From the Guidelines
For treating ringworm in a 22-month-old child, I strongly recommend using an oral antifungal agent, specifically terbinafine, due to its superior efficacy against Trichophyton tonsurans, a common cause of ringworm, as evidenced by studies 1. When considering treatment options, it's crucial to prioritize the most effective approach to minimize morbidity, mortality, and improve quality of life.
- The American Academy of Pediatrics suggests that oral agents, such as itraconazole and terbinafine, have proven efficacious in treating most cases of T corporis, with terbinafine appearing superior for T tonsurans 1.
- Topical antifungal creams, such as clotrimazole 1% or miconazole 2%, may be used for mild cases, but their effectiveness is limited, especially for scalp ringworm, which requires oral medication to penetrate hair follicles effectively.
- It's essential to keep the affected area clean and dry, washing it gently with mild soap and water before each application, and avoiding sharing towels, clothing, or bedding to prevent the spread of the infection.
- If the infection doesn't improve within 2 weeks, covers a large area, is on the scalp, or if the child develops fever or significant inflammation, consulting a pediatrician immediately is crucial, as prescription-strength medication may be needed.
- Terbinafine's superior efficacy against Trichophyton tonsurans makes it a preferred choice for treating ringworm in children, as it can help reduce the risk of complications and improve treatment outcomes 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Pediatric patients (older than 2 years): A dosage of 10 mg/kg daily is usually adequate The child is 22 months old, which is less than 2 years. The FDA drug label does not answer the question.
From the Research
Treatment Options for Ringworm in a 22-Month-Old
- The treatment for ringworm, also known as tinea capitis, typically requires a systemic anti-fungal medication rather than topical treatment 2.
- Two FDA-approved medications for treating tinea capitis are griseofulvin (Grifulvin) and terbinafine (Lamisil Granules), with treatment durations of 6 to 8 weeks and 6 weeks, respectively 2.
- Other medications not FDA-approved for tinea capitis may also be used off-label, with similar cure rates and shorter treatment durations 2.
Effectiveness of Antifungal Medications
- A study comparing the effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole, and terbinafine) found limited effectiveness of all four drugs in treating chronic and chronic relapsing dermatophytosis in India 3.
- Itraconazole was found to be the most effective drug, followed by fluconazole, terbinafine, and then griseofulvin, based on cure rates and number needed to treat 3.
- A meta-analysis of randomized clinical trials comparing griseofulvin and terbinafine for the treatment of childhood tinea capitis found that a 2- to 4-week course of terbinafine was at least as effective as a 6- to 8-week course of griseofulvin for Trichophyton infections of the scalp 4.
Topical Treatment
- Topical therapy is generally successful for treating common superficial tinea infections, such as tinea corporis, tinea cruris, and tinea pedis, unless the infection covers an extensive area or is resistant to initial therapy 5.
- Treatment typically requires attention to exacerbating factors, such as skin moisture, and choosing an appropriate antifungal agent 5.
- Newer medications may require fewer applications and a shorter duration of use, and the presence of inflammation may necessitate the use of an agent with inherent anti-inflammatory properties or a combination antifungal/steroid agent 5.