What is the treatment for dermatophytosis (ringworm)?

From the Guidelines

For the treatment of ringworm, oral antifungal medications such as terbinafine or griseofulvin are recommended, with the choice of medication directed by the causative dermatophyte and/or local epidemiology 1. The treatment of ringworm, also known as tinea capitis, typically involves oral antifungal medications. According to the British Association of Dermatologists' guidelines for the management of tinea capitis 2014, topical therapy alone is not recommended for the treatment of tinea capitis, and oral therapy is generally indicated to achieve both clinical and mycological cure 1.

Key Considerations

• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
• Terbinafine is more efficacious against Trichophyton species, while griseofulvin is more effective against Microsporum species 1.
• The recommended dose of terbinafine varies by body weight, with doses ranging from 125 mg per day for 2-4 weeks for children weighing 20-40 kg, to 250 mg per day for 2-4 weeks for children weighing over 40 kg 1.
• Griseofulvin is also effective, with a recommended dose of 15-20 mg kg-1 per day for 6-8 weeks for children weighing less than 50 kg, and 1 g per day for 6-8 weeks for children weighing over 50 kg 1.

Additional Measures

• Children receiving appropriate therapy should be allowed to attend school or nursery, and index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
• The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1. Some key points to consider when treating ringworm include:
• Keeping the affected area clean and dry
• Avoiding sharing personal items like towels or clothing
• Washing bedding and clothes in hot water to prevent spreading the infection
• Consulting a healthcare provider if symptoms worsen or don't improve after two weeks of treatment.

From the FDA Drug Label

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 Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: The treatment for ringworm is griseofulvin (PO), as it is indicated for the treatment of dermatophyte infections of the skin, including Tinea corporis, which is another name for ringworm 2.

From the Research

Treatment Options for Ringworm

• The treatment for ringworm, also known as tinea capitis, typically involves oral antifungal medications 3, 4, 5, 6.
• Commonly used oral antifungal agents include griseofulvin, terbinafine, itraconazole, and fluconazole 3, 4, 5, 6.
• Griseofulvin has been the mainstay of management for tinea capitis, but newer oral antifungal agents are being used more frequently 3.
• A study comparing the efficacy of griseofulvin, terbinafine, itraconazole, and fluconazole found that griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2-3 weeks 3.
• Another study found that itraconazole is the most effective drug for the treatment of chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and then griseofulvin 4.
• A comparative evaluation of griseofulvin, terbinafine, and fluconazole in the treatment of tinea capitis found that griseofulvin remains the drug of choice, with terbinafine being the second best agent and offering the advantage of a shorter course of therapy 5.
• Topical antifungal therapy can be used as adjuvant therapy to systemic antifungals, but it is not recommended as the sole treatment for tinea capitis due to its inability to penetrate the root of the hair follicles deep within the dermis 6.

Potential Side Effects and Interactions

• Inflammatory flare-up reactions of dermatomycoses can occur as a result of oral antifungal therapy, particularly with itraconazole and terbinafine 7.
• These reactions can be severe and may require discontinuation of the antifungal agent and treatment with topical and/or systemic corticosteroids 7.
• Patients should be monitored for potential side effects and interactions when taking oral antifungal medications for the treatment of ringworm 3, 4, 5, 6, 7.