Fungal infection of the skin (also known as ringworm or tinea) is caused by dermatophytes.
Tinea corporis (fungal infection of the body) is usually caused by Trichophyton rubrum.
Tinea cruris (fungal infection of the groin) is most commonly caused by autoinoculation from dermatophyte infection of the hands, feet, or nails and is caused by Trichophyton rubrum, Trichophyton mentagrophytes, or Epidermophyton floccosum.
Fungal skin infections are more common in men than in women. They can be caught by:
Direct contact with an infected person or animal.
Indirect contact with items contaminated with the fungus.
Contact with soil (rare).
Tinea corporis typically presents as one or more red or pink, flat or slightly raised, patches of skin which enlarge to become ring-shaped lesions with red, scaly borders and a clear central area.
Tinea cruris commonly presents as red to red-brown, flat or slightly raised plaques with active borders (pustules or vesicles), which are often itchy.
Diagnostic tests are not usually required, but microscopy and culture of skin samples should be taken if:
The diagnosis is unclear.
The infection has not responded to standard topical antifungals.
Oral antifungal treatment is being considered.
A topical imidazole or topical terbinafine is recommended treatment.
For skin that is particularly inflamed, a topical antifungal may be combined with a mildly potent corticosteroid (for up to seven days).
Oral antifungal treatment (terbinafine, griseofulvin, or itraconazole) is an option in adults if severe or extensive disease is present (referral is often indicated) or if topical treatment has failed. A positive microscopy or a positive culture of skin scrapings is recommended before starting treatment.
Any associated fungal nail infection should be treated at the same time to prevent re-infection.
People with fungal infection of the body or groin should be advised to wash the affected skin daily and dry thoroughly afterwards (particularly in the skin folds), wash clothes and bed linen frequently to eradicate the fungus, not share towels (and to wash them frequently), and to wear loose-fitting clothes made of cotton or a material designed to keep moisture away from the skin.
It is not necessary to keep children away from school.
Referral to a dermatologist may be required for:
Severe or extensive infection.
A person who is immunocompromised.
This CKS topic covers the management of dermatophyte fungal skin infection (ringworm or tinea) of the body or groin.
This CKS topic does not cover fungal infection at other sites, candidal infection of the skin, or pityriasis versicolor.
The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary health care.
CKS gratefully acknowledges the contribution of the British Association of Dermatologists in the development of this topic.
August 2013 — minor update. Nizoral® cream (ketoconazole 2%) is no longer licensed for use in children.
August 2013 — minor update to the text to reflect recent guidance from the European Medicines Agency regarding the use of oral ketoconazole [MHRA, 2013].
November 2012 — minor update. The links to the electronic medicines website (www.medicines.org.uk) have been updated.
January 2012 — minor typographical error corrected. Issued in February 2012.
August 2010 — minor update. Sulconazole 1% cream (Exelderm®) has been discontinued. The prescription has been removed. Issued in August 2010.
May 2009 — minor update. Econacort® cream (econazole 1% plus hydrocortisone 1% cream) has been discontinued. This prescription has been removed. Issued in June 2009.
January to May 2009 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.
There are no major changes to the recommendations.
September 2008 — minor correction to the Changes section. Issued in September 2008.
August 2008 — minor update. Nystatin cream and ointment discontinued; text amended. Issued August 2008.
April 2008 — minor update to the text for oral ketoconazole, this now reflects the most recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance.
March 2008 — minor update. New text inserted regarding rare cases of changes in INR when warfarin and oral terbinafine have been given concomitantly. Issued March 2008.
October to December 2005 — written. Validated in March 2006 and issued in May 2006.
No new evidence-based guidelines since 1 April 2009.
HTAs (Health Technology Assessments)
No new HTAs since 1 April 2009.
No new economic appraisals relevant to England since 1 April 2009.
Systematic reviews and meta-analyses
Systematic reviews published since the last revision of this topic:
No new randomized controlled trials published in the major journals since 1 April 2009.
No new national policies or guidelines since 1 April 2009.
