What is the diagnosis and treatment for Tinea corporis (Ringworm of the body)?

From the Guidelines

Tinea corporis should be treated with oral itraconazole, 100 mg, given orally once a day, for 15 days, as it has been shown to be superior to griseofulvin in achieving a mycological cure rate of 87%. This fungal infection, commonly known as ringworm, is caused by dermatophytes such as Trichophyton tonsurans, Trichophyton rubrum, and Trichophyton mentagrophytes, and can be spread through skin-to-skin contact, sharing personal items, and exposure to contaminated environments like swimming pools 1.

To prevent the spread of Tinea corporis, it is essential to avoid skin-to-skin contact with people known to have lesions, not share towels and other fomites, and limit exposure to swimming pools that have recently been associated with known outbreaks 1. Athletes, particularly high school wrestlers and judo practitioners, are at higher risk of developing Tinea corporis, also known as T corporis gladiatorum, due to the close contact and sharing of equipment involved in these sports 1.

In addition to oral antifungal treatment, good hygiene practices, such as keeping the affected area clean and dry, wearing loose-fitting clothing, and washing clothes, bedding, and towels in hot water, can help prevent the spread of the infection and promote healing 1. Terbinafine may also be considered as an alternative treatment option, particularly for cases caused by Trichophyton tonsurans, as it has been shown to be effective in treating this type of infection 1.

Key prevention measures 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
• Keeping the affected area clean and dry
• Wearing loose-fitting clothing
• Washing clothes, bedding, and towels in hot water to kill the fungus.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... Representative treatment periods are ... tinea corporis, 2 to 4 weeks; INDICATIONS AND USAGE Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis The recommended treatment period for Tinea corporis with griseofulvin is 2 to 4 weeks 2.

• The dosage for adults is 0.5 g daily and for pediatric patients (older than 2 years) is 10 mg/kg daily 2.
• Griseofulvin is indicated for the treatment of dermatophyte infections of the skin, including Tinea corporis 2.

From the Research

Definition and Diagnosis of Tinea Corporis

• Tinea corporis is a common fungal infection that mimics many other annular lesions, typically presenting as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge 3.
• The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids, and can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion or fungal culture 4, 3.

Treatment of Tinea Corporis

• The standard treatment of tinea corporis is with topical antifungals, and treatment should continue for at least one week after clinical clearing of infection 4.
• Systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient 3.
• Oral antifungal drugs such as fluconazole, griseofulvin, itraconazole, and terbinafine have been tested for effectiveness in treating tinea corporis, with itraconazole being the most effective in some studies 5.
• The choice of treatment depends on the extent of involvement, social situation, and availability of resources such as laboratory testing and follow-up 6.

Clinical Variants and Challenges

• Many clinical variants of tinea corporis exist, rendering the diagnosis difficult, especially with prior use of medications, such as calcineurin inhibitors or corticosteroids 3.
• Dermatophytic infections have undergone unprecedented changes in some regions, such as India, making it challenging to find effective treatments 5.
• The presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or the use of a combination antifungal/steroid agent, which should be used with caution due to potential side effects 4.