From the Guidelines
For tinea capitis, oral griseofulvin is the first-line treatment, and clotrimazole and ketoconazole are not the preferred options due to their limited efficacy and potential side effects, as noted in the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 1.
Treatment Overview
Tinea capitis requires systemic (oral) antifungal therapy because topical medications cannot penetrate the hair follicle adequately.
- Oral ketoconazole can be used at 3.3-6.6 mg/kg/day for 4-8 weeks, though it's not the preferred agent due to potential liver toxicity, as highlighted in the guidelines 1.
- Topical therapy alone with either medication is insufficient for cure but can be used as adjunctive treatment to reduce transmission.
- Ketoconazole or selenium sulfide shampoo (used twice weekly) can help reduce spore shedding.
Preferred Treatment Options
- Griseofulvin is the first-line treatment, with a recommended dose of 15-20 mg/kg/day for 6-8 weeks for children under 50 kg, and 1 g per day for 6-8 weeks for children over 50 kg, as outlined in the guidelines 1.
- Terbinafine is also a viable option, with a recommended dose of 125 mg per day for 2-4 weeks for children between 20-40 kg, and 250 mg per day for 2-4 weeks for children over 40 kg, as noted in the guidelines 1.
Important Considerations
- Treatment should continue until clinical and mycological cure is achieved, typically requiring 4-8 weeks.
- It's essential to examine family members for infection, as household transmission is common.
- Due to safety concerns with oral ketoconazole, alternatives like oral terbinafine, itraconazole, or fluconazole are generally preferred if griseofulvin is unavailable, as recommended in the guidelines 1.
From the Research
Comparison of Clotrimazole and Ketoconazole for Tinea Capitis
- There are no direct studies comparing clotrimazole and ketoconazole for the treatment of tinea capitis in the provided evidence.
- However, studies have compared other antifungal agents such as griseofulvin, terbinafine, and fluconazole for the treatment of tinea capitis 2, 3, 4, 5, 6.
- Ketoconazole has been compared to griseofulvin in the treatment of tinea capitis, with griseofulvin showing better efficacy and faster treatment response 3.
- Clotrimazole is not mentioned in the provided studies as a treatment option for tinea capitis.
- The current treatment options for tinea capitis include oral antifungal agents such as terbinafine, griseofulvin, itraconazole, and fluconazole, with topical antifungal therapy used as an adjunctive treatment 5, 6.
Efficacy of Antifungal Agents for Tinea Capitis
- Griseofulvin has been shown to be an effective treatment for tinea capitis, with cure rates of 96% in one study 2.
- Terbinafine has also been shown to be effective, with cure rates of 88% in one study 2.
- Fluconazole has been shown to have lower cure rates, with 78% in one study 4.
- Ketoconazole has been shown to have a slower treatment response compared to griseofulvin 3.
Treatment Recommendations for Tinea Capitis
- Oral antifungal therapy is considered the gold standard for tinea capitis treatment 5.
- Topical antifungal therapy can be used as an adjunctive treatment to reduce transmission of spores and increase cure rates 5, 6.
- The choice of antifungal agent may depend on factors such as the causative fungus, patient age, and treatment duration 6.