Learn how to treat and prevent this common fungal infection. Typically, this medication has to be applied two to three times a day for at least a week before the ringworm infection begins to clear. Because nails grow slowly, ringworm will take time to clear. These dermatologists' tips tell you how to protect your skin. Some sources suggest treating ringworm withapple cider vinegar by rubbing some on the infected area and covering it with a bandage. Some of the most common types are: ( 3) Ringworm of the the skin on the body (tinea corporis) The active ingredient in this ringworm fungus treatment is clotrimazole, which relieves the discomfort of ringworm symptoms and is clinically proven to cure most ringworm. Michigan Medicine. red splotches typically have a wavy border thats raised or scaly, Dr. Vij With proper treatment, a ringworm infection should clear up completely within a few weeks. Centers for Disease Control and Prevention. Skin scrapings and hair can be examined under the microscope immediately. Cultures are usually not necessary to diagnose tinea corporis.2 Skin biopsy with periodic acidSchiff (PAS) stain may rarely be indicated for atypical or persistent lesions. It is only passed from animal to human. The information on this site is intended for healthcare professionals in the United States and is not intended for the general public. These organisms thrive on dead keratin, a protein on the top layer of skin and in the hair and nails. Wear shower shoes. Leah Ansell, MD, is a board-certified dermatologist and an assistant professor of dermatology at Columbia University. For yeast infections: Clotrimazole is available as both 3-day and 7-day treatment courses. MANAGEMENT. This can make it more difficult to get rid of the ringworm. Remedies for Dog Ringworm - WebMD Because ringworm lives on top of the skin and is easily reached with ointments or creams,. They come in different formulations, but all work by killing the spores that allow fungi to reproduce. The You can expect permanent results in all but one area. Do not use topical clotrimazole or miconazole to treat tinea because topical butenafine (Lotrimin Ultra) and terbinafine have better effectiveness and similar cost (. Alternatively, place a coverslip over the dry scrapings and a drop or two of KOH next to the coverslip and allow it to run under the coverslip. This product usually can be used every three or four days, just as you would a regular shampoo, for up to eight weeks. Keep using the cream for at least 7 days after the rash is cleared. are famously lax about keeping their hands to themselves) and athletes who Product details. However, kerion should be treated aggressively while awaiting test results, and it may be reasonable to treat a child with typical lesions of tinea capitis involving pruritus, scale, alopecia, and posterior auricular lymphadenopathy without confirmatory testing. Terbinafine is used to treat infections caused by a fungus. The child with tinea capitis will generally have cervical and suboccipital lymphadenopathy, and the physician may need to broaden the differential diagnosis if lymphadenopathy is absent.7 However, lymphadenopathy can also occur in nonfungal scalp disease, and the absence of lymphadenopathy in an otherwise typical presentation should not delay aggressive treatment for tinea capitis.9. Treatment courses for onychomycosis are long (three to six months), failure rates are high (Table 42,12,1720 ), and recurrences are common (up to 50%).31 In older adults, treatment of onychomycosis is often optional, but most adolescents and young adults request treatment for cosmetic reasons or discomfort from shoes. Oral fluconazole is an option,32 but for most patients oral terbinafine is the treatment of choice because of its superior effectiveness,33 tolerability, and low cost.31,3438 Because toenails grow slowly, assessment of cure takes nine to 12 months. Ringworm can be transmitted between dogs and cats and humans. But it can take months or years to clear up some fungal nail, blood and lung infections. The infection starts as a rash with tiny red pimples. Cleveland Clinic 1995-2023. When washing the infected area or applying a cool compress, be sure to use a clean washcloth every time and use it only on the jock itch. (However, nystatin is often effective for cutaneous. Find out