Treatment of Ringworm (Tinea Corporis)
For uncomplicated ringworm, apply topical azole antifungals (clotrimazole or miconazole cream) twice daily for 2-4 weeks as first-line therapy. 1
First-Line Topical Treatment
- Topical azoles (clotrimazole or miconazole) applied twice daily for 2-4 weeks are the primary treatment for uncomplicated ringworm 1
- Nystatin cream serves as an alternative if azoles are not tolerated 1
- No single topical agent has proven superiority over others for superficial fungal infections 1
- Treatment should continue for at least one week after clinical clearing of infection to prevent relapse 2
When to Use Oral Antifungal Therapy
Oral therapy is indicated in the following situations:
- Extensive or widespread lesions where topical application to all affected areas is impractical 3
- Failure of topical therapy after 2-4 weeks 1
- Moderate to severe infections 1
- Tinea adjacent to eyes, ears, or mouth where topical application is difficult 3
Oral Treatment Options
When oral therapy is needed:
- Fluconazole 100-200 mg daily for 7-14 days is the preferred oral agent 1
- Terbinafine 250 mg daily for 1-2 weeks is an effective alternative 4
- Itraconazole 100 mg daily for 2 weeks or 200 mg daily for 7 days is another option 4
- Griseofulvin 500 mg daily (or 0.5 g daily in divided doses) for 2-4 weeks for tinea corporis when other agents are not suitable 5
Critical Management Principles
- Keep the infected area dry throughout treatment, as moisture promotes fungal growth 1
- Address predisposing factors such as diabetes, immunosuppression, or excessive moisture to prevent recurrence 1
- Confirm diagnosis with KOH preparation or fungal culture before initiating systemic therapy 5
- General hygiene measures should be observed to control sources of infection or reinfection 5
Common Pitfalls to Avoid
- Do not discontinue treatment prematurely when lesions appear to have cleared; continue for at least one week after clinical resolution 2
- Avoid using combination steroid-antifungal creams as first-line therapy, though they may achieve faster clinical cure, they carry risks of skin atrophy and should be reserved for cases with significant inflammation 6, 2
- Do not use terbinafine orally for pityriasis versicolor (a different fungal infection), as it is ineffective for that condition 4