Tinea Corporis: Medical Terminology and Treatment
The medical name for tinea of the skin is tinea corporis (also called "ringworm"), and for an otherwise healthy adult with typical erythematous, scaly, annular plaques, topical antifungal therapy with terbinafine or an azole (such as clotrimazole) for 2 weeks is the recommended first-line treatment. 1, 2, 3
Medical Nomenclature
Tinea infections are classified by anatomical location 2, 4:
- Tinea corporis: General body skin ("ringworm")
- Tinea cruris: Groin area ("jock itch")
- Tinea pedis: Feet ("athlete's foot")
- Tinea capitis: Scalp
- Tinea unguium: Nails (onychomycosis)
Clinical Presentation
Tinea corporis typically presents as well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patches or plaques with a raised leading edge and mild pruritus. 5
Diagnostic Confirmation
While clinical diagnosis is often sufficient, laboratory confirmation should be obtained when the diagnosis is uncertain, as other conditions (eczema, psoriasis) can mimic tinea corporis. 6, 2, 5
Diagnostic methods include:
- KOH preparation: Skin scrapings from the active border examined microscopically for hyphae or arthroconidia—provides rapid confirmation 6, 4
- Fungal culture: Gold standard on Sabouraud agar, especially for extensive, severe, or treatment-resistant cases 6, 4, 5
- Dermoscopy: Useful non-invasive diagnostic tool 5
Treatment Algorithm for Otherwise Healthy Adults
First-Line: Topical Antifungals
For localized tinea corporis in immunocompetent adults, topical therapy is the standard treatment. 2, 3, 7
Recommended topical agents (applied for 2 weeks): 3, 7
- Terbinafine 1% cream: Highly effective with evidence of superior cure rates compared to placebo (RR 4.51, NNT 3) 3
- Naftifine 1% cream: Effective with mycological cure rates significantly better than placebo (RR 2.38, NNT 3) 3
- Clotrimazole 1% cream: Effective azole option with mycological cure rates favoring treatment over placebo (RR 2.87, NNT 2) 3
- Other azoles: Miconazole, ketoconazole, econazole are also effective 3, 7
Treatment should continue for at least one week after clinical clearing to ensure mycological cure. 7
When to Use Oral Antifungals
Systemic therapy is indicated when: 2, 4, 5
- Lesions are extensive or multiple
- Infection involves hair follicles
- Patient is immunocompromised
- Topical treatment has failed
- Infection is chronic or recurrent
Oral terbinafine is considered first-line systemic therapy because it is well-tolerated, effective, and inexpensive. 2
Critical Pitfalls to Avoid
Do not use combination antifungal-corticosteroid creams as first-line therapy. While they may show higher clinical cure rates at end of treatment (RR 0.67 for azoles alone vs. combination), they carry risks of skin atrophy and other steroid complications, and antifungal stewardship discourages their routine use. 2, 3, 7
Do not stop treatment based solely on clinical improvement—mycological cure is the definitive endpoint. 8 Clinical appearance can be misleading, and premature discontinuation leads to relapse.
Do not overlook secondary bacterial infection in inflammatory cases, which may require separate antibiotic treatment. 9
Treatment Monitoring
The definitive endpoint for adequate treatment is mycological cure (negative KOH or culture), not just clinical response. 8 If there is incomplete healing by 3 months after treatment completion, development of new lesions, or worsening of existing lesions, retreatment is indicated. 8
Special Considerations
Emerging tinea infections may be more severe and generally do not improve with first-line topical or oral antifungals, potentially requiring prolonged oral therapy and specialized diagnostic testing. 2
Preventative measures include maintaining dry, cool skin; practicing good personal hygiene; and avoiding sharing towels, clothing, or personal items with infected individuals. 4