Dermatophyte Infection of the Skin

Doses are oral and for adults unless otherwise stated. Visit the Health Products Regulatory Board website or the printed Irish Medicines Formulary for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide.

Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.


Dermatophyte and other fungal infections of the skin

  • Tinea (ringworm)
  • Malassezia (pityriasis versicolor)
  • Candida

TINEA

  • Tinea corporis (T. rubrum/M.canis)
  • Tinea capitis (scalp ringworm)
  • Tinea manum (hands)
  • Tinea cruris (groin/flexural areas) T.rubrum
  • Tinea pedis (feet)

Avoid topical steroids--> tinea incognito

Do skin scrapings if suspicious


Topical

  • Terbenafine cream should suffice.
  • Oral if severe or recalcitrant disease.
  • Must do a skin scraping or brushing to culture species to direct treatment.
  • Terbenafine or Itraconazole

Tinea capitis (scalp ringworm)

  • Itraconazole – activity against Microsporum and Trichphyton species. Fungicidal and fungistatic. Licensed in Europe for children, not in U.K.
    • Dosing: 5mgs/kg 2-4 weeks
  • Griseofulvin: Only licensed antifungal for children under 12 in the U.K.
  • Dosing
    • 1g in children weighing >50kgs 6-8 weeks
    • 15-20mgs/kg in single or divided doses in children > 50kgs 6-8 weeks
  • Terbenafine: unlicensed in children in the U.K.
    • <20kgs - 62.5mgs od 2-4 weeks
    • >20 kgs - 125mgs od 2-4 weeks
    • >40kgs - 250mgs od for 2-4 weeks
  • Recheck with skin scraping/hair pull after course of treatment until clear.

Reference

Fuller L et al.BAD guidelines for tinea capitis 2014;171:454-463


Practical measures:

  • Treat household with Ketoconazole shampoo to prevent re-infection.
  • Treat asymptomatic carriers with a high spore load
  • Children should not be excluded from school.
  • Treatment should be prompt to avoid scarring alopecia.
  • Screen all family members skin scraping/hair pull.
  • Disinfect hair brushes, combs, razors. Do not share brushes to prevent spread.
  • Consider 2nd line agent if treatment failure

Reference

Fuller L et al.BAD guidelines for tinea capitis 2014;171:454-463.


Malassezia

First line :
Ketoconazole /selenium sulphide/ or zinc pyrithione shampoo applied topically to scalp and skin for 5- 10 minutes for 1-4 weeks. 1-4 times monthly for maintenance.
Imidazole creamod 1-4 weeks
Fluconazole 300mgs /week for 2 weeks.

Resistant :second line treatments
Itraconazole (Sporonox) 200mgs od 5-7 days
Lactic acid cream/ salicylic acid shampoo.


Comments

Take skin scrapings for culture if not localised.


Treatment

  • Treatment: 1 week terbinafine as effective as 4 weeks azole.A-
  • If intractable consider oral itraconazole. Discuss scalp infections with specialist.
Treatment Dose TX Duration
Topical 1% terbinafineA+ 1-2x/daily 1 weekA+
Topical undecenoic acid or 1% azoleA+ 1-2x/daily 4 – 6 weeksA+

Patient Information

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

The HSE Health A-Z website provides patient information on many hundreds of conditions and treatments.

Click on the links below to view information on Dermatophyte Infection of the Skin

Back to top

Reviewed June 2016