No new safety alerts since 1 April 2009.
Sulconazole 1% cream (Exelderm®) has been discontinued.
Econacort® cream (econazole 1% plus hydrocortisone 1% cream) has been discontinued.
Early recognition of features suggestive of fungal infection of the groin
Making an accurate diagnosis and excluding similar conditions
Making an accurate assessment (e.g. of severity)
Appropriate treatment in primary care settings
Appropriate referral to secondary care or other specialist service
Providing appropriate advice to patients
Fungal infection of the skin is caused by dermatophytes, and is also known as ringworm or tinea [Hainer, 2003].
Fungal skin infections are more common in men than in women. They can be caught by [Hainer, 2003]:
Direct contact with an infected person (anthropophilic infection) or animal, for example dogs, cats, guinea pigs, and cattle (zoophilic infection).
Contact with soil (geophilic infections), although this is rare.
Indirect contact with items contaminated with the fungus, for example clothing, towels, bedclothes, and chairs handled by people with the infection.
Tinea cruris (dermatophyte fungal infection of the groin) is most commonly caused by autoinoculation from dermatophyte infection of the hands, feet, or nails and is caused by Trichophyton rubrum, Trichophyton mentagrophytes, or Epidermophyton floccosum [Hainer, 2003; Loo, 2004; Andrews and Burns, 2008].
It occurs when temperature and humidity are high (such as occlusion from wet or tight-fitting clothing) [Hainer, 2003].
It usually affects adolescent and young adult men, although it may be seen in post-pubertal females who are overweight or who wear tight clothing [Andrews and Burns, 2008].
Diagnosis is usually made on the basis of clinical appearance.
On the body:
The rash typically presents as one or more red or pink, flat or slightly raised, patches of skin which enlarge to become ring-shaped lesions with red, scaly borders with a clear central area.
However, more rarely, the lesions can appear as:
Numerous overlapping concentric circles (tinea imbricate).
Herpetiform subcorneal vesicles or pustules (bullous tinea corporis).
In the groin:
The most commonly affected areas are the inguinal folds and proximal medial thighs. The perianal skin and buttocks may be affected, but in men the penis and scrotum are often spared.
The clinical presentation is variable, but the lesions are commonly red to red-brown, flat or slightly raised plaques with active borders (pustules or vesicles). They often itch, and in some cases there is uniform scale without central clearing.
Fluorescence is not seen when the rash is examined with a Wood's light.
Exclude other skin disease that look like a dermatophyte infection of the body or groin.
This recommendation is based on expert opinion [Weinstein and Berman, 2002; Hainer, 2003; Hay and Moore, 2004; Loo, 2004; Sarkany et al, 2004; Andrews and Burns, 2008; Havlickova and Friedrich, 2008].
Skin conditions which can look similar to fungal infection of the body
Discoid eczema — plaques of papulo-vesicles tend to occur symmetrically on the limbs.
Pityriasis rosea — symmetrical, and typically affects the trunk and the proximal limbs. The herald patch is almost impossible to differentiate from ringworm without microscopy of scales.
Pityriasis versicolor — patchy, sharply demarcated macules, with fine scale. Usually there is less inflammation than with tinea corporis. Under Wood's light, the scaly lesions may show pale yellow fluorescence.
Psoriasis — usually present on the knees, elbows, and scalp. Pitting of the nails may be present.
Granuloma annulare — single or multiple rings of small, smooth, red or flesh-coloured papules. Itch may be present.
Skin conditions which can look similar to fungal infection of the groin
Candidal intertrigo — usually more uniformly red, with no central clearing, and may have satellite lesions (see the CKS topic on Candida - skin).
Erythrasma — more uniformly brown with slight scaling and no active border. Fluoresces a brilliant coral-red.
Mechanical intertrigo — sharp edge, no central clearing or scale.
Psoriasis — sharp margination, pitted nails, and knee, elbow, and scalp lesions.
Seborrhoeic dermatitis — greasy scales, associated with scalp dandruff (see the CKS topic on Seborrhoeic dermatitis).
