What is the diagnosis and treatment for a 7-year-old female with tinea corporis (ringworm) lesions all over her body?

From the Guidelines

For a 7-year-old female with ringworm all over her body, I strongly recommend starting treatment with oral griseofulvin at a dose of 15-20 mg/kg/day, given her weight is likely under 50 kg, for 6-8 weeks, as it is the most effective treatment for widespread ringworm infection, particularly for Microsporum species, which are commonly found in children 1. The treatment of ringworm, also known as tinea corporis, typically involves the use of antifungal medications. Given the extensive nature of the infection, oral antifungal therapy is likely necessary to achieve both clinical and mycological cure.

• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with griseofulvin being more effective against Microsporum species, which are commonly found in children 1.
• Topical therapy alone is not recommended for the treatment of tinea capitis, and by extension, widespread ringworm infection, as it is unlikely to achieve a complete cure 1.
• Griseofulvin is the only licensed treatment for tinea capitis in children in the U.K., although the suspension formulation is no longer licensed for use, and its use should be guided by a healthcare professional 1.
• It is essential to note that the end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved, to ensure the infection is fully resolved 1.
• In addition to antifungal treatment, keeping the child's skin clean and dry, washing bedding and clothing daily in hot water, and avoiding sharing personal items can help prevent the spread of the infection.
• Symptoms should improve within a week, but it is crucial to complete the full treatment course to prevent recurrence, and if the condition doesn't improve after a week of treatment, becomes worse, or if there are signs of secondary bacterial infection, a healthcare provider should be consulted promptly for reassessment and possible adjustment of treatment.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION ... Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate

Representative treatment periods are ... tinea corporis, 2 to 4 weeks;

For a 7-year-old female with ringworm all over the body, the recommended dosage of griseofulvin (PO) is 10 mg/kg daily 2.

• The treatment period for tinea corporis is typically 2 to 4 weeks 2.
• Since the patient has ringworm all over the body, it is likely that the treatment period will be closer to the higher end of this range or even longer, depending on the severity of the infection and the patient's response to treatment.
• The dosage should be individualized, and the patient should be monitored closely for signs of improvement or adverse effects.
• It is essential to note that griseofulvin will not eradicate associated bacterial or yeast infections that may be present, and concomitant use of appropriate topical agents may be required 2.

From the Research

Treatment Options for Ringworm

• The treatment for ringworm, also known as tinea corporis, typically involves the use of oral antifungal agents 3, 4, 5, 6, 7.
• The most commonly used antifungal agents for the treatment of ringworm include griseofulvin, itraconazole, terbinafine, and fluconazole 3, 4, 5, 6, 7.

Efficacy of Antifungal Agents

• A study comparing the efficacy of griseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis found that all four agents were effective, with griseofulvin and terbinafine showing similar efficacy to itraconazole and fluconazole 3.
• Another study found that itraconazole was the most effective agent in the treatment of chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and griseofulvin 5.
• A review of the literature found that oral griseofulvin remains the treatment of choice for tinea capitis in children due to its efficacy, safety, and cost-effectiveness 7.

Safety and Adverse Effects

• The antifungal agents used to treat ringworm are generally well-tolerated, with few adverse effects reported 3, 4, 5, 6, 7.
• Griseofulvin has been associated with gastrointestinal effects, allergic reactions, and hepatic and renal dysfunction in some patients 3, 6.
• Itraconazole and terbinafine have been shown to be safe and effective in the treatment of onychomycosis caused by Scopulariopsis brevicaulis 6.