of lesions 1
• The definitive endpoint for treatment should be mycological cure, not just clinical response 1
• Follow-up with repeat mycology sampling is recommended until mycological clearance is documented 1

Prevention of Recurrence

Implement comprehensive prevention measures to avoid reinfection. 5, 1

• Avoid skin-to-skin contact with infected individuals and cover active lesions 5
• Do not share towels, clothing, or other fomites 5, 8
• Screen and treat all family members, especially with anthropophilic species like T. tonsurans - over 50% of family members may be affected 1
• Clean all contaminated combs, brushes, and towels with disinfectant or 2% sodium hypochlorite solution 1
• Keep skin dry and cool at all times 8
• Limit exposure to swimming pools associated with known outbreaks 5

Common Pitfalls

Treatment failure may result from poor compliance, suboptimal medication absorption, or relative organism insensitivity. 9

• If clinical improvement occurs but mycology remains positive, continue current therapy for an additional 2-4 weeks 9
• Premature discontinuation of antifungal therapy can lead to relapse - medication must be continued until the infecting organism is completely eradicated 7
• Concomitant bacterial or yeast infections may be present and will not respond to antifungal therapy alone 7