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Tinea Corporis — SCE Dermatology MCQ

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ModerateCutaneous InfectionTinea CorporisSCE Dermatology

A 48-year-old man with extensive tinea corporis affecting his trunk and limbs has not responded to topical Terbinafine applied for 4 weeks. He is otherwise immunocompetent. What is the appropriate management?

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Correct answer: E — Switch to oral Terbinafine 250 mg daily for 2-4 weeks

For extensive tinea corporis not responding to adequate topical antifungal therapy (Terbinafine applied once daily for 1-2 weeks is usually sufficient for localised disease), oral systemic antifungal therapy is indicated. Oral Terbinafine 250 mg daily for 2-4 weeks is effective for dermatophyte infections. Alternatives include oral Itraconazole 200 mg daily for 1-2 weeks. Before initiating oral therapy, the diagnosis should be confirmed with KOH/culture to exclude tinea incognito (steroid-modified tinea) or non-fungal mimics. Terbinafine-resistant dermatophyte infections (particularly T. indotineae/T. mentagrophytes genotype VIII from South Asia) are an emerging concern.

Reference: BAD 2014 Tinea Guidelines; BJD 2022 Resistant Dermatophytes