Treatment of Tinea Corporis
For localized tinea corporis, use topical terbinafine 1% cream once daily for 1-2 weeks as first-line therapy; for extensive disease or treatment failure, use oral terbinafine 250 mg daily for 1-2 weeks. 1
Topical Therapy for Localized Disease
Allylamine antifungals are superior to azoles due to shorter treatment duration and should be the preferred topical agents. 1
- Terbinafine 1% cream applied once daily for 1-2 weeks is the recommended first-line topical treatment for localized tinea corporis 1, 2
- Naftifine 1% is an effective alternative allylamine, demonstrating significantly higher mycological cure rates compared to placebo (RR 2.38, NNT 3) 3
- Topical therapy alone is appropriate only when skin involvement is limited, localized, and the patient is immunocompetent without prior treatment failure 1
Oral Therapy for Extensive or Resistant Disease
Oral antifungals are indicated when: 1, 4
- The infection is extensive (multiple widespread lesions that cannot be adequately covered)
- Topical treatment has failed
- The patient is immunocompromised
- Deep or recurrent infection is present
First-Line Oral Agent
Terbinafine 250 mg daily for 1-2 weeks achieves an 87.1% mycological cure rate at 6-week follow-up and is the preferred oral agent. 1
- Terbinafine demonstrates superior efficacy for Trichophyton tonsurans infections, which account for over 80% of tinea corporis cases in athletic populations 5, 6
- In wrestlers and judo practitioners, prevalence rates reach 24-53%, making species-specific treatment selection critical 6
Alternative Oral Agent
Itraconazole 100 mg daily for 15 days is an effective alternative, achieving 87% mycological cure rate—significantly superior to griseofulvin's 57% cure rate. 5, 1
Diagnostic Confirmation
Always confirm the diagnosis before initiating treatment through potassium hydroxide (KOH) preparation or fungal culture to identify the causative organism. 1
- KOH preparation showing hyphae/arthroconidia provides rapid confirmation 7
- Fungal culture on Sabouraud agar is the gold standard, particularly for extensive, severe, or treatment-resistant cases 8, 4
- Mycological cure (negative microscopy and culture), not just clinical improvement, is the definitive treatment endpoint 1, 6
Treatment Monitoring
- Follow-up with repeat mycology sampling until clearance is documented is necessary 1
- Clinical appearance may improve while infection persists, making laboratory confirmation of cure essential 6
Common Pitfalls to Avoid
Do not use combination antifungal/corticosteroid creams as they are associated with persistent and recurrent tinea corporis infections, particularly in children. 9
- Combination clotrimazole 1%/betamethasone dipropionate cream (Lotrisone) resulted in persistent/recurrent infections in children treated for 2-12 months 9
- Prior use of corticosteroids or calcineurin inhibitors makes clinical diagnosis difficult and can worsen fungal infections 8, 10
Griseofulvin should not be used as first-line therapy due to longer treatment duration (2-4 weeks per FDA labeling) and lower efficacy compared to terbinafine. 1, 11
Prevention and Household Management
Screen and treat all family members, as over 50% of household contacts may be affected with anthropophilic species like T. tonsurans. 1
- Clean all fomites (combs, brushes, towels) with disinfectant or 2% sodium hypochlorite solution 1
- Avoid skin-to-skin contact with infected individuals and do not share towels or other personal items 5
- For athletes, wrestling mats should be cleaned with freshly prepared household bleach solution (1/4 cup bleach per gallon water) applied for minimum 15 seconds contact time daily 5
Return to Athletic Competition
For athletes with tinea corporis gladiatorum, minimum 72 hours of treatment is required before return to contact activities, and lesions must be covered with gas-permeable dressing if localized. 7