What is the treatment for ringworm?

Treatment of Ringworm (Tinea Corporis)

For ringworm (tinea corporis), use topical terbinafine 1% cream applied once or twice daily for 1-2 weeks, which provides the most effective cure with the shortest treatment duration. 1, 2

First-Line Topical Treatment Options

Preferred Agent

• Terbinafine 1% cream is the most effective topical antifungal, achieving significantly higher clinical cure rates compared to placebo (RR 4.51, NNT 3) 3
• Apply once or twice daily for 1-2 weeks 1, 2
• This allylamine agent is well-tolerated, inexpensive, and requires shorter treatment duration than alternatives 2

Alternative Topical Agents

• Naftifine 1% cream is another highly effective option with mycological cure rates superior to placebo (RR 2.38, NNT 3) and clinical cure rates (RR 2.42, NNT 3) 3
• Clotrimazole 1% cream shows good efficacy with mycological cure rates favoring treatment over placebo (RR 2.87, NNT 2) 3
• Other azole antifungals (miconazole, ketoconazole) are also effective, though most were evaluated in single studies 3
• Apply topical agents for 2-4 weeks in most cases 3

When to Use Oral Therapy

Switch to oral terbinafine if the patient has:

• Extensive disease involving large body surface areas 2
• Lack of response to topical treatment after 2-4 weeks 2
• Immunocompromise 2
• Hair follicle involvement 2

Oral Treatment Regimen

• Oral terbinafine is considered first-line systemic therapy for dermatophyte infections 2, 4
• Dosing and duration should be based on extent of infection (typically 2-4 weeks for tinea corporis) 2, 4

Critical Management Principles

Avoid Combination Steroid-Antifungal Products

• Do not use topical corticosteroid-antifungal combinations despite their widespread availability 2, 5
• While these combinations may provide faster symptom relief initially, they carry significant risks 5:
  • Corticosteroids can interfere with antifungal therapeutic action 5
  • May allow dermatophytes to invade deeper tissues 5
  • Can cause cutaneous adverse effects, especially in children 5
• If absolutely necessary in highly inflamed lesions in adults, use only low-potency nonfluorinated corticosteroid combinations for maximum 2 weeks, then switch to pure antifungal 5
• Never use in children <12 years, on facial lesions, or in immunosuppressed patients 5

Confirm Diagnosis Before Treatment

• Clinical diagnosis alone is unreliable—ringworm can be confused with eczema, psoriasis, or other conditions 2
• Obtain skin scales for microscopy or culture to confirm dermatophyte infection before initiating treatment 2, 4
• This is particularly important if considering oral therapy or if the presentation is atypical 2

Common Pitfalls to Avoid

Emerging Resistant Infections

• Be aware that emerging tinea infections may be more severe and generally do not improve with first-line topical or oral antifungals 2
• These resistant infections may require prolonged oral antifungal therapy and specialized diagnostic testing 2
• If standard treatment fails after appropriate duration, consider fungal culture with susceptibility testing 2

Treatment Duration

• Complete the full course even if symptoms resolve early to prevent relapse 3
• Most topical treatments require 2-4 weeks, though terbinafine may be effective in 1-2 weeks 1, 3

Adverse Effects

• Topical antifungals are generally well-tolerated with minimal adverse effects 3
• Most common side effects are mild irritation and burning at application site 3
• These occur infrequently and are similar between active treatments and placebo 3