The first-line treatment for dermatophytosis (tinea) is which type of agent?

• A. Topical antiseptics
• B. Topical antifungal azoles
• C. Oral antibiotics
• D. Antivirals

Answer: (B)

Dermatophytosis is a superficial fungal infection of the skin, hair, and nails, so treating with a topical antifungal agent is the standard first step for uncomplicated cases. Azoles are a common first-line choice in this category because they inhibit the fungal enzyme 14α-demethylase, blocking conversion of lanosterol to ergosterol. Ergosterol is essential for the fungal cell membrane, so its disruption weakens the membrane and stops fungal growth, allowing the infection to clear with regular topical use. These drugs have good skin penetration, are generally well tolerated, and are readily available for topical application, making them practical and effective for most tinea infections of the skin.

Other options don’t target the fungus in the same way: topical antiseptics aren’t specific antifungals and aren’t reliably curative for established infections, antibiotics target bacteria, and antivirals target viruses. If the infection were extensive, involve deeper structures like nails or scalp, or not respond to topical therapy, systemic antifungals would then be considered.