Treat ringworm (a fungal rash despite its name) with topical allylamine antifungals like butenafine (1% cream twice daily for 2 weeks) or terbinafine (1% cream once or twice daily for 1–2 weeks). These agents have high cure rates and are also used for athlete’s foot and jock itch. For widespread or resistant cases, consult a doctor for oral antifungal options like terbinafine or itraconazole.
January 13, 2025

Ringworm: Most Effective Over-the-Counter Treatment

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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Topical antifungal treatments are the first-line therapy for ringworm, which is most commonly caused by the dermatophyte fungus T. rubrum, which is the same organism that causes jock itch and athlete’s foot. Topical allylamine creams tend to have higher cure rates than other anti-fungals.

First-line recommendations:

  • Butenafine: Allylamine anti-fungal. Apply 1% cream topically twice daily for 2 weeks. Lotrimin Ultra Ringworm Cream (FDA NDA 21307).

  • Terbinafine: Allylamine anti-fungal. Apply 1% cream topically once or twice daily for 1–2 weeks. Packaging may say athlete’s foot but ringworm is treated with the same antifungal agents. Lamisil Terbinafine Hydrochloride 1% (FDA NDA 21958).

Prescription medications:

For widespread or resistant infections, oral antifungals like terbinafine or itraconazole may be necessary.

Citations:

Ely, J. W., Rosenfeld, S., & Stone, M. S. (2014). Diagnosis and management of tinea infections. American family physician, 90(10), 702-711.


What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

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