What is the treatment for Tinea skin infections?

Treatment of Tinea Skin Infections

For tinea corporis and tinea cruris, use topical antifungal therapy (terbinafine or butenafine cream) for 2 weeks as first-line treatment, reserving oral therapy for extensive disease, treatment failure, or immunocompromised patients. 1, 2

Diagnostic Confirmation Before Treatment

• Confirm diagnosis with potassium hydroxide (KOH) preparation or fungal culture before initiating therapy, particularly for onychomycosis and tinea capitis 3
• Collect specimens using scalpel scraping, hair pluck, brush, or swab depending on the lesion location 1
• In clinically obvious cases with scale, lymphadenopathy, alopecia, or kerion, start empiric treatment immediately while awaiting culture results 4

Treatment by Site and Severity

Tinea Corporis and Tinea Cruris (Body and Groin)

Topical Therapy (First-Line):

• Apply terbinafine 1% cream or butenafine cream once or twice daily for 2 weeks 2, 3
• Continue treatment for at least 1 week after clinical clearing 2
• Topical therapy alone is sufficient for limited disease 1, 2

Oral Therapy (When Topical Fails or Extensive Disease):

• Terbinafine 250 mg daily for 1-2 weeks is particularly effective against T. tonsurans 1, 5
• Itraconazole 100 mg daily for 15 days achieves 87% mycological cure rate (superior to griseofulvin's 57%) 1
• Fluconazole 50-100 mg daily or 150 mg once weekly for 2-3 weeks is a third-line option 1, 5

Tinea Capitis (Scalp)

Oral therapy is absolutely required; topical treatment alone is never effective 4

Treatment Selection Based on Organism:

• For Trichophyton species: Terbinafine is superior and preferred 4

  • <20 kg: 62.5 mg daily for 2-4 weeks
  • 20-40 kg: 125 mg daily for 2-4 weeks

  • 40 kg: 250 mg daily for 2-4 weeks 4

• For Microsporum species: Griseofulvin is more effective and preferred 4

  • <50 kg: 15-20 mg/kg/day for 6-8 weeks

  • 50 kg: 1 g/day for 6-8 weeks 4, 6

  • Take with fatty food to increase absorption 7

• Itraconazole (second-line): Active against both organisms 4

  • 50-100 mg daily for 4 weeks or 5 mg/kg/day for 2-4 weeks 4

Tinea Pedis (Feet)

Topical Therapy:

• Terbinafine 1% cream once or twice daily for 1-2 weeks achieves >80% cure rates 8
• Allylamine medications require only 1-2 weeks of treatment 2
• Traditional azole therapy requires 4 weeks 2

Oral Therapy (for extensive or moccasin-type):

• Terbinafine 250 mg daily for 2 weeks 5, 3
• Itraconazole 100 mg daily for 2 weeks or 400 mg daily for 1 week 5
• Fluconazole 150 mg once weekly (pulse dosing) 5

Tinea Unguium (Onychomycosis)

Oral terbinafine is first-line therapy due to high cure rate, tolerability, and low cost 3

• Fingernails: minimum 4 months 6
• Toenails: minimum 6 months 6

Treatment Failure Management

If mycology remains positive but clinical improvement is seen:

• Continue current therapy for an additional 2-4 weeks 4

If no clinical improvement:

• Assess for non-compliance, suboptimal drug absorption, organism resistance, or reinfection 4
• Switch agents: from terbinafine to griseofulvin for Microsporum, or to itraconazole 4

Essential Adjunctive Measures

• Screen all family members and close contacts for T. tonsurans infections, as >50% may be affected 1, 4
• Treat asymptomatic carriers with high spore loads systemically 4
• Clean all fomites (hairbrushes, combs, towels) with disinfectant or 2% sodium hypochlorite solution 1, 4
• Use antifungal shampoos (ketoconazole 2%, selenium sulfide 1%, or povidone-iodine) to reduce spore transmission 7
• Avoid skin-to-skin contact with infected individuals and do not share personal items 1

Treatment Endpoint and Monitoring

The definitive endpoint is mycological cure, not clinical cure 1, 4

• Repeat mycology sampling until clearance is documented 1, 4
• Clinical improvement alone is insufficient to stop therapy 4
• Follow-up should include both clinical and mycological assessment 1

Critical Pitfalls to Avoid

• Never use topical antifungals alone for tinea capitis—they do not penetrate hair follicles 4
• Do not use terbinafine for Microsporum infections—griseofulvin is superior 4
• Do not stop treatment based on clinical appearance alone—confirm mycological cure 1, 4
• Do not forget to screen household contacts, especially with T. tonsurans 1, 4
• Avoid using combination antifungal/steroid agents long-term due to risk of skin atrophy 2