Dermatophyte infection
- Send skin scrapping and brushing to micro lab as can be useful diagnostic information
- Other conditions can look like Tinea, if unclear discuss with Dermatology
- If patient not responding to treatment, discuss with Dermatology or Micro/ID
- For patients receiving oral antifungal (terbinafine or itraconazole), monitor liver function every 4 to 6 weeks during treatment and discontinue if liver function tests raised or symptoms of liver toxicity
- Check BNF or Summary of Product Characteristics, before starting oral antifungal, for cautions, contra-indications and drug interactions.
Ringworm of skin (Tinea corporis/cruris)
Mild or non-extensive:
Preferred:
Clotrimazole 1% cream bd-tds continuing for 1 week after lesions are healed (usually 4 to 6 weeks in total)
Alternative:
Terbinafine 1% cream bd for 1 to 2 weeks
Consider adding a short course of hydrocortisone 1% cream if there is associated marked inflammation. Advise starting treatment with antifungal cream 24-48 hours prior to introducing topical steroids.
Intractable, severe or extensive:
Preferred:
Terbinafine 250mg po od Skin: 4 weeks Groin: 2 to 4 weeks
Alternative:
Itraconazole 200mg po od for 7 days
Athlete’s foot (Tinea pedis)
Mild or non-extensive:
Preferred:
Clotrimazole 1% cream bd-tds for 2 to 3 weeks
Alternatives:
Terbinafine 1% cream bd for 1 week
OR
Miconazole 2% cream bd continuing for 10 days after lesions healed, typically 2 to 3 weeks
Consider adding a short course of hydrocortisone 1% cream if there is associated marked inflammation. Advise starting treatment with antifungal cream 24-48 hours prior to introducing topical steroids.
Intractable, severe or extensive:
Preferred:
Terbinafine 250mg po od for 2 to 6 weeks
Alternative:
Itraconazole 100mg po od for 30 days OR 200mg po bd for 7 days
Onychomycosis (fungal nail infection, Tinea unguium)
Preferred:
Terbinafine 250mg po od Fingernails: 6 weeks Toenails: 3 to 6 months
Alternative (includes non-dermatophyte and candida nail infections):
Itraconazole 200mg po bd for 7 days (with subsequent courses repeated after a further 21 days without treatment)
Fingernails: 2 courses
Toenails: 3 courses
Scalp ringworm (Tinea capitis)
Preferred:
Terbinafine 250mg po od 2 to 4 weeks
Alternative:
Griseofulvin 500mg po bd or 1g po od for 4 to 8 weeks
Consider prescribing ketoconazole 2% shampoo during initial oral antifungal treatment to reduce risk of transmission
Treatment based on cultured organism:
- If the infective organism is Trichophyton tonsurans, continue terbinafine (if taking already), or switch to treatment with terbinafine.
- If the infective organism is a Microsporum species, continue griseofulvin (if taking already), or switch to treatment with griseofulvin.