How should I approach the management of recurrent tinea corporis in a patient with a history of multiple infections?

Management of recurrent tinea corporis in a patient with multiple infections should begin with a thorough assessment to identify possible causes of recurrence, including reinfection from close contacts, immunocompromised status, or an alternative diagnosis. Skin sampling for fungal microscopy and culture is essential to confirm the diagnosis and guide treatment, especially if previous treatments have failed or the diagnosis is uncertain ¹.

If fungal infection is confirmed or strongly suspected clinically, oral antifungal therapy should be considered, particularly in cases of severe, extensive, or recurrent disease, or when topical treatment has been unsuccessful. Terbinafine is recommended as the first-line oral antifungal due to its efficacy and safety profile, with itraconazole or griseofulvin as alternatives if terbinafine is contraindicated or not tolerated ¹.

Topical antifungal treatment remains important for mild, non-extensive disease and as adjunctive therapy. Terbinafine cream or imidazole antifungals (such as clotrimazole or miconazole) are effective options. Treatment duration should be adequate, and patients should be advised on proper application and adherence to reduce recurrence risk ¹.

Addressing underlying factors is critical: ensure patient adherence to treatment and self-care advice, avoid inappropriate use of topical corticosteroids which can cause steroid-modified tinea (tinea incognito), and manage any immunosuppression or comorbidities that may predispose to recurrence ¹.

Environmental and contact precautions should be reinforced, including washing clothes and bed linen frequently, avoiding sharing towels, and treating close contacts if necessary to prevent reinfection ¹.

In cases of persistent or recurrent infection despite appropriate oral and topical therapy, repeat fungal sampling is advised to check for drug resistance or mixed infections. Drug resistance to terbinafine, itraconazole, and griseofulvin has been reported, and treatment may need to be adjusted accordingly ¹.

Referral to a dermatology specialist should be considered if there is severe or extensive disease, treatment failure, frequent recurrences, diagnostic uncertainty, or if the patient is immunocompromised ¹.

Recent literature emphasizes the importance of confirming diagnosis with mycological testing and highlights emerging concerns about antifungal resistance, supporting the guideline recommendations for repeat sampling and specialist referral in refractory cases (Leung, 2020; Verma, 2017; Hay, 2022).