Diagnostic tests are not usually required, but take samples for microscopy and culture if:
The diagnosis is unclear.
The infection has not responded to standard topical antifungals.
Oral antifungal treatment is being considered.
To take samples for fungal investigation:
Wipe off any treatment creams before sampling.
Scrape skin from the advancing edge of the lesion using a blunt scalpel blade or similar implement.
Collect 5 mm2 of skin flakes for microscopy and culture.
Collect the sample into folded dark paper squares (secure with a paper clip), or use a commercially available fungal packet.
Keep samples at room temperature. Do not refrigerate.
Ensure clinical details are stated, including any treatment, animal contact, and overseas travel.
Swabs are usually of no value for dermatophyte infections, but may provide a culture result if scrapings are inadequate.
When to take samples for microscopy and culture
How to take samples
These recommendations are based on guidance from the Health Protection Agency [HPA, 2009].
Scenario: Management : covers the management of people with dermatophyte fungal skin infection (ringworm or tinea) of the body or groin.
Advise the person to:
Wash the affected skin daily and dry thoroughly afterwards, particularly in the skin folds.
Wash clothes and bed linen frequently to eradicate the fungus.
Not share towels, and to wash them frequently.
Wear loose-fitting clothes made of cotton or a material designed to keep moisture away from the skin.
It is not necessary to keep children away from school. However, to ensure that the infection is not transmitted to others, carefully follow the recommendations on hygiene and treatment.
Treat with a topical imidazole (clotrimazole, econazole, or miconazole). Topical ketoconazole or topical terbinafine are alternatives, but are not licensed for use in children.
The timing of application and duration of treatment depends on the drug used. For more information, see Prescriptions.
For skin that is particularly inflamed, consider prescribing a topical antifungal combined with a mildly potent corticosteroid for a maximum of seven days.
Do not give a corticosteroid preparation alone.
Use a combination preparation with caution on fungal infection of the groin, because of the increased risk of adverse effects with topical corticosteroids in occluded areas.
Consider oral antifungal treatment in adults if severe or extensive disease is present (referral is often indicated) or if topical treatment has failed.
A positive microscopy or a positive culture of skin scrapings is recommended before starting treatment.
If test results are negative, but the clinical appearance is very suggestive of fungal infection, repeat the sample and start treatment.
If oral antifungal treatment is being considered in children, seek specialist advice.
Topical antifungal treatments
CKS found evidence from randomized trials that topical imidazoles and topical terbinafine are effective for the treatment of fungal infections of the body and groin. They are also widely recommended by experts in reviews of the literature [Gupta et al, 2004; Loo, 2004; Andrews and Burns, 2008].
The information on the licensing of topical ketoconazole and topical terbinafine in children is based on the manufacturers' summaries of product characteristics [ABPI Medicines Compendium, 2013a; ABPI Medicines Compendium, 2013b].
There was insufficient trial evidence to recommend one preparation over another, but imidazoles are currently the most commonly used topical treatments for fungal infections of the skin [Havlickova and Friedrich, 2008].
Topical antifungals have advantages over oral antifungals [Havlickova and Friedrich, 2008]:
Less risk of adverse effects.
Fewer drug interactions.
No requirement for laboratory tests to monitor treatment.
Expert opinion varies on the use of topical corticosteroids. Some prefer not to use them alone because of the potential for fungal proliferation, worsening of symptoms, and the development of tinea incognito (an atypical skin appearance due to local corticosteroid application, which may mask true dermatophyte infection) [Erbagci, 2004; Gupta et al, 2004].
Topical antifungal combined with corticosteroid
The recommendation to consider using a topical antifungal combined with a mildly potent corticosteroid for severely inflamed and irritant infections is based on expert opinion that this will provide more rapid symptom relief than a topical antifungal alone [Erbagci, 2004; Havlickova and Friedrich, 2008].
However, the studies providing evidence to support this approach investigated moderately potent and potent corticosteroids, rather than mildly potent corticosteroids [Weinstein and Berman, 2002].
