Tinea corporis is a superficial dermatophyte infection of the cornified layers of skin on the trunk and extremities. Lesions are typically annular with central clearing and a scaling border and may be pruritic (Fig. 33-42). Infection may be transmitted from person to person, by animals such as household pets or farm animals, and through fomites. Because the cornified layer of skin is involved, topical therapy is usually sufficient for localized cases. A topical antifungal should be applied to the lesion and proximal surrounding skin twice daily for a minimum of 2 weeks. Various agents have demonstrated effectiveness, including the azoles (micon-azole, clotrimazole, ketoconazole, itraconazole) and the allylamines (naftifine, terbinafine). Terbinafine 1% cream (available OTC as Lamisil AF) produced a mycologic cure of 84.2%, versus 23.3% with placebo (Budimulja et al., 2001). In another study, patients with mycologically diagnosed tinea corporis and tinea cruris were randomly allocated
to receive either 250 mg of oral terbinafine once daily or 500 mg of griseofulvin once daily for 2 weeks. The cure rates were higher for terbinafine at 6 weeks (Voravutinon, 1993). Patients should be instructed to avoid direct contact with others and avoid sharing towels and clothing to prevent spread of the infection. Oral antifungal agents should be considered for first-line therapy for tinea corporis covering large areas of the body (Fig. 33-43).
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