by selecting your child's symptom or health condition in the list below: Seattle Childrens complies with applicable federal and other civil rights laws and does not discriminate, exclude people or treat them differently based on race, color, religion (creed), sex, gender identity or expression, sexual orientation, national origin (ancestry), age, disability, or any other status protected by applicable federal, state or local law. If the ringworm has spread to a fingernail, you will need to take an antifungal medicine to get rid of the infection. Remedies for Ringworm: What to Do and When to See a Doctor - WebMD Creams, lotions, or powders don't work for ringworm on the scalp. Copyright 2014 by the American Academy of Family Physicians. However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen. Copyright 2000-2023. Keep the infected area clean and dry. Australas J Dermatol. Ringworm Treatment: Try These 6 Natural Remedies - Dr. Axe Good news, says Dr. Vij: Its generally easy to treat.. OTC Antifungal Creams: Uses, Brands, and Side Effects - GoodRx Ringworm: 12 tips for getting the best results from treatment No prescription is needed. Antifungals: What They Treat, How They Work & Side Effects Avoid boiling the KOH, but the slide should be hot enough to be uncomfortable to the dorsum of the hand, usually three to four seconds over the flame. With treatment, ringworm usually goes away within a few weeks. Antifungal medicine can clear ringworm from every area of the body. Its not for use in children, the elderly, or those with severeliver disease. KOH can damage microscope lenses. Put it on the rash and 1 inch (2.5 cm) beyond its borders. Worsening after empiric treatment with a topical steroid should raise the suspicion of a dermatophyte infection. Even if it seems to go away within a few days, always continue ringworm treatment for as long as your healthcare provider recommends. Ajoene, which is a natural compound extracted from garlic, has also shown promise in the treatment of ringworm. The acute form presents with erythema and maceration between the toes, sometimes accompanied by painful vesicles. Many physicians treat tinea capitis without a confirmatory culture or KOH preparation if the presentation is typical (i.e., urban setting and child presents with scaling, alopecia, and adenopathy).2,7,8 The most common mimics include seborrheic dermatitis and alopecia areata (Table 2).2,3 In atypical cases, a KOH preparation can be performed by scraping the black dots (broken hairs) and looking for fungal spores. Some sources suggest treating ringworm with apple cider vinegar by rubbing some on the infected area and covering it with a bandage. Similarly, in a small study published in the Journal of the American Academy of Dermatology in 2000, ajoene was more effective than terbinafine (which is the active ingredient in Lamisil) in treating athlete's foot. Rarely, can be spread human-to-human. Cosmetics (makeup or sunscreens) may be used on the treated skin areas no sooner than 20 minutes after this medicine is applied. You wont get a prescription for this if you haveliver disease orlupus. It works by preventing fungi from growing and . However, it commonly reoccurs, in which case, ongoing treatment may be recommended. Centers for Disease Control and Prevention. Ringworm in Children | Cedars-Sinai A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Tinea corporis may be mistaken for many other skin disorders, especially eczema, psoriasis, and seborrheic dermatitis (Table 2).2,3 A potassium hydroxide (KOH) preparation is often helpful when the diagnosis is uncertain based on history and visual inspection. How to Cure Ringworm - Cleveland Clinic Some people notice their ringworm starts to improve after just a few days. Dogs and cats can also get (and spread) ringworm. You will be subject to the destination website's privacy policy when you follow the link. Wash all items you take off before wearing them again. However, results of the Wood lamp examination can be falsely negative if the patient has bathed recently. Ringworm: diagnosis and treatment. Usecondoms or another form ofcontraception if youre on it. Wash everything youve touched or worn in hot water and laundry detergent. 