Some experts recommend avoiding treating areas of thin skin and naturally occluded body areas, such as the groin, with combination treatment [Weinstein and Berman, 2002] because of possible adverse effects from topical corticosteroids (for example skin thinning, telangiectasia and striae). Others recommend using short-term courses of combination products for this purpose. A combination of a mild topical corticosteroid with a topical antifungal is therefore offered as an option, but only for a short period of time, to minimize the potential for adverse effects.
Oral antifungal treatment
Topical antifungal treatment is generally successful. However, if the infection covers an extensive area or is resistant to initial treatment, experts recommend oral antifungals [Weinstein and Berman, 2002; Gupta et al, 2004; Havlickova and Friedrich, 2008].
Specialist advice is advised before prescribing an oral antifungal for a child less than 16 years of age because terbinafine and itraconazole are not licensed for this age group and there are a lack of suitable preparations available for children (even for griseofulvin, which is licensed).
If an oral antifungal is appropriate (see Treatment), prescribe terbinafine, griseofulvin, or itraconazole.
Treatment duration is often shorter than with griseofulvin.
There are fewer drug interactions with terbinafine than with itraconazole.
Adverse effects are usually mild or transient, although there are concerns about liver toxicity.
Oral griseofulvin (licensed):
Is used less commonly following the introduction of newer, safer azoles (itraconazole and fluconazole) and terbinafine.
Women of childbearing age should be advised to avoid pregnancy during, and for 1 month after, treatment with griseofulvin. Men should ensure contraceptive precautions are taken during, and for the 6 months after, their own treatment due to potential adverse effects on the male reproductive system.
Griseofulvin is a fungistatic drug. It must be given continuously for a relatively long period of time, which may contribute to reduced compliance and decreased effectiveness.
Itraconazole is not recommended for use in children or elderly people because of a lack of data on its safety and efficacy in these groups.
Rare cases of serious hepatotoxicity have been reported.
The Committee on Safety of Medicines has advised caution when prescribing itraconazole to people at high risk of heart failure (for example older people, those with cardiac disease, people receiving negative inotropic drugs such as calcium-channel blockers, and people receiving high doses or long treatment courses of itraconazole).
Oral fluconazole and oral ketoconazole are not recommended.
There is evidence that oral griseofulvin, terbinafine, and itraconazole are effective for the treatment of fungal infections of the body and groin, but CKS found insufficient evidence to recommend one oral antifungal in preference to another.
The information to guide the choice of oral antifungal was largely based on expert opinion and manufacturers' information [Gupta et al, 2004; Chemidex Pharma Ltd., 2005; Aronson, 2006; HPA, 2007; Andrews and Burns, 2008; BNF for Children, 2008; ABPI Medicines Compendium, 2009; BNF 57, 2009].
Treatments not recommended
Oral fluconazole: there is evidence that fluconazole is effective for treating fungal infections of the body and groin. However, there is more evidence to support the use of griseofulvin, terbinafine, and itraconazole.
Oral ketoconazole — the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) has suspended the marketing authorisation for oral ketoconazole, and it should no longer be used for the treatment of fungal infections [MHRA, 2013]. The decision was made because some people taking these medicines may be at an increased risk of liver damage and the risk outweighs the benefits. Alternative anti-fungal treatments are available.
The following information is a guide only. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (www.medicines.org.uk) or the British National Formulary (BNF) (www.bnf.org).
Treat for at least 4 weeks and continue treatment for 2 weeks after all signs of infection have disappeared.
For adults, prescribe 500 mg once a day or 250 mg twice a day.
Oral terbinafine (not licensed for children)
For ringworm, treat for 4 weeks. For fungal infection of the groin, treat for 2–4 weeks.
For adults, the recommended dosage is 250 mg once per day.
Itraconazole is not recommended for use in children or the elderly.
In adults, treat with either:
100 mg daily for 15 days, or
200 mg twice daily for 7 days.
Doses for children have not been included because in most cases specialist advice will be needed. Also, terbinafine is not licensed for this purpose and there is no UK-approved liquid paediatric formulation of griseofulvin.
