Treatment

Advise on general hygiene to avoid factors which predisposes to infection e.g.- Loose clothing, non-occlusive footwear (e.g., sandals) (1)

Topical antifungal agents:

• used in athlete's foot, groin infections, and skin ringworm
• drugs include imidazoles (clotrimazole, econazole, ketoconazole) and terbinafine
• in severely inflamed and irritative infections a topical antifungal with corticosteroid can be used (1)

Oral antifungal agents:

• Systemic therapy, after confirmation of diagnosis, is generally required for tinea infections of the scalp, hair and nails.
• Systemic therapy may also be required for skin infections which have failed to respond to topical therapy.
• drugs such as oral terbinafine, griseofulvin or itraconazole are used for treatment in athlete's foot, groin infections, or skin ringworm infections
• in scalp ringworm infections - oral terbinafine can be used as the first line of treatment (1)

While it is reasonable to treat uncomplicated interdigital tinea pedis with antifungal creams with antifungal creams; ideally the diagnosis of a fungal infection should be confirmed by taking hair, nail or skin samples.

Key points (2):

• most cases:
  • use topical terbinafine as fungicidal, treatment time shorter and more effective than with fungistatic imidazoles or undecenoates.If candida possible, use topical imidazole
• if intractable, or scalp:
  • send skin scrapings, if infection confirmed:
    • use oral terbinafine or itraconazole
• scalp:
  • oral therapy, and discuss with specialist

Reference:

• (1) American Academy of Dermatology. Tinea (Dermatophyte) infection
• (2) Public Health England (June 2021). Managing common infections: guidance for primary care