Treatment and Return-to-Wrestling Guidelines for Tinea Corporis
For a wrestler with tinea corporis, treat with topical terbinafine or naftifine applied once or twice daily, and the athlete may return to wrestling after a minimum of 72 hours of antifungal therapy, provided lesions are covered with a gas-permeable dressing and the infection is not extensive or active. 1
Recommended Treatment Regimen
First-Line Topical Therapy
- Terbinafine 1% gel or cream applied once daily for 1 week is the preferred topical agent for wrestlers 1, 2
- Naftifine ointment applied twice daily for 4 weeks is an equally effective alternative 3, 1
- These allylamine antifungals offer superior efficacy and shorter treatment duration (1-2 weeks) compared to azole antifungals 1
Systemic Therapy Indications
For extensive disease (multiple lesions that cannot be adequately covered):
- Terbinafine 250 mg orally once daily for 1-2 weeks is particularly effective against Trichophyton tonsurans, which causes >80% of wrestler infections 1, 4
- Itraconazole 100 mg daily for 15 days achieves 87% mycological cure rate, superior to griseofulvin's 57% 1, 4
Return-to-Wrestling Criteria
Minimum Requirements (All Must Be Met)
- At least 72 hours of topical OR systemic antifungal therapy completed 1
- Lesions must be covered with a gas-permeable dressing during competition 1
- No extensive or active disease that cannot be adequately covered 1, 5
Disqualification Criteria
- Extensive and active lesions confirmed by KOH preparation showing hyphae/arthroconidia 1, 5
- Solitary or closely clustered localized lesions that cannot be covered with standard dressings 1, 5
- Athletes must remain disqualified until adequately treated 1
Critical Pitfalls to Avoid
Do not rely on clinical improvement alone as the treatment endpoint—mycological cure (negative microscopy and culture) is the definitive endpoint, as clinical appearance may improve while infection persists 1, 4
Common Mistakes
- Allowing return to wrestling before 72 hours of treatment, which increases outbreak risk 1
- Using azole antifungals (clotrimazole, miconazole) instead of allylamines, which require longer treatment courses 1
- Failing to screen and treat sparring partners and household contacts (>50% may be affected) 3, 1
Outbreak Prevention Measures
- Avoid skin-to-skin contact with infected individuals during the 72-hour minimum treatment period 3, 1, 4
- Do not share towels, personal items, or equipment 3, 1, 4
- Evaluate and treat sparring partners even if asymptomatic 3
- Ensure daily change of clothing and careful drying after showers 3
Treatment Monitoring
- Obtain KOH preparation or fungal culture to confirm diagnosis before treatment 1, 5
- If clinical improvement occurs but mycology remains positive, continue therapy for an additional 2-4 weeks 4
- Follow-up sampling until mycological clearance is documented 5
Evidence Quality Note
The 72-hour return-to-play threshold represents consensus among the American Academy of Pediatrics, National Collegiate Athletic Association, National Federation of State High School Associations, and National Athletic Trainers' Association 1. This is more conservative than older outbreak reports that suggested 10-15 days of treatment 6, reflecting updated understanding of transmission dynamics and more effective modern antifungals.