Consider referral to dermatology if:
The diagnosis is uncertain.
There is no response to primary care management.
Infection is severe or extensive.
Infection is recurrent.
The person is immunocompromised.
CKS found no evidence or expert reviews on referral, and has therefore based this recommendation on common clinical practice.
There is moderate evidence that topical terbinafine, and weak evidence that topical imidazoles, are effective for the treatment of fungal infections of the groin and body.
Topical antifungal treatment compared with placebo
Topical clotrimazole compared with placebo:
In one randomized controlled trial (RCT) people with mycologically-confirmed athlete's foot, ringworm of the body, fungal groin infection, pityriasis versicolor, or cutaneous candidiasis were randomized to receive one of four treatments: clotrimazole cream, its placebo vehicle alone, clotrimazole solution, or its placebo vehicle alone, for 4–6 weeks.
Significantly more people with fungal infection of the body or groin treated with clotrimazole cream or with clotrimazole solution had negative microscopy at 6 weeks, compared with people treated with the placebo vehicles (p < 0.001 for clotrimazole cream compared with placebo, p < 0.001 for clotrimazole solution compared with placebo) [Spiekermann and Young, 1976].
Topical terbinafine compared with placebo:
In one RCT (n = 66), treatment for 1 week with terbinafine 1% solution was compared with placebo solution in people with mycologically-confirmed skin ringworm or fungal groin infection [Lebwohl et al, 2001]. The primary outcome measure was mycological cure.
After 4 weeks, 65% of the terbinafine group were cured, compared with 8% of the placebo group (p < 0.001).
An RCT (n = 117) compared treatment with terbinafine 1% cream for 1 week with placebo cream [Budimulja et al, 2001]. Efficacy was assessed by comparing the mycological cure rates in the two groups.
At week 8, 84% of people in the terbinafine group were cured, compared with 23% of people using placebo (p < 0.001).
An RCT (n = 83) randomized people with mycologically-confirmed skin ringworm or fungal groin infection to treatment with topical terbinafine 1% gel or placebo gel, once a day for 1 week [van Heerden and Vismer, 1997].
At 8 weeks, 83% of the terbinafine group were cured, compared with 27% of the placebo group (p < 0.001).
Comparative trials of topical antifungal treatments
Topical terbinafine compared with topical ketoconazole:
One RCT (n = 65) found that terbinafine was more effective than ketoconazole [Bonifaz and Saul, 2000]. Topical terbinafine 1% gel, applied once a day for 1 week was compared with ketoconazole 2% cream applied once a day for 2 weeks.
At week 2, 94% of the terbinafine group were cured, compared with 69% of the ketoconazole group (p < 0.027).
Topical miconazole compared with topical sulconazole:
One RCT (n = 94) found similar cure rates for miconazole and sulconazole [Tanenbaum et al, 1982]. People with athlete's foot, skin ringworm, or fungal groin infection were randomized to receive sulconazole nitrate 1% cream or miconazole 2% cream, twice a day for 3 weeks.
At week 3, the cure rate for sulconazole nitrate (29/32) was similar to the cure rate for miconazole (31/31) for people with skin ringworm or fungal groin infection. No p-values were quoted.
There is a lack of direct evidence from placebo-controlled trials to support the use of oral antifungals to treat fungal infection of the body and groin. There is moderate indirect evidence, from a number of small randomized controlled trials (RCTs) comparing different oral antifungals, to support their use. In general, there was a large variation between the trials with respect to follow-up period and duration of treatments. Based on the current published data, there is insufficient information to recommend one oral antifungal over another on the basis of efficacy.
Oral antifungals compared with placebo
CKS found one placebo-controlled trial of itraconazole. No placebo-controlled trials for other oral antifungal drugs for fungal infection of the body or groin were found.
One RCT (n = 67) compared the efficacy of oral itraconazole, 100 mg each day for 2 weeks with placebo, in people with fungal groin infection or skin ringworm.
