What is the treatment for tinea corporis (ringworm of the body)?

From the Guidelines

Tinea corporis should be treated with oral antifungal medications, such as itraconazole 100 mg daily for 15 days, as it has been shown to be superior to griseofulvin in achieving mycological cure. The treatment of tinea corporis, a fungal infection of the skin, is crucial to prevent its spread and reduce the risk of complications. According to a study published in Pediatrics 1, oral agents, including itraconazole, have proven efficacious in the treatment of most cases of tinea corporis.

Treatment Options

• For mild to moderate cases, topical antifungal creams like clotrimazole 1% (Lotrimin), miconazole 2% (Micatin), or terbinafine 1% (Lamisil) can be applied to the affected area and about 2 cm beyond the border of the rash twice daily for 2-4 weeks.
• For more severe, extensive, or resistant infections, oral antifungal medications may be necessary, such as terbinafine 250 mg daily for 2-4 weeks, itraconazole 200 mg daily for 1-2 weeks, or fluconazole 150-300 mg weekly for 2-4 weeks.
• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, as recommended by the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 1.

Prevention and Management

• To prevent the spread of the infection, it is essential to avoid sharing personal items like towels or clothing and to keep the affected area clean and dry.
• The affected individual should avoid skin-to-skin contact with others, especially those with known lesions, and avoid sharing towels and other fomites.
• In cases of clinical improvement but ongoing positive mycology, continue current therapy for a further 2-4 weeks, as recommended by the British Association of Dermatologists' guidelines 1.

Key Considerations

• The most common cause of tinea corporis is Trichophyton tonsurans, accounting for more than 80% of cases, but it may also be caused by Trichophyton rubrum and Trichophyton mentagrophytes, as reported in a study published in Pediatrics 1.
• Terbinafine appears superior for T tonsurans, as shown in a study published in Pediatrics 1.
• The end point of treatment is mycological rather than clinical cure; therefore, repeat mycology sampling is recommended until mycological clearance is achieved, as recommended by the British Association of Dermatologists' guidelines 1.

From the FDA Drug Label

Uses • cures most athlete's foot (tinea pedis) • cures most jock itch (tinea cruris) and ringworm (tinea corporis) • relieves itching, burning, cracking and scaling which accompany these conditions Representative treatment periods are tinea capitis, 4 to 6 weeks; tinea corporis, 2 to 4 weeks; tinea pedis, 4 to 8 weeks;

Treatment for Tinea Corporis:

• Terbinafine (TOP) is used to cure ringworm (tinea corporis) 2.
• Griseofulvin (PO) can be used to treat tinea corporis, with a treatment period of 2 to 4 weeks 3.
• The dosage of Griseofulvin (PO) for adults is 0.5 g daily, and for pediatric patients (older than 2 years) is 10 mg/kg daily 3.

From the Research

Treatment Options for Tinea Corporis

• Tinea corporis, also known as ringworm, is a superficial fungal infection caused by dermatophytes 4.
• Treatment requires attention to exacerbating factors such as skin moisture and choosing an appropriate antifungal agent 4.
• Topical therapy is generally successful unless the infection covers an extensive area or is resistant to initial therapy, in which case systemic therapy may be required 4.

Topical Antifungal Treatments

• A wide range of topical antifungal drugs are used to treat tinea corporis, but it is unclear which are the most effective 5.
• Terbinafine and naftifine have been shown to be effective in achieving clinical and mycological cure 5.
• Azoles, such as clotrimazole, have also been shown to be effective in achieving mycological cure 5.
• Combinations of topical steroids and antifungals may be effective, but the quality of evidence is low due to imprecision, indirectness, and risk of bias 5.

Systemic Antifungal Treatments

• Oral terbinafine and itraconazole are commonly used to treat tinea corporis 6, 7.
• A study comparing the efficacy of 250 mg and 500 mg oral terbinafine found no significant difference in clinical parameters between the two groups 6.
• Another study comparing the efficacy of oral terbinafine and itraconazole found that itraconazole was more effective in achieving mycological cure and clinical global improvement 7.
• Both terbinafine and itraconazole have been shown to be safe and effective in the treatment of tinea corporis, with mild adverse effects such as gastrointestinal upset and headache 6, 7.