Tinea Corporis Medication
- Author: Jack L Lesher, Jr, MD; Chief Editor: Dirk M Elston, MD more...
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.
Naftifine is a 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 weeks, reevaluate patient.
Terbinafine topical has fungicidal activity; it is a 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 it until symptoms significantly improve.
Ciclopirox olamine interferes with the synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells.
Butenafine inhibits squalene epoxidation, which, in turn, causes blockage of ergosterol biosynthesis (an essential component of fungal cell membranes), causing fungal cell growth to arrest.
Fluconazole is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation, which prevents the conversion of lanosterol to ergosterol, thereby disrupting cellular membranes. It has little affinity for mammalian cytochromes, which is believed to explain its low toxicity. Fluconazole is available as tablet for oral administration, as powder for oral suspension, and as a sterile solution for intravenous use. It has fewer adverse effects and better tissue distribution than older systemic imidazoles.
Itraconazole has fungistatic activity; it is a 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 inhibits the synthesis of ergosterol (main sterol of fungal cell membranes), causing cellular components to leak; this results in cell death. It is rarely used because of effective alternative agents and the risk of hepatotoxicity.
Terbinafine has fungicidal activity; it is a 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 it until symptoms significantly improve.
Other systemic antifungals
Griseofulvin has fungistatic activity; fungal cell division is impaired by interfering with microtubules. It binds to keratin precursor cells. Keratin is gradually replaced by noninfected tissue, which is highly resistant to fungal invasions.
Clotrimazole is a nonabsorbable imidazole. It is a 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 is an imidazole, broad-spectrum antifungal agent indicated for topical treatment of tinea corporis. It inhibits the synthesis of ergosterol (main sterol of fungal cell membranes), causing cellular components to leak; the result is cell death.
Miconazole damages the fungal cell-wall membrane by inhibiting the 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 damages the fungal cell wall membrane by inhibiting the biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak, resulting in fungal cell death.
Sertaconazole is a topical imidazole antifungal active against T rubrum, T mentagrophytes, and Epidermophyton floccosum.
Sulconazole is a broad-spectrum antifungal agent that inhibits the synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death.
Luliconazole is available as a 1% topical cream administered once daily for 1 week. It is an imidazole antifungal that alters the fungal cell membrane by interacting with 14-alpha demethylase (an enzyme necessary for conversion of lanosterol to ergosterol). It is indicated for tinea corporis.
Pires CA, Cruz NF, Lobato AM, Sousa PO, Carneiro FR, Mendes AM. Clinical, epidemiological, and therapeutic profile of dermatophytosis. An Bras Dermatol. 2014 Mar-Apr. 89(2):259-64. [Medline]. [Full Text].
Adams BB. Tinea corporis gladiatorum. J Am Acad Dermatol. 2002 Aug. 47(2):286-90. [Medline].
Ilkit M, Saracli M, Kurdak H, et al. Clonal outbreak of Trichophyton tonsurans tinea capitis gladiatorum among wrestlers in Adana, Turkey. Med Mycol. 2009 Oct 14. [Medline].
Sun PL, Ho HT. Concentric rings: an unusual presentation of tinea corporis caused by Microsporum gypseum. Mycoses. 2006 Mar. 49(2):150-1. [Medline].
Sanchez-Castellanos ME, Mayorga-Rodriguez JA, Sandoval-Tress C, Hernandez-Torres M. Tinea incognito due to Trichophyton mentagrophytes. Mycoses. 2007 Jan. 50(1):85-7. [Medline].
Seyfarth F, Ziemer M, Gräser Y, Elsner P, Hipler UC. Widespread tinea corporis caused by Trichophyton rubrum with non-typical cultural characteristics--diagnosis via PCR. Mycoses. 2007. 50 Suppl 2:26-30. [Medline].
Leyden J. Pharmacokinetics and pharmacology of terbinafine and itraconazole. J Am Acad Dermatol. 1998 May. 38(5 Pt 3):S42-7. [Medline].
Mapelli ET, Borghi E, Cerri A, Sciota R, Morace G, Menni S. Tinea corporis due to Trichophyton rubrum in a Woman and Tinea capitis in her 15-Day-Old Baby: Molecular Evidence of Vertical Transmission. Mycopathologia. 2011 Oct 14. [Medline].