The mycological cure rate in the itraconazole group was significantly higher (57%) than the cure rate in the placebo group (17%) after 2 weeks of treatment (p = 0.02) [Pariser et al, 1994].
Oral terbinafine compared with oral griseofulvin
One small randomized controlled trial (RCT) found that oral terbinafine and oral griseofulvin, for up to 6 weeks, were similarly effective for the treatment of fungal groin and skin ringworm infections. A second RCT found evidence that terbinafine treatment led to significantly higher cure rates than griseofulvin, although the treatment with griseofulvin only lasted for 2 weeks.
One RCT (n = 92) randomized people with mycologically-confirmed fungal groin infection or skin ringworm to receive terbinafine (125 mg twice a day) or griseofulvin (500 mg twice a day) for up to 6 weeks.
At week 10 (8 weeks after the end of treatment), mycological cure rates for both drugs were similar, being 95% for griseofulvin and 93% for terbinafine [del Palacio et al, 1990].
One RCT (n = 64) randomized people with mycologically-confirmed fungal groin infection or skin ringworm to receive terbinafine (250 mg once a day) or griseofulvin (500 mg once a day), for 2 weeks [Voravutinon, 1993].
At week 6, 87% of the terbinafine group were cured, compared with 54% of the griseofulvin group (p < 0.05).
Oral griseofulvin compared with oral fluconazole
One RCT (n = 230) compared oral treatment with griseofulvin (250 mg once a day) with fluconazole (150 mg once a week) for 4–6 weeks, in people with fungal groin infection or skin ringworm [Faergemann et al, 1997].
The clinical cure rate at 6 weeks was similar for both groups, 74% for the fluconazole group and 62% for the griseofulvin group (p = 0.06).
Mycological cure rates were not available for 37% of participants, but the cure rates for those that could be evaluated were 78% for the fluconazole group and 80% for the griseofulvin group (no p-values were quoted).
Oral griseofulvin compared with oral itraconazole
One RCT (n = 40) randomized people with mycologically-confirmed fungal groin infection or skin ringworm to receive itraconazole (100 mg once a day) or griseofulvin (500 mg once a day), for 15 days [Panagiotidou et al, 1992].
At 15 days post-treatment there was no statistically significant difference in mycological cure rates between the two groups: 16/18 (88%) for people receiving itraconazole and 16/21 (76%) for people receiving griseofulvin (no p-values were quoted).
One RCT (n = 78) randomized people with skin ringworm or fungal groin infection to receive either itraconazole (100 mg each day) or griseofulvin (500 mg each day) for 15 days (this is shorter then the usual recommended course of griseofulvin).
At week 4, mycological cure was achieved in 87% of people in the itraconazole group and in 57% of people in the griseofulvin group [Bourlond et al, 1989].
Oral terbinafine compared with oral fluconazole
One RCT (n = 42) found that terbinafine and fluconazole achieved similar cure rates. Fluconazole 100 mg a day was compared with terbinafine 250 mg a day, for 2–6 weeks. Participants had mycologically confirmed fungal groin infection or skin ringworm as well as athlete's foot.
At the end of follow up (8 weeks) mycological cure was achieved in 14/16 (87%) of people treated with fluconazole, compared with 11/15 (73%) of people treated with terbinafine. No p-values were quoted [Baldari et al, 2000].
Itraconazole 100 mg daily compared with 200 mg daily
One RCT (n = 114) randomized people with tinea corporis or tinea cruris to receive itraconazole 100 mg each day for 2 weeks or itraconazole 200 mg each day for 1 week.
After 6 weeks follow up, mycological cure was achieved in 70% of people taking 100 mg itraconazole, compared with a cure rate of 60% in those taking 200 mg itraconazole [Boonk et al, 1998].
Scope of search
A literature search was conducted for guidelines, systematic reviews and randomized controlled trials the on primary care management of Fungal skin infections of the body and groin, with additional searches in the following areas:
Topical and oral treatment
Medline and Embase - January 2000 – April 2009
Key search terms
Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline and these were adapted for other databases. Further details are available on request.
