What is the optimal treatment for a 7‑year‑old boy with multiple sites of tinea corporis (ringworm)?

Treatment of Multiple Areas of Tinea Corporis in a 7-Year-Old Boy

For a 7-year-old boy with multiple areas of tinea corporis (ringworm), oral antifungal therapy is indicated because the infection involves multiple sites, and systemic treatment is recommended when topical therapy is insufficient for extensive disease. 1

First-Line Oral Treatment Options

The optimal choice is either terbinafine or itraconazole, both of which have demonstrated superior efficacy compared to griseofulvin for tinea corporis in children:

Terbinafine (Preferred for Trichophyton species)

• Dosing: 250 mg daily for 1-2 weeks (for children over 50 lbs; adjust to weight-based dosing for smaller children) 1
• Particularly effective against Trichophyton tonsurans, the most common causative organism in North America 1, 2
• Shorter treatment duration improves adherence compared to griseofulvin 3
• Baseline liver function tests are recommended before initiating treatment 1

Itraconazole (Alternative first-line option)

• Dosing: 100 mg daily for 15 days 1
• Demonstrates 87% mycological cure rate versus 57% for griseofulvin 1
• Used off-label in children under 12 years in some countries, though licensed for children over 12 in the UK 1
• Important drug interactions to consider: enhanced toxicity with warfarin, certain antihistamines, antipsychotics, midazolam, digoxin, and simvastatin 1
• Baseline liver function tests recommended 1

When to Consider Topical Therapy Instead

Topical antifungals are generally reserved for mild, limited disease (single or few lesions), not multiple areas 1, 4:

• Clotrimazole or miconazole cream applied twice daily for 2-4 weeks 1
• However, systemic therapy is specifically indicated when infection is resistant to topical treatment or involves multiple sites 1

Essential Adjunctive Measures

Prevention of recurrence and transmission requires comprehensive environmental and household management:

• Screen and treat all family members, as over 50% may be affected with anthropophilic species like Trichophyton tonsurans 1
• Clean all contaminated items (combs, brushes, towels) with disinfectant or 2% sodium hypochlorite solution 1, 5
• Avoid skin-to-skin contact with infected individuals and sharing personal items 1, 5
• Cover lesions to reduce transmission 1

Treatment Monitoring

Follow-up should include both clinical and mycological assessment:

• The definitive endpoint is mycological cure, not just clinical response 1, 5
• Continue follow-up with repeat mycology sampling until mycological clearance is documented 1
• Treatment failure may require extending treatment duration 1

Common Pitfalls to Avoid

• Do not use griseofulvin as first-line treatment for tinea corporis—it requires longer treatment duration (2-4 weeks per FDA label 6), is less effective than terbinafine, and has lower cure rates 1
• Do not rely on topical therapy alone when multiple areas are involved—this is an indication for systemic treatment 1, 4
• Do not skip baseline liver function testing when using terbinafine or itraconazole, especially if any pre-existing hepatic concerns 1