Foster KW, Ghannoum MA, Elewski BE. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol. 2004 May. 50(5):748-52. [Medline].
Carod JF, Ratsitorahina M, Raherimandimby H, Hincky Vitrat V, Ravaolimalala Andrianaja V, Contet-Audonneau N. Outbreak of Tinea capitis and corporis in a primary school in Antananarivo, Madagascar. J Infect Dev Ctries. 2011 Oct 13. 5(10):732-6. [Medline].
Hryncewicz-Gwózdz A, Beck-Jendroschek V, Brasch J, Kalinowska K, Jagielski T. Tinea capitis and tinea corporis with a severe inflammatory response due to Trichophyton tonsurans. Acta Derm Venereol. 2011 Oct. 91(6):708-10. [Medline].
Seyfarth F, Goetze S, Erhard M, Burmester A, Elsner P, Hipler UC. [Infection with a rare geophilic dermatophyte.]. Hautarzt. 2009 Aug 14. [Medline].
Yehia MA, El-Ammawi TS, Al-Mazidi KM, Abu El-Ela MA, Al-Ajmi HS. The Spectrum of Fungal Infections with a Special Reference to Dermatophytoses in the Capital Area of Kuwait During 2000-2005: A Retrospective Analysis. Mycopathologia. 2009 Nov 17. [Medline].
Ziemer M, Seyfarth F, Elsner P, Hipler UC. Atypical manifestations of tinea corporis. Mycoses. 2007. 50 Suppl 2:31-5. [Medline].
Kim HS, Cho BK, Oh ST. A case of tinea corporis purpurica. Mycoses. 2007 Jul. 50(4):314-6. [Medline].
Romano C, Massai L, Strangi R, Feci L, Miracco C, Fimiani M. Tinea corporis purpurica and onychomycosis caused by Trichophyton violaceum. Mycoses. 2009 Sep 22. [Medline].
Shiraki Y, Hiruma M, Matsuba Y, et al. A case of tinea corporis caused by Arthroderma benhamiae (teleomorph of Tinea mentagrophytes) in a pet shop employee. J Am Acad Dermatol. 2006 Jul. 55(1):153-4. [Medline].
Placzek M, van den Heuvel ME, Flaig MJ, Korting HC. Perniosis-like tinea corporis caused by Trichophyton verrucosum in cold-exposed individuals. Mycoses. 2006 Nov. 49(6):476-9. [Medline].
Weinstein A, Berman B. Topical treatment of common superficial tinea infections. Am Fam Physician. 2002 May 15. 65(10):2095-102. [Medline].
Choudhary S, Bisati S, Singh A, Koley S. Efficacy and Safety of Terbinafine Hydrochloride 1% Cream vs. Sertaconazole Nitrate 2% Cream in Tinea Corporis and Tinea Cruris: A Comparative Therapeutic Trial. Indian J Dermatol. 2013 Nov. 58(6):457-60. [Medline]. [Full Text].
Liebel F, Lyte P, Garay M, Babad J, Southall MD. Anti-inflammatory and anti-itch activity of sertaconazole nitrate. Arch Dermatol Res. 2006 Sep. 298(4):191-9. [Medline].
Brooks, M. FDA Approves New Topical Antifungal Luliconazole 1%. Medscape Medical News. Available at http://www.medscape.com/viewarticle/814470. Accessed: November 18, 2013.
Luzu (luliconazole topical cream 1%). [package insert]. Valeant Pharmaceuticals. 2013.
Chen S, Ran Y, Dai Y, Lama J, Hu W, Zhang C. Administration of Oral Itraconazole Capsule with Whole Milk Shows Enhanced Efficacy As Supported by Scanning Electron Microscopy in a Child with Tinea Capitis Due to Microsporum canis. Pediatr Dermatol. 2015 Oct 8. [Medline].
da Silva Barros ME, de Assis Santos D, Soares Hamdan J. Antifungal susceptibility testing of Trichophyton rubrum by E-test. Arch Dermatol Res. 2007 May. 299(2):107-9. [Medline].
Wingfield AB, Fernandez-Obregon AC, Wignall FS, Greer DL. Treatment of tinea imbricata: a randomized clinical trial using griseofulvin, terbinafine, itraconazole and fluconazole. Br J Dermatol. 2004 Jan. 150(1):119-26. [Medline].