4. If you want to diminish a noticeable scar, know these 10 things before having laser treatment. And those itchy red patches are all too common. The scraped scale should fall onto a microscope slide or into a test tube. Ringworm that appears on the feet (tinea pedis, or athlete's foot) may need to be managed differently than ringworm that affects the scalp (tinea capitis), for example. Your doctor will write a prescription for an antifungalmedication that youll have to take by mouth for 1 to 3 months. . You can use an ultraviolet (UV) shoe sanitizer or ozone cabinet for clothes or shoes. Wash your hands each time you touch your rash and before you touch anyone else. Medications for ringworm are highly effective, but you can help them along by taking certain measures: It's possible, but it would likely take months for that to happen. As much as possible, don'twear clothing or footwear that can cause you to sweat. Over-the-counter and prescription treatments can stop the fungus from spreading to other parts of your body or to others. After 48 hours of treatment, ringworm usually is no longer easily spread. It can also show up anywhere on the body. Use an anti-fungal cream (such as Lotrimin) 2 times per day. infection spreads through skin-to-skin contact, so it often affects kids (who The Center for Food Security & Pubic Health. (second edition). Creobic Scabies Treatment Cream Cure Skin Ringworm Parasites Itching Lotrimin AF Ringworm Cream, Clotrimazole 1%, Clinically Proven Effective Antifungal Treatment of Most Ringworm. Dermatophytes are usually limited to involvement of hair, nails, and stratum corneum, which are inhospitable to other infectious agents. Ringworm (Tinea Corporis): Diagnosis, Treatment and Prevention How long do you need to take antifungal drugs? There also are natural treatments that have shown promise in treating certain types of ringworm. ringworm of the foot (interdigital and plantar tinea pedis; athlete's foot); yeast infections of the skin (cutaneous candidiasis). Black dot, caused by Trichophyton tonsurans, is most common in the United States (Figure 4). Here are six simple ways to treat ringworm. Terbinafine (Topical Route) Description and Brand Names - Mayo Clinic says. 4 x Gotucream (2 fl oz) - Organic Ringworm Treatment Cream Terbinafine comes as a cream, gel or spray for treating athlete's foot, ringworm, jock itch and pityriasis versicolor. Tinea unguium is more commonly known as onychomycosis. Hautarzt. Even after the rash disappears, some ringworm symptoms such as itching and redness may linger as your skin continues to heal. Lotrimin AF Athlete's Foot Powder Spray, Miconazole Nitrate 2%, Clinically Proven Effective Antifungal Treatment of Most AF, Jock Itch and Ringworm, 4.6 Ounces (133 . You typically apply the antifungal twice a day for 10 to 14 days. Nails: You need prescription medicine to clear ringworm from the nails. Efficacy of ajoene in the treatment of tinea pedis: a double-blind and comparative study with terbinafine. Subjects applied one of the three options to areas affected with a fungal infection twice a day for four weeks. Cream Combination Skin Anti-Aging Day Treatment, Cream Oily Skin Anti-Aging Contour Treatments, Nature's Cure Cream Unisex Acne . This is prescribed in pill form for 7 or 15 days. Saving Lives, Protecting People, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), Antimicrobial Resistance: People & Environment, Valley Fever: Timely Diagnosis, Early Assessment, and Proper Management, Mission and Community Service Groups: Be Aware of Valley Fever, Presumed Ocular Histoplasmosis Syndrome (POHS), Emerging antimicrobial-resistant ringworm infections, Medications that Weaken Your Immune System, For Public Health and Healthcare Professionals, About Healthcare-Associated Mold Outbreaks, Antifungal susceptibility testing yeasts using gradient diffusion strips, Identification of filamentous fungi using MALDI-ToF using the Bruker Biotyper, Target Genes, Primer Sets, and Thermocycler Settings for Fungal DNA Amplification, Impact of Fungal Diseases in the United States, Health Equity Priorities for Fungal Diseases, Preventing Deaths from Cryptococcal Meningitis, Think Fungus: Fungal Disease Awareness Week, National Center for Emerging and Zoonotic Infectious Disease, Division of Foodborne, Waterborne, and Environmental Diseases, U.S. Department of Health & Human Services, Miconazole (Aloe Vesta Antifungal, Azolen, Baza