What is the recommended treatment for a patient with Tinea corporis infection?

Treatment of Tinea Corporis

For localized tinea corporis, topical antifungal therapy with azoles or allylamines applied once or twice daily for 2 weeks is the first-line treatment, while oral antifungals are reserved for extensive infections, treatment failures, or immunocompromised patients. 1, 2

Topical Therapy (First-Line for Localized Disease)

• Topical azoles or allylamines applied once or twice daily for 2 weeks are the primary treatment for localized tinea corporis. 1, 3
• Terbinafine topical formulation is FDA-approved and cures most ringworm (tinea corporis) while relieving itching, burning, cracking, and scaling. 4
• Treatment should continue for at least one week after clinical clearing of infection to prevent relapse. 3
• Newer topical medications require fewer applications and shorter duration of use compared to older formulations. 3

Oral Therapy (For Extensive or Resistant Disease)

When to Use Oral Antifungals

• Oral therapy is indicated when the infection is resistant to topical treatment, covers an extensive area, or occurs in immunocompromised patients. 2, 3

Specific Oral Regimens

Terbinafine:

• 250 mg daily for 1-2 weeks is highly effective, particularly for Trichophyton tonsurans infections. 2, 5
• One-week therapy with terbinafine 250 mg daily achieves complete mycological cure in tinea corporis/cruris cases. 6

Itraconazole:

• 100 mg daily for 15 days achieves 87% mycological cure rate, superior to griseofulvin's 57% cure rate. 2
• Alternative dosing: 200 mg daily for 7 days or 100 mg daily for 2 weeks. 5
• Important drug interactions exist with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin. 2
• Licensed for children over 12 years in the UK. 2

Fluconazole:

• 50-100 mg daily or 150 mg once weekly for 2-3 weeks is effective. 5
• Consider as third-line option due to licensing limitations and less cost-effectiveness compared to terbinafine. 2

Organism-Specific Treatment Selection

• Terbinafine is superior for Trichophyton species infections. 2, 7
• Treatment protocols should reflect local epidemiology and the most likely causative organism. 8, 7

Diagnostic Confirmation

• Accurate diagnosis through potassium hydroxide preparation microscopy or culture is essential before initiating treatment. 2, 7
• Specimens should be collected via scalpel scraping, hair pluck, brush, or swab as appropriate to the lesion. 1, 2

Prevention and Management of Recurrence

• Avoid skin-to-skin contact with infected individuals and do not share towels, clothing, or personal items. 2
• Clean contaminated combs and brushes with disinfectant or 2% sodium hypochlorite solution. 1, 2
• Screen and treat family members if infection is caused by anthropophilic species like Trichophyton tonsurans, as over 50% of household contacts may be affected. 1, 2
• Cover lesions to prevent transmission. 2

Treatment Monitoring

• Mycological cure, not just clinical response, is the definitive treatment endpoint. 1, 7
• Follow-up should include both clinical and mycological assessment until clearance is documented. 2, 7
• If treatment failure occurs, assess compliance, drug absorption, organism sensitivity, and potential reinfection. 1
• If clinical improvement occurs but mycology remains positive, continue current therapy for an additional 2-4 weeks. 1

Special Considerations

• The presence of inflammation may necessitate using an agent with inherent anti-inflammatory properties or a combination antifungal/steroid agent, though the latter should be used with caution due to potential for skin atrophy. 3
• Keep skin dry and cool at all times to prevent exacerbation. 9
• Practice good personal hygiene as a preventative measure. 9