What is the recommended treatment for an otherwise healthy individual with a ringworm infection?

Treatment for Ringworm (Tinea Corporis)

For an otherwise healthy individual with ringworm, apply topical terbinafine 1% cream once daily for 1 week, which achieves approximately 94% mycological cure rates. 1

Topical Treatment (First-Line)

Topical antifungals are the primary treatment for localized tinea corporis (ringworm). 2

Preferred Topical Agents

• Terbinafine 1% cream: Apply once daily for 1 week for jock itch and ringworm 3

  • This allylamine achieves ~94% mycological cure in patients ≥12 years old 1
  • Significantly more effective than placebo (RR 4.51, NNT 3) 4

• Naftifine 1%: Apply once or twice daily for 1-2 weeks 4

  • More effective than placebo for both mycological cure (RR 2.38, NNT 3) and clinical cure (RR 2.42, NNT 3) 4

Alternative Over-the-Counter Options

• Clotrimazole 1% cream: Apply twice daily for 4 weeks 1, 4

  • Azole antifungal with proven efficacy (RR 2.87 vs placebo, NNT 2) 4

• Other azoles: Miconazole, ketoconazole, or other imidazoles applied twice daily for 2-4 weeks 4

Application Instructions

• Wash affected skin with soap and water and dry completely before applying 3
• Wash hands after each use 3
• Continue treatment for the full prescribed duration even if symptoms improve earlier 4

When to Consider Oral Therapy

Oral antifungals should be used when:

• Topical treatment fails after 2-4 weeks 1
• The infection is extensive or involves multiple body sites 2
• Application of topical medication is not feasible 2
• The infection is chronic or recurrent 2

Oral Treatment Options

• Terbinafine: 250 mg daily for 1-2 weeks 5

  • Most effective oral agent for dermatophyte infections 6

• Itraconazole: 100 mg daily for 2 weeks OR 200 mg daily for 7 days 5

• Fluconazole: 50-100 mg daily for 2-3 weeks OR 150 mg once weekly for 2-3 weeks 5

  • Less effective than terbinafine for dermatophytes but easier dosing 6

Important Clinical Considerations

Common pitfalls to avoid:

• Non-compliance: Patients often stop treatment when symptoms resolve, leading to relapse 1
• Inadequate treatment duration: Topical therapy requires consistent application for the full course 4
• Reinfection: Address potential sources of reinfection (contaminated clothing, towels, or contact with infected individuals) 1

If treatment fails, consider:

• Non-adherence to the regimen 1
• Inadequate drug absorption 1
• Resistant organisms (rare) 1
• Incorrect diagnosis (not actually dermatophyte infection) 1
• Reinfection from environmental sources 1

Adverse Effects

• Topical antifungals are generally well-tolerated with minimal adverse effects 4
• Most common side effects are mild irritation and burning at application site 4
• Adverse effects occur infrequently and are similar between active treatments and placebo 4

Combination Products (Not Recommended as First-Line)

• Azole-steroid combination creams show higher clinical cure rates at end of treatment but similar mycological cure rates compared to azoles alone 4
• These are not recommended in clinical guidelines as first-line therapy 4
• The addition of steroids may provide faster symptom relief but does not improve long-term cure 4