Antifungal, Carrington Antifungal, Critic Aid Clear, Cruex Prescription Strength, DermaFungal, Desenex, Fungoid Tincture, Micaderm, Micatin, Micro-Guard, Miranel, Mitrazol, Podactin, Remedy Antifungal, Secura Antifungal). Patients with chronic or recurrent tinea pedis may benefit from wide shoes, drying between the toes after bathing, and placing lamb's wool between the toes.5 Patients with tinea gladiatorum, a generalized form of tinea corporis seen in wrestlers, should be treated with topical therapy for 72 hours before return to wrestling.6, Several pitfalls of managing tinea infections are listed in Table 3.2,7,8, In the United States, tinea capitis most commonly affects children of African heritage between three and nine years of age.4 There are three types of tinea capitis: gray patch, black dot, and favus. Apple cider vinegar has strong antifungal properties, so it may help treat ringworm when applied topically to the affected area. But tinea can also infiltrate the feet (where its known as athletes foot) or the groin (hello, jock itch). The match may leave a smoky deposit on the slide. Amazon's Choicefor 3 day ringworm treatment PHYTOZINE Ringworm Cream - Treats Stubborn Ringworm Infections, Fights Ringworm On Skin, Anti-Fungal Tolnaftate, Powerful Topical Treatment (1 Ounce) 1 Ounce (Pack of 1) 4.2 out of 5 stars3,132 $23.96$23.96($23.96/Count) Save more with Subscribe & Save Get it as soon as Mon, Aug 1 Ringworm, or tinea, is not a creature but an infection caused by fungus, says dermatologist Alok Vij, MD. This medicine comes in many different forms like creams, ointments, and pills. yesterday. Lotrimin Ultra Athlete's Foot Cream with No Touch Applicator, Lotrimin AF Athletes Foot Daily Prevention Deodorant Powder Spray, Lotrimin AF Athletes Foot Daily Prevention Medicated Foot Powder, Lotrimin Daily Sweat & Odor Control Medicated Foot Powder, Lotrimin AF Athletes Foot Antifungal Cream, Lotrimin AF Athletes Foot Antifungal Powder, Lotrimin AF Athletes Foot Deodorant Powder Spray, Lotrimin AF Jock Itch Antifungal Powder Spray, Treat itchy ringworm on the body with Lotrimin. University of Michigan. Here is some care advice that should help. If you have ringworm, your dermatologist will treat it with antifungal medicine. What can I do to make ringworm heal faster? This may make it less contagious. All rights reserved. was $49.99 $49.99. Do not perform potassium hydroxide preparations or cultures on asymptomatic household members of children with tinea capitis, but do consider empiric treatment with a sporicidal shampoo. University of Michigan. Lotrimin AF Ringworm Cream, Clotrimazole 1%, Clinically Proven You may also need to follow preventive measures to avoid reinfection. Read our, Ringworm: Causes, Symptoms, and Treatment, Ringworm That Doesnt Respond to OTC Treatment. Place two drops of 10% or 20% KOH on the scrapings, followed by a coverslip. If the infection is on yourskin as in the case of athletes foot orjock itch your doctor will likely suggest an OTCantifungal cream, lotion, or powder. Athletes foot: An antifungal cream or spray that you buy without a prescription may clear athletes foot. Your dermatologist may also examine other areas of your body. This is important to know since ringworm can sometimes be passed from animals to humans. When it looks like you have ringworm on your scalp or beard area, your dermatologist may remove some hair. In addition, results from Gotucream are backed by a solid 30 day money back guarantee. How to Identify and Treat Athletes Foot Bumps, Oxistat cream or lotion (oxiconazole nitrate), Ringworm: diagnosis, treatment, and outcome, Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomized, placebo-controlled, blinded study, Efficacy of ajoene in the treatment of tinea pedis: a double-blind and comparative study with terbinafine. More serious cases, and infections . Thankfully its not nearly as creepy (or as crawly) as it sounds. Tinea infections can be difficult to diagnose and treat. However, DO NOT treat ringworm with apple cider vinegar. Ringworm - Seattle Children's Hospital Athlete's foot can usually be treated with non-prescription medication applied to the skin. Ringworm is a common fungal infection that can affect the skin, scalp, and nails. Ringworm of the scalp or beard. The shelf life of a bottle of KOH is at least five years. Everyone's at risk for skin cancer. JOHN W. ELY, MD, MSPH, SANDRA ROSENFELD, MD, AND MARY SEABURY STONE, MD. ", Mayo Clinic: "Ringworm (body)", Tea tree oil., Phytomedicine: "Antifungal activity of tea tree oil from Melaleuca alternifolia against Trichophyton equinum: an in vivo assay.". Mosby Elsevier, Spain, 2008:1138-46. If after two weeks of treating your ringworm you still have symptoms that bother you, see a healthcare provider. For a mild case of ringworm, try these self-care tips. