Recurrent tenia infections of the groin and body. How significant is the role of spores and what medications are effective.
Duration of medications
The most common cause of "recurrence " of tinea is insufficient initial treatment. The organism may reside in the hair follicles and if topical treatment is used it may be ineffective . Also not all patients will respond to all oral medications in the same way. We start with oral griseofulvin ULtramicrosize at 250mg bid but this is a weight based drug and obesity should be considered in titrating the dose. Recurrence may also occur if there is a reservoir of tinea in other areas of the body such as on the feet or nails and the dermatophyte may then be spread by scratching.
Topical treatment also vary in efficacy because most that are found over the counter in the US are fungistatic rather than fungicidal. These may slow the grow of the tinea but do not kill the fungi. Many effective topicals are in the azole class.
As far as "spores", I would say that if patients are having problem you treat until they are culture negative. Spores are everywhere and on everything the patient encounters and not necessarily thought to be a reservoir of disease.
Tenia is wrong. It should be tinea. Dermatophytes do not form spores except arthroconia on the skin. Recurrence may be due to inadequate treatment. In Calcutta School of Tropical, tinea is treated depending on the type with either modified Whitefield ointment for 3 weeks and after clinical cure for another week. When tinea is wide spread Griseofulvin is given for a few months depending the type.
The fungus persists on contaminated materials as long as lesions or animal hair harbour viable spores. For tinea capitis oral griseofulvin is the treatment of choice for resistant infection and for tinea corporis infected children should be excluded from schools and swimming pools until at least 24 hours following the commencement of appropriate treatment. It can be treated effectively with topical medications.
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