Tinea corporis

Caused by dermatophyte (fungi genera) – infect epidermis
Types: Corporis (body – ringworm), pedis (foot), capitis (scalp), unguium (nail – onychomycosis
Diagnosis: clinical and KOH prep
Treatment: most respond to topical for 1 to 3 weeks
     * tinea capitis responds better to oral therapy
  • pearls – apply 2cm beyond area, continue 7 days past resolution
  • any of the azoles topicals work or terbinafine
    • some examples
      • Clotrimazole (lotrimin 1% BID (available OTC)
        • up to 4 weeks
        • preferred -> first line
      • Terbinafine (Lamisil)  1% 1-2 per day(available OTC)
        • topical for 1 to 3 weeks
        • preferred
        • <10$
      • ketoconazole 2% once daily
        • 2 weeks, 6 for pedis
        • cream is ~ 50$, shampoo ~30$
      • miconzaole 2% BID (available OTC)
        • 4 weeks, 2 weeks cruris
        • Cheap <15$
  • Nystatin – not effective, works for Candida (yeast)
  • combo with steroid not recommended (skin atrophy)
If oral is required the following can be effective
  1. Corporis and cruris – body (ringworm)
    1. endpoint of tx is clinical resolution (1 to 3 weeks)
    2. If topical fails
      1. terbinafine 250mg Qd for 1- 2 weeks
      2. fluconazole 150mg once weekly for 2-4weeks
      3. itraconazole 200mg Qd 1 wk
  2. Pedis – foot (athlete’s), can be interdigital, moccasin-type, inflammatory
  1. If topical fails oral tx
    1. terbinafine 250mg Qd for 2 weeks
    2. fluconazole 150mg once weekly for 2-6 weeks
    3. itraconazole 200mg BID 1 wk
  • Capitis (scalp) oral is 1st line, typically in pediatric population
    1. itchy (pruritic), scaling, hair loss
    2. Oral treatment is more effective
    3. terbinafine 250mg per day for 6 weeks (can be 2 – 4wk)
    4. Griseofluvin (microsize)
      1. Peds: 20 mg/kg for 6 to 12 wks (max dose 1000mg)
      2. 500MG/DAY FOR ADULTS
      3. best absorbed with fatty food (ice cream, peanut butter)
  • Unguium (onychomycosis) – nail
    1. treatment not mandatory – treat if immunocomp, DM, Hx of cellulitis, discomfort, COSMETIC
    2. oral or topical tx depending on clinical presentation
    3. If superficial scrape plate and apply topical
    4. Oral Terbinafine is 1st line due to low cost for mild to severe
      1. toenail = 250mg daily for 12 wks
      2. fingernail 250mg daily for 6 wks
      3. obtain ALT at baseline and if > 6wks
      4. side effects = HA, rash, GI distress, taste issues
    5. If cannot tolerate Terbinafine use Itraconazole
      1. continuous -> 200mg for 6 (finger) or 12 (toe)
      2. Pulse -> 200mg BID x 1 wk, repeat in 4 wks (repeat again for toe 4 wks later)
    6. Symptomatic relief
      1. Topical Urea 40% cream – helps soften nail so it can be clipped
        1. apply generous, wrap with bandage overnight, wash w/soap + water in morning and repeat until able to clip.
      2. general measures – keep feet clean and dry, use flipflops in locker room, don’t share trimmers