What is the treatment for tinea corporis?

Treatment of Tinea Corporis

For tinea corporis, topical antifungal therapy for 2-4 weeks is first-line treatment, with oral antifungals reserved for extensive, resistant, or treatment-failure cases. 1

Topical Antifungal Therapy (First-Line)

Treatment Duration and Selection

• Treat for 2-4 weeks with topical antifungals and continue for at least one week after clinical clearing to ensure mycological cure. 2, 3
• Topical azoles (such as ketoconazole 2% cream) are effective for tinea corporis caused by Trichophyton rubrum, T. mentagrophytes, and Epidermophyton floccosum. 4
• Allylamines like terbinafine 1% cream applied once daily for just 7 days achieve 84% mycological cure rates, offering a shorter treatment course than traditional 2-4 week regimens. 5
• Naftifine 1% demonstrates superior efficacy compared to placebo with mycological cure rates of 2.38 times higher (NNT 3). 6

Key Considerations for Topical Therapy

• There is no significant difference in cure rates between azoles and benzylamines, though allylamines may require shorter treatment duration. 6
• Topical steroid-antifungal combinations show higher clinical cure rates at end of treatment but are not recommended in guidelines due to potential steroid-related complications including skin atrophy. 1, 3, 6

Oral Antifungal Therapy (For Resistant or Extensive Cases)

When to Use Oral Therapy

• Oral antifungals are indicated when infection is resistant to topical treatment or covers extensive areas. 1

Specific Oral Regimens

Terbinafine (Preferred for T. tonsurans):

• 250 mg daily for 1-2 weeks is particularly effective against Trichophyton tonsurans infections. 1, 7

Itraconazole:

• 100 mg daily for 15 days achieves 87% mycological cure rate, superior to griseofulvin's 57% cure rate. 1
• Alternative dosing: 200 mg daily for 7 days or 100 mg daily for 2 weeks. 7
• Important drug interactions exist with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin. 1
• Licensed for children over 12 years in the UK. 1

Fluconazole (Third-Line):

• 50-100 mg daily or 150 mg once weekly for 2-3 weeks is effective but less cost-effective than terbinafine with limited comparative data. 1, 7
• Not licensed for tinea in children under 10 years in the UK. 1

Griseofulvin (Not Recommended First-Line):

• Avoid griseofulvin as first-line treatment due to longer treatment duration (2-4 weeks), lower efficacy than terbinafine, and inferior cure rates compared to itraconazole. 1, 2
• If used: 0.5 g daily (500 mg/day) for adults, 10 mg/kg daily for pediatric patients over 2 years. 2

Diagnostic Confirmation

• Confirm diagnosis through potassium hydroxide preparation microscopy or culture before initiating treatment to identify the causative organism. 1, 8
• Collect specimens using scalpel scraping, hair pluck, brush, or swab as appropriate. 1

Treatment Monitoring and Success Criteria

• The definitive endpoint is mycological cure, not just clinical response—follow up with repeat mycology sampling until mycological clearance is documented. 1, 8
• Treatment failure may require extending duration or switching to an alternative antifungal. 8

Prevention of Recurrence

• Screen and treat all family members when anthropophilic species like T. tonsurans are identified, as over 50% of family members may be affected. 1
• Avoid skin-to-skin contact with infected individuals and do not share towels or personal items. 1
• Clean contaminated combs, brushes, and fomites with disinfectant or 2% sodium hypochlorite solution. 1
• Cover lesions and keep affected areas clean and dry. 8

Common Pitfalls to Avoid

• Do not stop treatment based solely on clinical improvement—continue until mycological cure is confirmed to prevent relapse. 8, 2
• Do not overlook secondary bacterial infection in inflammatory cases. 8
• Ensure general hygiene measures are maintained throughout treatment to control sources of reinfection. 2