What is the treatment for tinea corporis?

Treatment of Tinea Corporis

Topical antifungal therapy is the first-line treatment for localized tinea corporis, with topical terbinafine or other allylamines applied once daily for 1-2 weeks being the preferred initial approach. 1

Initial Treatment Strategy

Topical Therapy (First-Line)

• Allylamine antifungals (terbinafine, naftifine) are preferred because they require shorter treatment duration (1-2 weeks) compared to azole antifungals 1
• Topical terbinafine 1% cream applied once daily for 7 days achieves 84.2% mycological cure rate and is FDA-approved for tinea corporis 2, 3
• Azole antifungals require 2 weeks of treatment for tinea corporis 4
• Treatment should continue for at least one week after clinical clearing of infection 4

When to Use Oral Therapy

Oral antifungal therapy is indicated when: 5, 1, 6

• The infection is extensive or covers a large area
• Topical treatment has failed or the infection is resistant
• The patient is immunocompromised
• Multiple lesions are present
• The infection is deep, recurrent, or chronic

Oral Antifungal Regimens

First-Line Oral Options

• Terbinafine 250 mg daily for 1-2 weeks is particularly effective against Trichophyton tonsurans and is the preferred oral agent 5, 1, 7
• Itraconazole 100 mg daily for 15 days achieves 87% mycological cure rate, which is superior to griseofulvin's 57% 5, 1
• Alternative itraconazole dosing: 200 mg daily for 7 days 7

Second-Line Oral Options

• Fluconazole 50-100 mg daily for 2-3 weeks, or 150 mg once weekly for 2-3 weeks 7
• Fluconazole is considered third-line with significant limitations and is less cost-effective than terbinafine 5

Avoid Griseofulvin

• Griseofulvin should not be used as first-line treatment because it requires longer treatment duration, is less effective than terbinafine, and has lower cure rates 5

Diagnostic Confirmation

Confirm dermatophyte infection before initiating therapy using potassium hydroxide (KOH) preparation or fungal culture, as accurate diagnosis is essential 1, 4, 8

Treatment Monitoring and Follow-Up

• Mycological cure, not just clinical response, is the definitive treatment endpoint 5, 1
• Follow-up with repeat mycology sampling is recommended until mycological clearance is documented 5, 1
• If clinical improvement occurs but mycology remains positive, continue therapy for an additional 2-4 weeks 1

Prevention of Recurrence

Critical preventive measures include: 5, 1

• Screen and treat all family members, as over 50% of household contacts may be affected with anthropophilic species like T. tonsurans
• Clean all fomites (combs, brushes, towels) with disinfectant or 2% sodium hypochlorite solution
• Avoid skin-to-skin contact with infected individuals
• Do not share towels, clothing, or personal items
• Keep skin dry and cool at all times 8

Important Drug Interactions

When prescribing itraconazole, be aware of enhanced toxicity with: 5

• Warfarin
• Certain antihistamines and antipsychotics
• Midazolam
• Digoxin
• Simvastatin

Special Considerations for Inflammation

If significant inflammation is present, consider using an agent with inherent anti-inflammatory properties or a combination antifungal/steroid agent, though use the latter with caution due to potential for skin atrophy and other steroid-associated complications 4