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Satchell AC, Saurajen A, Bell C, Barnetson RS. ", : "Antifungal activity of tea tree oil from Melaleuca alternifolia against Trichophyton equinum: an in vivo assay. Clean the affected area with soap, and dry with a different towel from the rest of your body. After 48 hours of treatment, ringworm does not spread to others at all. Repeat up to 3 times daily. Apply and rub balm to affected area 1-3 times a day. This article will explain the various types of medications used to treat ringworm (tinea). An exception is that ringworm can occur often among wrestlers. 2-day shipping. Tinea is usually followed by a Latin term that designates the involved site, such as tinea corporis and tinea pedis (Table 1). Most of these medicines you apply twice a day for two to four weeks. When everyone uses antifungal shampoo, this helps prevent family members from infecting each other. Ringworm: diagnosis, treatment, and outcome. The active ingredient in this ringworm fungus treatment is clotrimazole, which relieves the discomfort of ringworm symptoms and is clinically proven to cure most ringworm. Clotrimazole: apply 2-3 times a day for at least four weeks. The child with tinea capitis should return for clinical assessment at the completion of therapy or sooner if indicated, but follow-up cultures are usually unnecessary if there is clinical improvement. Advertising on our site helps support our mission. Fungal diseases: ringworm. All Rights Reserved. Ringworm treatment usually depends on the part of the body that has it. Pet rodents also can carry it. If the ringworm is on your skin, an OTC antifungal cream, lotion, or powder may work. Medications that weaken your immune system and fungal infections. USD Now $9.98. Thank you, {{form.email}}, for signing up. Hands: You may be able to clear a mild case with an antifungal cream. The miconazole 3 day ringworm treatment cream works well for treatment of athletes ' feet and it is highly effective. It is a greaseless and non-staining formula. A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Before using the washcloth again, youll want to wash it in hot, sudsy water to kill the fungus. Some children may need longer treatment. Tick bite within the last month and new onset of "ringworm", Rash gets bigger or spreads after 1 week on treatment. If the ringworm covers a large area of skin, you may need to take a prescription antifungal medicine. Tinea capitis may progress to kerion, which is characterized by boggy tender plaques and pustules. Wash everything you wear or touch in hot water before wearing or using it again. Ringworm is a fungal infection of the skin and scalp. In one survey, tinea was the skin condition most likely to be misdiagnosed by primary care physicians.1. Find patient medical information for Ringworm topical on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings. 2. Also if you wait too long to treat ringworm, it can spread and become much harder to manage. Tinea corporis, tinea cruris, and tinea pedis are generally responsive to topical creams such as terbinafine (Lamisil) and butenafine (Lotrimin Ultra), but oral antifungal agents may . The scalp should also be cultured to identify the organism and immunocompromise should be considered. When cleaning the area with ringworm, wash the affected area (s) and dry it (them) with a clean towel. This content is owned by the AAFP. Look for over-the-counter antifungal creams such as Tinactin (tolnaftate topical) or Lotramin (clotrimazole). Physicians should confirm suspected onychomycosis and tinea capitis with a potassium hydroxide preparation or culture. Scan the slide under low power, and use high power to confirm hyphae in suspicious areas. And you shouldnt drive or drink alcohol while youre taking it. Ringworm on the scalp (tinea capitis) usually needs to be treated with prescription antifungal medication taken by mouth for 1 to 3 months. For non-prescription creams, lotions, or powders, follow the directions on the package label. CDC twenty four seven. Apply enough ketoconazole gel to cover the affected and surrounding skin areas, and rub in gently with your fingertips. In some cases a systemic drug (one that is taken by mouth) is necessary. Author disclosure: No relevant financial affiliations. Schmitt Pediatric Guidelines LLC. Heres what you need to know. Insert the cream inside the vagina once daily for 3 or 7 days (depending on treatment course). Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Lotrimin in Lotrimin - Walmart.com even any worms involved. We do not endorse non-Cleveland Clinic products or services. $25.30. https://familydoctor.org/familydoctor/en/diseases-conditions/tinea-infections/treatment.html. However, some preliminary research suggests there may be natural remedies that work for some people. Do not use combination products such as betamethasone/clotrimazole because they can aggravate fungal infections. The sample is then applied to Sabouraud liquid medium or Dermatophyte test medium. It is characterized by itchy, scaly, and red patches on the skin. Fight fungus with the power of Lotrimin AF Ringworm Cream . False-negative KOH preparations often result from inadequate scrapings. Men should usecondoms duringsex for up to 6 months after stopping treatment. What are the best over-the-counter medications for ringworm? How Long Is Ringworm Contagious If Treated vs. Untreated? - Healthline In addition to the common distal subungual form, which is characterized by thickened, brittle, discolored nails (Figure 5), onychomycosis may present with an uncommon proximal subungual form, which should raise suspicion of immunocompromise, and a white superficial form, which is more common in children than adults24 (Figure 6). These come as creams, ointments, powders, or sprays and usually work quickly. Popular choices include clotrimazole (Lotrimin) and tolnaftate topical (Tinactin). Advertising on our site helps support our mission. Even when a microscope is available, the decision to perform an immediate KOH preparation may have to be balanced against other priorities.1,40. Don't cover ringworm with a bandage or other dressing. Do everything you can to prevent the fungus from spreadingto other body parts or to another person or pet. Miconazole (Aloe Vesta Antifungal, Azolen,Baza Antifungal, Carrington Antifungal, Critic Aid Clear, Cruex Prescription Strength, DermaFungal, Desenex, Fungoid Tincture,Micaderm,Micatin, Micro-Guard, Miranel,Mitrazol, Podactin, Remedy Antifungal, Secura Antifungal). Dermatologists team up to improve patient care, JAK inhibitors: A newer type of medication, Free materials to help raise skin cancer awareness, Dermatologist-approved lesson plans, activities you can use. People use miconazole (Desenex, Micatin) to treat ringworm, jock itch, and athlete's foot. A 1999 study found that a gel containing ajoene helped treat tinea cruris (jock itch) and tinea corporis (ringworm on the skin). In many cases, your doctor may recommend an over-the-counter (OTC) medicine you can get at the drugstore. McGraw Hill Medical, New York, 2008: 1807-16. Jock itch: To treat this type of ringworm, your dermatologist may recommend an antifungal cream, spray, or powder that you can buy without a prescription. Ringworm in Babies: Treatment and Prevention - Healthline Heres how to spot this common fungal infection and how to wipe it out. engage in close contact, such as wrestlers. To treat the itch, it often helps to apply a wet, cool washcloth to the area for 20 to 30 minutes. When you have ringworm, antifungal creams are your friends. Miconazole: apply twice a day and continue for 10 days after the skin is back to normal. Ringworm Treatments & Medications | SingleCare The fungi that cause ringworm can live for up to nearly two years if they're in the warm, moist environment where they thrive. Early studies show it does work as an antifungal against ringworm. If your child has ringworm, make sure they don't share sports headgear, such as batting helmets, with teammates. Find many great new & used options and get the best deals for Creobic Scabies Treatment Cream Cure Skin Ringworm Parasites Itching