Executive summary
- First-line is topical for localised disease; choose an allylamine (terbinafine) or azole based on site/severity and local policy.
- Duration matters: “a few days” fails — aim for full recommended courses and continue briefly after clearance.
- Tinea incognito: steroid use can mask erythema and worsen spread; think fungal when a “steroid-responsive rash” rebounds.
Topical regimens (typical primary care pattern)
- Terbinafine 1% cream/gel: often once daily for 1–2 weeks for body/groin; foot can require longer depending on severity.
- Clotrimazole 1% cream: often BD for 2–4 weeks.
- Support: keep area dry, change socks/underwear daily, treat concomitant tinea pedis to prevent recurrence.
When to escalate / refer
- Extensive/refractory disease or immunosuppression → consider oral therapy and/or dermatology advice per pathway.
- Scalp (tinea capitis) needs systemic therapy (specialist/local protocol).
- Suspected dermatophyte nail disease often needs longer oral courses and mycology confirmation depending on local policy.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.