Medication Summary
The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Topical antifungal agents are effective for treating most cases of tinea corporis. Systemic therapy may be indicated for tinea corporis that is extensive, involves immunocompromised patients, or is refractory to topical therapy. For severe infections, systemic therapy can be combined with topical antifungal treatments.
Oral granules of terbinafine (Lamisil) are available in packets containing 125 mg and 187.5 mg and are for use in children with tinea capitis who are aged 4 years and older; these granules can be sprinkled once daily on pudding or mashed potatoes. While approved only for tinea capitis, these oral granules likely are used off label in children with tinea corporis when systemic therapy is needed. The suggested dosing schedule for tinea capitis is 125 mg/d for less than 25 kg body weight, 187.5 mg/d for 25-35 kg body weight, and 250 mg/d for greater than 35 kg body weight.
Topical allylamines
Naftifine 1% cream or gel (Naftin)
Broad-spectrum antifungal agent that appears to interfere with sterol biosynthesis by inhibiting the enzyme squalene 2,3-epoxidase. This inhibition results in decreased amounts of sterols, causing cell death. If no clinical improvement occurs after 4 wk, reevaluate patient.
Terbinafine topical (Lamisil)
Fungicidal activity; synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis of fungi, resulting in deficiency in ergosterol that causes fungal cell death. Use until symptoms significantly improve.
Topical pyridones
Ciclopirox olamine 1% cream (Loprox)
Interferes with synthesis of DNA, RNA, and protein by inhibiting transport of essential elements in fungal cells.
Topical benzylamines
Butenafine 1% cream (Mentax)
Inhibits squalene epoxidation, which, in turn, causes blockage of ergosterol biosynthesis (an essential component of fungal cell membranes), causing fungal cell growth to arrest.
Systemic azoles
Fluconazole (Diflucan)
Synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes. Has little affinity for mammalian cytochromes, which is believed to explain its low toxicity. Available as tab for oral administration, as powder for oral susp, and as a sterile solution for IV use. Has fewer adverse effects and better tissue distribution than older systemic imidazoles.
Itraconazole (Sporanox)
Fungistatic activity; synthetic triazole antifungal agent that inhibits fungal cell growth by inhibiting the cytochrome P-450–dependent synthesis of ergosterol, a vital component of fungal cell membranes.
Ketoconazole (Nizoral)
Inhibits synthesis of ergosterol (main sterol of fungal cell membranes), causing cellular components to leak; results in cell death.
Systemic allylamines
Terbinafine (Lamisil, Daskil)
Fungicidal activity; synthetic allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis of fungi, resulting in a deficiency in ergosterol that causes fungal cell death. Use until symptoms significantly improve.
Other systemic antifungals
Griseofulvin (Fulvicin)
Fungistatic activity; fungal cell division is impaired by interfering with microtubule. Binds to keratin precursor cells. Keratin is gradually replaced by noninfected tissue, which is highly resistant to fungal invasions.
Topical azoles
Clotrimazole 1% cream (Mycelex, Lotrimin)
Nonabsorbable imidazole. Broad-spectrum synthetic antifungal agent that inhibits growth of fungus by altering cell membrane permeability, which causes fungal cell death.
Therapy is directed at the underlying condition, with the goal of minimizing symptoms and preventing complications.
Ketoconazole topical (Nizoral)
Imidazole, broad-spectrum antifungal agent indicated for topical treatment of tinea corporis. Inhibits synthesis of ergosterol (main sterol of fungal cell membranes), causing cellular components to leak; result is cell death.
Miconazole topical (Monistat)
Damages fungal cell-wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak and resulting in fungal cell death. Lotion is preferred in intertriginous areas. If cream is used, apply sparingly to avoid maceration effects.
Oxiconazole 1% cream (Oxistat)
Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak, resulting in fungal cell death.
Sertaconazole 2% cream (Ertaczo)
Topical imidazole antifungal active against T rubrum, T mentagrophytes, and Epidermophyton floccosum.
Sulconazole 1% cream or solution (Exelderm)
Broad-spectrum antifungal agent that inhibits synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death.
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