Anti Fungus at the best online prices at eBay! Ringworm Treatment - Ringworm Cream- Relieves Itching - Cream Antimicrobial and Antifungal- Fast Acting Tinea Itch Relief,20g. The scrotum itself is usually spared in tinea cruris, but involved in candidiasis. Find out why dark spots appear and what can fade them. Lesions may be single or multiple and the size generally ranges from 1 to 5 cm, but larger lesions and confluence of lesions can also occur. Often it's caught from puppies or kittens that have it. Lotrimin AF Ringworm Cream clotrimazole cream is clinically proven to cure the fungus infection tinea corporis, commonly known as ringworm. Save with. Ringworm treatment Antifungal creams for ringworm. This will help prevent the infection from coming back. They're available in drugstores, the pharmacy section of supermarkets, big-box stores, and online. Ringworm is highly contagious and can be spread between people and animals, so it's important to take measures to keep your skin and clothing clean. Also searched were Essential Evidence Plus, the Cochrane Database of Systematic Reviews, and UpToDate. with a bandage. Good news, says Dr. Vij: "It's generally easy to treat." Look for over-the-counter antifungal creams such as Tinactin ( tolnaftate topical) or Lotramin ( clotrimazole ). Studies show this vinegar does have some antifungal properties. It needs direct skin contact to be passed this way. Learn more about tinea versicolor treatment here. Your dermatologist may need to remove unhealthy tissue to help the area heal. However, randomized clinical trials have confirmed that newer agents, such as terbinafine and fluconazole (Diflucan), have equal effectiveness and safety and shorter treatment courses1416 (Table 4).2,12,1720 Terbinafine may be superior to griseofulvin for Trichophyton species, whereas griseofulvin may be superior to terbinafine for the less common Microsporum species.21,22 Culture results are usually not available for two to six weeks, but 95% of tinea capitis cases in the United States are caused by Trichophyton, making terbinafine a reasonable first choice.23 However, kerion should be treated with griseofulvin unless Trichophyton has been documented as the pathogen.2,17 Failure to treat kerion promptly can lead to scarring and permanent hair loss.2, Microsize (Grifulvin V suspension): 20 to 25 mg per kg per day; single daily dose or two divided doses (maximum: 1 g per day), Ultramicrosize (Gris-Peg tablets): 10 to 15 mg per kg per day; single daily dose or two divided doses (maximum: 750 mg per day), Microsize: $44 ($165) for 300 mL of 125-mg-per-5-mL solution, Ultramicrosize: $263 ($430) for 60 250-mg tablets, No baseline testing in absence of liver disease, If required for longer than eight weeks, ALT, AST, bilirubin, and creatinine measurements and CBC every eight weeks2,17, Six to 12 weeks (continue for two weeks after symptoms and signs have resolved)2, 25 to 35 kg (55 lb to 78 lb): 187.5 mg once daily, CBC at six weeks for courses lasting longer than six weeks, Six weeks; longer for Microsporum infections, Assume Trichophyton unless culture reveals Microsporum, Daily dosing: 6 mg per kg per day for three to six weeks, Tablets: $100 for 30 150-mg tablets ($1,185 for 90 50-mg tablets), Suspension: $33 ($290) for 35 mL of 40-mg-per-mL suspension, Approved for children older than six months for other indications, Baseline ALT, AST, and creatinine measurement and CBC, Capsules: 5 mg per kg daily for four to six weeks, Solution: 3 mg per kg daily for four to six weeks, Pulse therapy with capsules: 5 mg per kg daily for one week each month for two to three months, Pulse therapy with oral solution: 3 mg per kg daily for one week each month for two to three months, Solution: NA ($265) for 150 mL of 10-mg-per-mL solution, Capsules: $102 ($590) for 30 100-mg capsules, Apply daily to affected nail and adjacent skin; remove with alcohol every seven days, 40 kg (89 lb) or more and adults: 250 mg daily, Approved for children older than four years for tinea capitis, ALT and AST measurement, CBC at six weeks, Six weeks for fingernails; 12 weeks for toenails, Approved for adults and children older than six months for other indications, Baseline ALT, AST, alkaline phosphatase, and creatinine measurements, CBC, 12 to 16 weeks for fingernails; 18 to 26 weeks for toenails.