OpenHealth Q&A

Seeking Guidance on Ringworm Treatment

Hello everyone, I’m a 30-year-old woman grappling with tinea manuum, more commonly known as ringworm, affecting my palms, the backs of my hands, and spaces between my fingers. This condition has persisted for 1.5 years, and I'm reaching out because I feel lost amidst the conflicting advice from various doctors. In Sweden, one must be referred from a primary care center to consult a dermatologist, however, my doctor has declined this referral, stating my condition wouldn’t warrant it. **CURRENT TREATMENT** I recently completed a four-week course of oral terbinafine, taking 250 mg daily. My doctor advised that if the infection didn’t completely resolve, I should return for further treatment. I was informed that it’s prudent to continue taking terbinafine for two additional weeks after my symptoms clear to prevent a relapse. Additionally, I was instructed to use a strong topical cortisone (class 3) for preventative measures since my doctor was unsure whether my issue was ringworm or eczema. However, I refrained from using the cortisone, as I had previously applied it for three months with no success, and I’m confident that my condition is not eczema. As I was undergoing terbinafine treatment, I encountered some improvement. Nevertheless, the hot weather in Sweden exacerbated the rash between my fingers. Towards the end of week three, I started using foam between my fingers to maintain space and reduce moisture. By the conclusion of my treatment, I noted that the skin between my fingers looked significantly better, no longer appearing moist. Now, about 1.5 weeks post-treatment, I believe I’m still observing positive changes. Currently, I’m not undertaking any specific treatment; I’m merely trying to keep the area dry and waiting it out. **DOCTOR CONFUSION AND LACK OF FOLLOW-UP** When I attempted to renew my terbinafine prescription, another doctor complicated matters further by incorrectly stating that four weeks of treatment should suffice. This doctor noted in my records the phrase "suspected fungal infection" from the initial consultation. Without offering a follow-up appointment, they recommended continued use of the strong topical cortisone, again without clarification. When I sought another renewal for terbinafine, yet another physician prescribed the same potent cortisone treatment as before but with the same application instructions from my misdiagnosis. Again, no reasonable explanation was provided. It feels as if my treatment for ringworm is being abandoned without any follow-up to assess its effectiveness. I’m hoping for some advice or answers, as I’m feeling uninformed about my treatment plan and uncertain about my condition’s status. **QUESTIONS:** 1. Following my four weeks of oral terbinafine, should I allow time for my symptoms to completely subside, or should I extend the treatment until I’ve been symptom-free for two weeks before stopping? 2. If I’m meant to simply wait, how long should I expect to do so? Furthermore, when can I be considered non-contagious? 3. I’ve heard suggestions to use topical terbinafine. Is applying this topical treatment advisable, and what potential risks does it pose? 4. Have the other physicians effectively disregarded my ringworm treatment, or is there a valid rationale for recommending continued use of strong topical cortisone? Thank you for your assistance!

Answers (1)

8/7/2025, 3:41:11 PM

OpenHealth AI

Thank you for sharing your experience with tinea manuum (ringworm) and the challenges you're facing with treatment. It can indeed be frustrating to navigate conflicting opinions and inconsistent care. Let’s address your specific concerns and provide clear guidance on managing your condition.

Summary of Key Points:

1. Continuation of Terbinafine: Ideally, continue oral terbinafine for two weeks post-symptom resolution unless directed otherwise.
2. Waiting Period: You should monitor for at least 2-4 weeks after discontinuation of treatment for any recurrence before assessing your condition.
3. Topical Terbinafine: Using a topical antifungal can be beneficial, especially if there's residual concern about the infection.
4. Topical Cortisone Clarity: There are contexts in which continued use of topical cortisone may be warranted, especially if there is underlying skin irritation.

Detailed Explanation:

1. Terbinafine Treatment: After completing your course of terbinafine, continuing for two additional weeks after symptoms resolve is standard practice. If your condition shows improvement, it may not be necessary to extend treatment beyond that, but you should discuss directly with your doctor if symptoms reemerge.

2. Monitoring Recovery: After stopping terbinafine, observe your skin for 2-4 weeks. If the rash fully clears and stays clear during this period, you can consider yourself non-contagious. Fungal infections generally require about 48 hours of dry skin for the risk of spreading to decrease.

3. Topical Terbinafine Use: Applying topical terbinafine can help eliminate any residual fungal presence. The risk is minimal, but it's essential to ensure the skin is clean and dry before application to enhance its efficacy.

4. Topical Cortisone Consideration: The recommendation to continue with topical cortisone could stem from concerns about inflammation or dermatitis associated with prolonged fungal infection. It is often used to reduce itchiness or irritation during recovery but should ideally be monitored closely to observe its effects.

Actionable Steps:

1. Continue Terbinafine (if advised): If your skin is still showing signs of ringworm, you might consider discussing an extension of oral terbinafine treatment with your doctor, especially since you showed improvement during your previous course.

2. Monitor Symptoms: Keep a close eye on any changes in your skin condition, documenting any improvements or potential flare-ups over the next few weeks.

3. Consider Topical Treatment: If symptoms do not improve or if you have concerns about residual infection, inquire about the use of topical terbinafine with a healthcare provider.

4. Discuss Cortisone Use: If inflammation persists, talk to your physician about the rationale behind continued use of the topical cortisone, especially given your past experiences with it.

5. Seek a Second Opinion: If uncertainty continues, consider consulting another dermatology specialist to get a fresh perspective on your case. Sometimes, getting an additional opinion can clarify treatment strategies.

Conclusion:

Your discomfort and uncertainty are completely valid, and effectively managing tinea manuum can take time. Keep advocating for your health, and ensure that you feel heard and supported in your treatment plan. Please don’t hesitate to ask if you have further questions or need additional support.