This handout is for dermatophytosis / tinea (corporis, cruris, pedis, capitis, onychomycosis). Your care team identified this based on: annular/arciform scaly plaque with an active advancing scaly border and central clearing (tinea corporis/cruris; el-gohary cochrane 2014 pmid 25090020).
Other reasons your team may use this plan: interdigital maceration/fissuring or moccasin-distribution hyperkeratotic plantar scale ± vesicles (tinea pedis; cochrane topical evidence pmid 25090020); scaly scalp patch with broken hairs / black dots / kerion in a child → tinea capitis entry — always systemic (chen jaad/cochrane 2016 pmid 27816294); subungual hyperkeratosis, onycholysis, yellow-brown discolouration of toenail(s) (onychomycosis; gupta jeadv 2006 pmid 17062029).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| terbinafine | 1% cream/gel/solution | topical | once–twice daily | El-Gohary Cochrane 2014 (PMID 25090020) — topical terbinafine highest clinical-cure signal vs placebo (RR 4.51, 95% CI 3.10–6.56, NNT 3); fungicidal allylamine, shorter courses than azoles. |
| naftifine | 1–2% cream/gel | topical | once daily | El-Gohary Cochrane 2014 (PMID 25090020) — naftifine 1% mycologic cure favoured vs placebo (RR 2.38, 95% CI 1.80–3.14, NNT 3); anti-inflammatory allylamine. |
| clotrimazole | 1% cream | topical | BID | El-Gohary Cochrane 2014 (PMID 25090020) — clotrimazole 1% mycologic cure vs placebo RR 2.87 (95% CI 2.28–3.62, NNT 2); broad azole option. |
| ketoconazole | 2% cream | topical | once–twice daily | El-Gohary Cochrane 2014 (PMID 25090020) — topical azoles broadly effective with no class superiority over benzylamines; ketoconazole well suited to cruris. |
| miconazole | 2% cream/powder | topical | BID | El-Gohary Cochrane 2014 (PMID 25090020) — established azole; powder formulation aids interdigital tinea pedis + reservoir control. |
| ciclopirox | 0.77% cream/gel | topical | BID | El-Gohary Cochrane 2014 (PMID 25090020) — broad-spectrum non-azole/allylamine alternative; also a topical-onychomycosis agent (see Step 4). |
| avoid_topical_combination_corticosteroid_antifungal | — | — | — | Wacker Mycoses 2004 (PMID 15504132); El-Gohary Cochrane 2014 (PMID 25090020 — combination steroid-antifungal creams not recommended in guidelines) — combination creams breed tinea incognito and resistance; use single-agent antifungal. |
Plan: Dermatophytosis — site-stepwise topical→oral ladder (Cochrane topical 2014 / Cochrane capitis 2016 / onychomycosis RCTs / T. indotineae stewardship 2025)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Recurrence prevention + reservoir control: footwear/hosiery hygiene, antifungal foot powder, treat tinea pedis as the onychomycosis + cellulitis reservoir, household/fomite treatment and screening for tinea capitis (combs, hats, pets for M. canis), athlete/communal-shower precautions, occupational counselling. Onychomycosis relapse-prevention with intermittent topical maintenance and pedis eradication. Confirmed T. indotineae → antifungal stewardship counselling (no empiric terbinafine monotherapy, avoid OTC combination steroid-antifungal creams that breed incognito) and dermatology continuity.
Guideline: Dermatophytosis evidence chain (PubMed-verified 2026-05-18): T. indotineae & terbinafine resistance — Gupta et al, JEADV 2025 scoping review + stewardship (PMID 40613321); Gupta et al, Am J Clin Dermatol 2023 North-American AFST/MIC management (PMID 37553539); Gupta et al, Expert Rev Anti Infect Ther 2024 (PMID 39114868); Gupta et al, Antibiotics 2025 SQLE mutations (PMID 40426539); Jabet et al, Emerg Infect Dis 2022 France series (PMID 34932456); Sonego et al, J Clin Med 2024 treatment options (PMID 38930086). Tinea capitis — Chen et al, JAAD abridged Cochrane 2016 (PMID 27816294); González et al, Cochrane 2007 (PMID 17943825); Gupta et al, JEADV 2018 systematic review (PMID 29797669). Onychomycosis — Gupta et al, JEADV 2006 RCT (PMID 17062029); Pajaziti & Vasili, Med Arch 2015 RCT (PMID 26261386). Glabrous-tinea topicals — El-Gohary et al, Cochrane 2014 (PMID 25090020); van Zuuren et al, BJD 2015 summary (PMID 25294700). Diagnostics — Cuchí-Burgos et al, 2021 qPCR (PMID 34353508); Villanueva-Reyes et al, Diagn Microbiol Infect Dis 2026 (PMID 41793813). Tinea incognito — Gallegos Espadas et al, Cureus 2024 (PMID 39569254); Wacker et al, Mycoses 2004 (PMID 15504132)