From the Guidelines
Resistant tinea corporis should be treated with oral antifungal medications, particularly terbinafine, as it appears superior for Trichophyton tonsurans, a common cause of tinea corporis gladiatorum, as noted in a study published in Pediatrics 1. When treating resistant tinea corporis, it is essential to consider the causative agent, as different fungi may respond better to specific antifungals.
- Terbinafine is a suitable option, given its efficacy against Trichophyton tonsurans, which accounts for more than 80% of cases of tinea capitis gladiatorum, and is also effective against other species like Trichophyton rubrum and Trichophyton mentagrophytes, as mentioned in the study 1.
- Itraconazole is another viable option, with a study demonstrating its superiority over griseofulvin in achieving mycological cure rates when given for 15 days 1. Key considerations in managing resistant tinea corporis include:
- Ensuring proper hygiene practices, such as avoiding skin-to-skin contact with individuals having lesions, not sharing personal items like towels, and limiting exposure to potentially contaminated environments like swimming pools, as advised in the study 1.
- Continuing topical antifungal treatments, like clotrimazole or miconazole, alongside oral therapy to enhance treatment outcomes.
- Implementing measures to prevent moisture accumulation, such as washing affected areas with gentle soap, drying thoroughly, and wearing loose cotton clothing.
- Washing bedding and clothing in hot water to eliminate fungal spores and prevent reinfection. In cases where symptoms persist after oral treatment, further evaluation, including skin scrapings and culture, may be necessary to confirm the diagnosis and guide subsequent treatment decisions, especially in patients with underlying conditions like diabetes or immunocompromised states, which may require longer treatment courses and closer monitoring for potential side effects of oral antifungals 1.
From the FDA Drug Label
Accurate diagnosis of the infecting organism is essential. Identification should be made either by direct microscopic examination of a mounting of infected tissue in a solution of potassium hydroxide or by culture on an appropriate medium Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination. Representative treatment periods are ... tinea corporis, 2 to 4 weeks;
- Resistant tinea corporis may require a longer treatment period than the recommended 2 to 4 weeks with griseofulvin (PO) 2.
- The treatment should be individualized and the medication should be continued until the infecting organism is completely eradicated.
- Concomitant use of appropriate topical agents is usually required, particularly in treatment of tinea pedis, and naftifine (TOP) 3 can be used for the topical treatment of tinea corporis caused by certain organisms.
From the Research
Resistant Tinea Corporis
- Resistant tinea corporis refers to a fungal infection of the skin that does not respond to standard treatments 4, 5.
- The diagnosis of resistant tinea corporis can be challenging, and a combination of clinical evaluation, microscopic examination, and fungal culture may be necessary to confirm the diagnosis 4, 6, 5.
- Treatment of resistant tinea corporis may require systemic antifungal agents, such as terbinafine or itraconazole, especially if the infection is extensive, deep, or unresponsive to topical treatment 4, 7, 6, 5.
Causes of Resistance
- The development of resistance to antifungal agents can occur due to various factors, including the overuse or misuse of these agents 8, 5.
- The use of topical corticosteroids or calcineurin inhibitors can also lead to the development of resistant tinea corporis by suppressing the immune response and allowing the fungus to persist 5.
Treatment Options
- Topical antifungal agents, such as terbinafine or naftifine, can be effective in treating tinea corporis, but may not be sufficient for resistant cases 4, 8, 5.
- Systemic antifungal agents, such as terbinafine or itraconazole, may be necessary for resistant cases, especially if the infection is extensive or unresponsive to topical treatment 4, 7, 6, 5.
- Combination therapy, using both topical and systemic antifungal agents, may also be effective in treating resistant tinea corporis 8, 5.