Management of Tinea Corporis and Tinea Pedis

Diagnosis

Tinea corporis presents as circular, scaly lesions with central clearing, according to the American Academy of Pediatrics 1
Tinea pedis presents as fine scaly or vesiculopustular eruptions, often itchy, commonly affecting the spaces between toes, as noted by the American Academy of Pediatrics and other guideline societies 1, 2

The American Academy of Pediatrics recommends topical antifungal therapy as the first-line treatment for limited disease, with options including azole creams (e.g., clotrimazole 1%) applied twice daily for 2-4 weeks 1
For extensive disease or when topical therapy fails, the American Academy of Pediatrics suggests oral therapy options such as itraconazole 100 mg daily for 15 days (87% mycological cure rate) 1
Terbinafine is superior for infections caused by T. tonsurans, according to the American Academy of Pediatrics 1

The American Academy of Pediatrics and other guideline societies recommend topical therapy as the first-line treatment for most cases, with options including terbinafine 1% cream applied twice daily for 1 week (66% effective cure rate) and ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks (60% cure at end of treatment, 85% two weeks after treatment) 1, 2
For severe disease, failed topical therapy, concomitant onychomycosis, or immunocompromised patients, oral therapy options such as terbinafine 250 mg once daily for 1 week (faster clinical resolution than topical treatments) and itraconazole 100 mg daily for 2 weeks (similar efficacy to terbinafine but slightly higher relapse rate) are recommended by the American Academy of Pediatrics and other guideline societies 1, 2

To prevent the spread of tinea corporis and tinea pedis, the American Academy of Pediatrics recommends avoiding skin-to-skin contact with infected individuals, not sharing towels or other personal items, and thoroughly drying between toes after showering 1, 2
Additional preventive measures include changing socks daily, cleaning athletic footwear periodically, applying foot powder after bathing to reduce tinea pedis rates, and covering active foot lesions with socks before wearing underwear to prevent spread to the groin area, as suggested by the American Academy of Pediatrics and other guideline societies 1, 2

Risk factors for tinea pedis include swimming, running, warm humid environments, male gender, obesity, and diabetes, according to the American Academy of Pediatrics and other guideline societies 1, 2
Failing to treat all infected family members simultaneously can result in reinfection, and neglecting to address contaminated footwear can lead to recurrence, as noted by the American Academy of Pediatrics and other guideline societies 2

The British Association of Dermatologists recommends that the definitive endpoint for adequate treatment should be mycological cure, not just clinical response, and suggests considering follow-up with repeat mycology sampling at the end of the standard treatment period 3

The American Academy of Pediatrics recommends Terbinafine 250 mg daily for 1-2 weeks as a first-line oral treatment option, offering superior efficacy for Trichophyton tonsurans infections, with once-daily dosing convenience 4
The American Academy of Pediatrics suggests that Itraconazole 200 mg daily for 7 days achieves 90% mycological cure, and 100 mg daily for 15 days achieves 87% mycological cure rate, superior to griseofulvin's 57% 4
The American Academy of Pediatrics recommends prophylactic Fluconazole 100 mg daily for 3 days given before competitive wrestling season and repeated 6 weeks later to reduce tinea corporis incidence from 67.4% to 3.5% in high-risk athletes 4
The American Academy of Pediatrics advises that prophylactic fluconazole should only be used in consultation with an infectious diseases expert, as the risk-benefit analysis has not been fully determined 4

The American Academy of Pediatrics recommends avoiding skin-to-skin contact with infected individuals and covering active lesions to prevent recurrence 4
The American Academy of Pediatrics suggests not sharing towels, clothing, or other personal items (fomites) to prevent reinfection 4
The American Academy of Pediatrics advises limiting exposure to swimming pools recently associated with outbreaks to prevent recurrence 4

The American Academy of Pediatrics recommends prophylactic fluconazole 100 mg daily for 3 days before wrestling season and repeated at 6 weeks to reduce infection rates from 67.4% to 3.5% in athletes 5
Prophylactic fluconazole should only be used in consultation with an infectious diseases expert due to an undetermined risk-benefit profile 5

Itraconazole 100 mg daily for 15 days achieves 87% mycological cure, significantly superior to griseofulvin's 57% cure rate 5
Terbinafine 250 mg daily for 1-2 weeks is superior for T. tonsurans infections and offers convenient once-daily dosing 5
Ciclopirox olamine 0.77% cream/gel applied twice daily for 4 weeks achieves 60% cure at treatment end and 85% cure two weeks post-treatment, superior to clotrimazole 1% 5
Terbinafine 250 mg once daily for 1 week provides similar mycological efficacy to 4 weeks of topical clotrimazole but with faster clinical resolution 5
Avoid skin-to-skin contact with infected individuals and cover active lesions to prevent transmission 5
Do not share towels, clothing, or personal items (fomites) to prevent transmission 5
Swimming, running, warm humid environments are risk factors for tinea pedis 5
Male gender, obesity, and diabetes are risk factors for tinea pedis 5
Monitor for rare but serious adverse events with oral terbinafine, including neutropenia and liver failure, particularly in patients with preexisting conditions 5