What is the treatment for dermatophytosis (ringworm)?

From the Guidelines

Dermatophytosis (ringworm) treatment typically involves oral antifungal medications, as topical therapy alone is not recommended for the treatment of tinea capitis 1.

First-line therapy

• Griseofulvin and terbinafine are the most widely used first-line treatments, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1.
• The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.

Dosage

• Griseofulvin dose: 15-20 mg/kg/day for children under 50 kg, and 1 g/day for children over 50 kg, for 6-8 weeks 1.
• Terbinafine dose: 625 mg/day for children under 20 kg, 125 mg/day for children between 20-40 kg, and 250 mg/day for children over 40 kg, for 2-4 weeks 1.

Treatment failure

• Consider lack of compliance, suboptimal absorption of drug, relative insensitivity of the organism, and reinfection 1.
• If there is clinical improvement but ongoing positive mycology, continue current therapy for a further 2-4 weeks 1.
• If there is no initial clinical improvement, proceed to second-line therapy 1.

Second-line therapy

• Itraconazole is a safe and effective option, with activity against both Trichophyton and Microsporum species 1.
• Itraconazole can be used at a dose of 50-100 mg/day for 4 weeks, or 5 mg/kg/day for 2-4 weeks 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: Note: Prior to therapy, a dermatophyte should be identified as responsible for the infection Prior to initiating treatment, appropriate specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy) should be obtained to confirm the diagnosis

The treatment for dermatophytosis (ringworm) is griseofulvin oral suspension. It is essential to:

• Identify the causative dermatophyte before starting therapy
• Confirm the diagnosis through laboratory testing (KOH preparation, fungal culture, or nail biopsy) before initiating treatment
• Use griseofulvin for infections not adequately treated by topical therapy, and for hair and nail infections 2

From the Research

Treatment Options for Dermatophytosis (Ringworm)

• Topical antifungal treatments, such as terbinafine, naftifine, and clotrimazole, have been shown to be effective in treating dermatophytosis 3, 4
• Oral antifungal drugs, including fluconazole, griseofulvin, itraconazole, and terbinafine, can also be used to treat dermatophytosis, although their effectiveness may vary depending on the specific condition and location 5, 6, 7
• Terbinafine has been found to be a highly effective short-duration therapy for dermatophytosis of the skin, with mycological cure rates of 93.5% and effective treatment rates of 89.7% at 4 weeks 3
• Itraconazole has been shown to be the most effective oral antifungal drug in treating chronic and chronic relapsing dermatophytosis in India, with a cure rate of 66% at 8 weeks 6
• Griseofulvin is currently considered the primary antifungal agent used to treat tinea capitis, but terbinafine has been found to be an effective alternative, particularly against Trichophyton tonsurans 5, 7

Specific Treatment Regimens

• Terbinafine 1% cream applied twice daily for 1 week has been shown to be effective in treating tinea pedis 3
• Terbinafine oral granules have been found to be effective in treating tinea capitis in children, with a complete cure rate of 45.1% at 6 weeks 7
• Itraconazole 5 mg/kg/day for 8 weeks has been shown to be effective in treating chronic and chronic relapsing dermatophytosis in India 6

Comparison of Treatment Options

• Terbinafine has been found to be more effective than clotrimazole in treating tinea pedis, with mycological cure rates of 93.5% vs 73.1% at 4 weeks 3
• Itraconazole has been shown to be more effective than fluconazole, griseofulvin, and terbinafine in treating chronic and chronic relapsing dermatophytosis in India, with a cure rate of 66% at 8 weeks 6
• Terbinafine has been found to be an effective alternative to griseofulvin in treating tinea capitis, particularly against Trichophyton tonsurans 5, 7