Tinea corporis.tw, ringworm.tw, tinea cruris.tw, exp Dermatomycoses/
exp Antifungal Agents/, exp Naphthalenes/, exp Griseofulvin/, griseofulvin.tw, terbinafine.tw, exp Itraconazole/, itraconazole.tw
exp Imidazoles/, exp Clotrimazole/, clotrimazole.tw, exp Econazole/, econazole.tw, exp Ketoconazole/, ketoconazole.tw, exp Miconazole/, miconazole.tw, sulconazole.tw
|/||indicates a MeSH subject heading with all subheadings selected|
|.tw||indicates a search for a term in the title or abstract|
|exp||indicates that the MeSH subject heading was exploded to include the narrower, more specific terms beneath it in the MeSH tree|
|$||indicates that the search term was truncated (e.g. wart$ searches for wart and warts)|
Topic specific literature search sources
Sources of guidelines
Medline (with guideline filter)
Sources of systematic reviews and meta-analyses
Database of Abstracts of Reviews of Effects
Medline (with systematic review filter)
EMBASE (with systematic review filter)
Sources of health technology assessments and economic appraisals
NHS Economic Evaluations
Health Technology Assessments
Sources of randomized controlled trials
Central Register of Controlled Trials
Medline (with randomized controlled trial filter)
EMBASE (with randomized controlled trial filter)
Sources of evidence based reviews and evidence summaries
Sources of national policy
Health Management Information Consortium (HMIC)
ABPI Medicines Compendium (2009) Summary of product characteristics for Sporanox capsules. Electronic Medicines Compendium..Datapharm Communications Ltd.www.medicines.org.uk [Free Full-text]
ABPI Medicines Compendium (2013a) Summary of product characteristics for Lamisil cream. Electronic Medicines Compendium..Datapharm Communications Ltd.www.medicines.org.uk [Free Full-text]
ABPI Medicines Compendium (2013b) Summary of product characteristics for Nizoral 2% Cream. Electronic Medicines Compendium..Datapharm Communications Ltd.www.medicines.org.uk [Free Full-text]
Aronson, J.K. (Ed.) (2006) Meyler's side effects of drugs. The international encyclopedia of adverse drug reactions and interactions. Volume 3: E-I. 15th edn. Amsterdam: Elsevier.
Baldari, U., Righini, M.G., Raccagni, A.A. et al. (2000) Comparative double blind, double dummy study on the efficacy and safety of fluconazole 100 mg/day versus terbinafine 250 mg/day in the treatment of dermatomycoses. Giornale Italiano di Dermatologia e Venereologia 135(2), 229-235.
BNF 57 (2009) British National Formulary. 57th edn. London: British Medical Association and Royal Pharmaceutical Society of Great Britain.
BNF for Children (2008) British National Formulary for children. London: British Medical Association and the Royal Pharmaceutical Society of Great Britain.
Bonifaz, A. and Saul, A. (2000) Comparative study between terbinafine 1% emulsion-gel versus ketoconazole 2% cream in Tinea cruris and Tinea corporis. European Journal of Dermatology 10(2), 107-109. [Abstract] [Free Full-text]
Boonk, W., de Geer, D., de Kreek, E. et al. (1998) Itraconazole in the treatment of Tinea corporis and Tinea cruris: comparison of two treatment schedules. Mycoses 41(11-12), 509-514. [Abstract]
Bourlond, A., Lachapelle, J.M., Aussems, J. et al. (1989) Double-blind comparison of itraconazole with griseofulvin in the treatment of Tinea corporis and Tinea cruris. International Journal of Dermatology 28(6), 410-412. [Abstract]
Budimulja, U., Bramono, K., Urip, K.S. et al. (2001) Once daily treatment with terbinafine 1% cream (Lamisil) for one week is effective in the treatment of Tinea corporis and cruris. A placebo-controlled study. Mycoses 44(7-8), 300-306. [Abstract]
Chemidex Pharma Ltd. (2005) Summary of product characteristics for Griseofulvin 125 mg tablets. Surrey, UK: Chemidex Parma Ltd.
