What is the oral treatment for dermatophytosis (ringworm)?

From the Guidelines

Oral therapy with terbinafine or griseofulvin is the recommended treatment for ringworm, with the choice of medication directed by the causative dermatophyte and/or local epidemiology. The treatment of ringworm, also known as tinea capitis, typically involves oral antifungal medications, as topical therapy alone is not sufficient to achieve both clinical and mycological cure 1.

Key Considerations

• The choice of oral therapy should be guided by the type of dermatophyte causing the infection, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1.
• The dosage of terbinafine and griseofulvin varies by body weight, with specific recommendations provided for children and adults 1.
• Treatment failure should be addressed by considering lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and second-line therapy with itraconazole may be necessary 1.

Treatment Options

• Terbinafine: 250 mg per day for 2-4 weeks for adults, with dosages adjusted for children based on body weight 1.
• Griseofulvin: 15-20 mg/kg per day for 6-8 weeks for children under 50 kg, and 1 g per day for 6-8 weeks for adults over 50 kg 1.
• Itraconazole: 50-100 mg per day for 4 weeks, or 5 mg/kg per day for 2-4 weeks, as a second-line therapy 1.

Important Considerations

• Patients should be monitored for side effects, including headache, gastrointestinal upset, and rarely, liver problems, while taking these medications.
• Good hygiene practices, such as keeping affected areas clean and dry, avoiding sharing personal items, and washing bedding and clothing in hot water, are essential to prevent reinfection or spreading the fungus to others.
• The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.

From the FDA Drug Label

Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: Epidermophyton floccosum Microsporum audouinii Microsporum canis Microsporum gypseum Trichophyton crateriform Trichophyton gallinae Trichophyton interdigitalis Trichophyton megnini Trichophyton mentagrophytes Trichophyton rubrum Trichophyton schoenleini Trichophyton sulphureum Trichophyton tonsurans Trichophyton verrucosum The oral treatment for ringworm is Griseofulvin. It is effective against various species of fungi that cause dermatophyte infections, including:

• Epidermophyton floccosum
• Microsporum audouinii
• Microsporum canis
• Microsporum gypseum
• Trichophyton species 2, 2

From the Research

Oral Treatment Options for Ringworm

• Terbinafine is an effective oral treatment for ringworm, with a fungicidal activity against a wide variety of dermatophytes, moulds, and certain dimorphic fungi 3.
• The recommended dosage of terbinafine for ringworm is 250 mg/day, which has been shown to achieve mycological cure in > 80% of patients 3.
• Other oral treatment options for ringworm include griseofulvin, itraconazole, and fluconazole, which have been compared in various studies 4, 5, 6.
• A study comparing the efficacy of griseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis found that all four treatments were effective, with terbinafine showing a high cure rate of 94% 4.
• Another study comparing the efficacy of itraconazole, terbinafine, and fluconazole with griseofulvin in the treatment of tinea imbricata found that terbinafine and griseofulvin were effective in achieving significant remission 5.
• A more recent study found that itraconazole was the most effective treatment for chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and then griseofulvin 6.

Dosage and Administration

• The dosage of terbinafine for ringworm is typically 250 mg/day, taken orally 3.
• The treatment duration for ringworm with terbinafine is usually 4-6 weeks, depending on the severity of the infection 3.
• Other oral antifungal agents, such as griseofulvin, itraconazole, and fluconazole, may have different dosages and treatment durations 4, 5, 6.

Efficacy and Safety

• Terbinafine has been shown to be effective in achieving mycological cure in > 80% of patients with ringworm 3.
• The safety profile of terbinafine is generally good, with few adverse effects reported 3, 7.
• Other oral antifungal agents, such as griseofulvin, itraconazole, and fluconazole, may have different efficacy and safety profiles 4, 5, 6.