What is the treatment for tinea corporis?

Treatment of Tinea Corporis

Topical antifungal therapy is the first-line treatment for localized tinea corporis, with allylamine agents (terbinafine or naftifine) applied once daily for 1-2 weeks being preferred over azoles due to shorter treatment duration. 1, 2

When to Use Topical vs. Oral Therapy

Topical therapy alone is appropriate for:

• Localized, limited skin involvement 2
• Immunocompetent patients without treatment failure 1, 3

Oral antifungal therapy is indicated when:

• The infection is extensive or resistant to topical treatment 1, 2
• Hair follicles are involved 3
• The patient is immunocompromised 2, 3
• Topical therapy has failed 1

Topical Treatment Regimens

Allylamine antifungals (preferred):

• Terbinafine 1% cream applied once daily for 1-2 weeks 2, 4, 5
• Naftifine applied once daily for 1-2 weeks 2
• These agents offer shorter treatment duration compared to azoles 2

Azole antifungals (alternative):

• Applied for 2-4 weeks, which is longer than allylamines 6, 4
• Treatment should continue for at least one week after clinical clearing 4

Oral Treatment Regimens

Terbinafine (first-line oral agent):

• 250 mg daily for 1-2 weeks 1, 2, 7
• Particularly effective against Trichophyton tonsurans, T. rubrum, and T. mentagrophytes 1, 2
• Achieves 87.1% mycological cure rate at 6 weeks follow-up 2
• Well tolerated with minimal drug interactions compared to azoles 2
• Contraindicated in active/chronic liver disease and lupus erythematosus 2

Itraconazole (alternative oral agent):

• 100 mg daily for 15 days achieves 87% mycological cure rate 1, 2
• 200 mg daily for 7 days is also effective 7
• Superior to griseofulvin (87% vs 57% cure rate) 1, 2
• Licensed for children over 12 years in the UK 1
• Important drug interactions with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin 1

Fluconazole (third-line option):

• 50-100 mg daily or 150 mg once weekly for 2-3 weeks 7
• 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):

• 500 mg daily (or 10 mg/kg daily in children) for 2-4 weeks 6
• Requires longer treatment duration and has lower cure rates than terbinafine 1
• Should be taken with fatty food to improve absorption 8
• Only licensed product for tinea capitis in children in the UK, but not preferred for tinea corporis 8, 1

Critical Diagnostic Considerations

Confirm diagnosis before treatment:

• Perform potassium hydroxide (KOH) preparation or fungal culture to identify the causative organism 1, 2, 6
• Clinical diagnosis alone is unreliable as eczema and other conditions can mimic tinea corporis 3
• Collect specimens using scalpel scraping, hair pluck, brush, or swab as appropriate 1

Treatment Monitoring and Endpoints

Mycological cure, not just clinical response, is the definitive treatment endpoint:

• Follow-up with repeat mycology sampling until clearance is documented 1, 2
• If clinical improvement occurs but mycology remains positive, continue therapy for an additional 2-4 weeks 2
• Clinical relapse will occur if medication is not continued until the organism is eradicated 6

Prevention of Recurrence

Essential preventive measures include:

• Screen and treat all family members, as over 50% of household contacts may be affected with anthropophilic species like T. tonsurans 1, 2
• Clean all fomites (combs, brushes, towels) with disinfectant or 2% sodium hypochlorite solution 1, 2
• Avoid skin-to-skin contact with infected individuals 1, 2
• Do not share towels, clothing, or personal items 1, 9
• Keep skin dry and cool at all times 9
• Cover lesions during treatment 1

Common Pitfalls to Avoid

Avoid combination antifungal-corticosteroid agents:

• These should be used with extreme caution due to potential for skin atrophy and steroid-associated complications 4, 3
• Antifungal stewardship should be emphasized to prevent resistance 3

Do not use griseofulvin as first-line therapy:

• It requires longer treatment duration and is less effective than terbinafine 1

Do not stop treatment prematurely:

• Continue treatment for at least one week after clinical clearing to prevent relapse 4