del Palacio, H.A., Lopez, G.S., Gonzalez, L.F. et al. (1990) A comparative double-blind study of terbinafine (Lamisil) and griseofulvin in Tinea corporis and Tinea cruris. Clinical & Experimental Dermatology 15(3), 210-216. [Abstract]
Erbagci, Z. (2004) Topical therapy for dermatophytoses: should corticosteroids be included? American Journal of Clinical Dermatology 5(6), 375-384. [Abstract]
Faergemann, J., Mork, N.J., Haglund, A. and Odegard, T. (1997) A multicentre (double-blind) comparative study to assess the safety and efficacy of fluconazole and griseofulvin in the treatment of Tinea corporis and Tinea cruris. British Journal of Dermatology 136(4), 575-577. [Abstract]
Gupta, A.K., Chaudhry, M. and Elewski, B. (2003) Tinea corporis, tinea cruris, tinea nigra, and piedra. Dermatologic Clinics 21(3), 395-400. [Abstract]
Gupta, A.K., Cooper, E.A., Ryder, J.E. et al. (2004) Optimal management of fungal infections of the skin, hair, and nails. American Journal of Clinical Dermatology 5(4), 225-237. [Abstract]
Havlickova, B. and Friedrich, M. (2008) The advantages of topical combination therapy in the treatment of inflammatory dermatomycoses. Mycoses 51(Suppl 4), 16-26. [Abstract]
Hay, R.J. and Moore, M.K. (2004)
HPA (2007) Tinea capitis in the United Kingdom: a report on its diagnosis, management and prevention. ..Health Protection Agency.www.hpa.org.uk [Free Full-text]
HPA (2009) Fungal skin & nail infections: diagnosis & laboratory investigation: quick reference guide for primary care. ..Health Protection Agency.www.hpa.org.uk [Free Full-text]
Lebwohl, M., Elewski, B., Eisen, D. and Savin, R.C. (2001) Efficacy and safety of terbinafine 1% solution in the treatment of interdigital Tinea pedis and Tinea corporis or Tinea cruris. Cutis 67(3), 261-266. [Abstract]
Loo, D.S. (2004) Cutaneous fungal infections in the elderly. Dermatologic Clinics 22(1), 33-50. [Abstract]
MHRA (2013) Press release: oral ketoconazole-containing medicines should no longer be used for fungal infections. ..Medicines and Healthcare Products Regulatory Agency.www.mhra.gov.uk [Free Full-text]
Panagiotidou, D., Kousidou, T., Chaidemenos, G. et al. (1992) A comparison of itraconazole and griseofulvin in the treatment of Tinea corporis and Tinea cruris: a double-blind study. Journal of International Medical Research 20(5), 392-400. [Abstract]
Pariser, D.M., Pariser, R.J., Ruoff, G. and Ray, T.L. (1994) Double-blind comparison of itraconazole and placebo in the treatment of Tinea corporis and Tinea cruris. Journal of the American Academy of Dermatology 31(2 Pt 1), 232-234. [Abstract]
Sarkany, R.P.E., Breathnach, S.M., Seymour, C.A. et al. (2004)
Spiekermann, P.H. and Young, M.D. (1976) Clinical evaluation of clotrimazole. A broad-spectrum antifungal agent. Archives of Dermatology 112(3), 350-352. [Abstract]
Tanenbaum, L., Anderson, C., Rosenberg, M.J. et al. (1982) Sulconazole nitrate 1.0 percent cream: a comparison with miconazole in the treatment of Tinea pedis and Tinea cruris/corporis. Cutis 30(1), 105-118. [Abstract]
van Heerden, J.S. and Vismer, H.F. (1997) Tinea corporis/cruris: new treatment options. Dermatology 194(Suppl 1), 14-18. [Abstract]
Voravutinon, V. (1993) Oral treatment of Tinea corporis and Tinea cruris with terbinafine and griseofulvin: a randomized double blind comparative study. Journal of the Medical Association of Thailand 76(7), 388-393. [Abstract]