What is the progression of care for pharmacologic treatment of tinea corporis (ringworm of the body)?

From the Guidelines

For tinea corporis, the progression of pharmacologic treatment typically starts with topical antifungals for mild to moderate cases, and oral antifungal therapy is indicated for extensive infections or those that don't respond to topical therapy after 2 weeks. The first-line options for topical antifungals include azoles (clotrimazole 1%, miconazole 2%, econazole 1%) applied twice daily, or allylamines (terbinafine 1%, naftifine 1%) applied once or twice daily for 2-4 weeks 1. It is essential to continue treatment for at least one week after clinical resolution to prevent recurrence. If the infection is extensive, involves hair follicles, or doesn't respond to topical therapy after 2 weeks, oral antifungal therapy is indicated, with options including terbinafine 250 mg daily for 2-4 weeks, itraconazole 100 mg daily for 15 days, as it has been shown to be superior to griseofulvin in achieving mycological cure rates 1. For patients with recurrent infections, consider extending treatment duration and addressing predisposing factors such as immunosuppression or diabetes. Topical treatments work by disrupting fungal cell membrane synthesis or inhibiting ergosterol production, while oral agents provide systemic distribution for more extensive infections. Patients should be advised to keep affected areas clean and dry, avoid sharing personal items, and complete the full treatment course even if symptoms improve early. Some key considerations in the treatment of tinea corporis include:

• Avoiding skin-to-skin contact with people known to have lesions
• Not sharing towels and other fomites
• Limiting exposure to swimming pools that have recently been associated with known outbreaks 1
• Using potassium hydroxide examination to aid diagnosis, especially in high-risk groups such as wrestlers and judo practitioners 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. Identification should be made either by direct microscopic examination of a mounting of infected tissue in a solution of potassium hydroxide or by culture on an appropriate medium Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination. Representative treatment periods are tinea capitis, 4 to 6 weeks; tinea corporis, 2 to 4 weeks; Adults: 0. 5 g daily (125 mg four times a day, 250 mg twice a day, or 500 mg/day). Patients with less severe or 300 extensive infections may require less, whereas those with widespread lesions may require a starting dose of 0.75 g to 1.0 g/day. Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate

The progression of care for pharmacologic treatment of tinea corporis is as follows:

• Diagnosis: Accurate diagnosis of the infecting organism is essential, using direct microscopic examination or culture on an appropriate medium.
• Treatment duration: Medication should be continued for 2 to 4 weeks until the infecting organism is completely eradicated.
• Dosage:
  • Adults: 0.5 g daily, which can be adjusted based on the severity of the infection.
  • Pediatric patients: 10 mg/kg daily, divided into multiple doses.
• Monitoring: Clinical or laboratory examination should be used to indicate when the infecting organism has been eradicated 2.

From the Research

Pharmacologic Treatment for Tinea Corporis

The progression of care for pharmacologic treatment of tinea corporis involves the following steps:

• Diagnosis: Accurate diagnosis is necessary for effective treatment, usually based on history and clinical appearance plus direct microscopy of a potassium hydroxide preparation 3.
• Topical therapy: Topical therapy is generally successful unless the infection covers an extensive area or is resistant to initial therapy 3, 4.
• Treatment duration: Treatment should continue for at least one week after clinical clearing of infection, with a typical duration of 2 weeks for tinea corporis 3.
• Systemic therapy: Systemic therapy may be required if the infection is extensive, resistant to topical therapy, or in immunodeficient patients 3, 5.

Topical Antifungal Treatments

• Effective treatments: Terbinafine, naftifine, and clotrimazole have been shown to be effective in achieving clinical and mycological cure 4.
• Comparison of treatments: There is no significant difference in cure rates between different classes of treatment, but some interventions may be more appealing due to fewer applications and shorter duration of treatment 4.
• Adverse effects: Adverse effects are generally mild and reported infrequently, with irritation and burning being the most common 4, 6.

Systemic Antifungal Treatments

• Oral terbinafine and itraconazole: Both have been shown to be effective in treating tinea corporis, with itraconazole being slightly more effective in achieving mycological cure 6.
• Treatment duration: A duration of 4 weeks is commonly used for oral terbinafine and itraconazole 6.
• Adverse effects: Mild adverse effects such as gastrointestinal upset, headache, and taste disturbances have been reported, but are comparable between the two treatments 6.