From the Guidelines
For facial fungal infections in children, I recommend starting with griseofulvin as the treatment of choice, due to its efficacy in eradicating common fungal pathogens such as T. violaceum, T. verrucosum, and M. canis, as supported by the British Association of Dermatologists' guidelines 1. When considering treatment options, it's essential to weigh the benefits and drawbacks of each medication. Griseofulvin remains a widely used treatment due to its cost-effectiveness and availability, despite fluconazole showing promise in eradication 1.
- Key points to consider when treating facial fungal infections in children include:
- Griseofulvin as the first-line treatment, given its established efficacy and cost-effectiveness
- Fluconazole as an alternative, particularly in cases where griseofulvin is not suitable or available, although its use in children under 10 years old is not licensed in the U.K. 1
- The importance of completing the full treatment course to prevent recurrence and ensure complete eradication of the fungal infection
- Maintaining good hygiene practices, such as keeping the affected area clean and dry, to prevent the spread of the infection
- Monitoring the infection's response to treatment and consulting a pediatrician if the infection is severe, does not respond to initial treatment, or if there are concerns about the treatment's efficacy or safety.
From the FDA Drug Label
The use of fluconazole in children with cryptococcal meningitis, Candida esophagitis, or systemic Candida infections is supported by the efficacy shown for these indications in adults and by the results from several small noncomparative pediatric clinical studies An open-label, randomized, controlled trial has shown fluconazole to be effective in the treatment of oropharyngeal candidiasis in children 6 months to 13 years of age. Efficacy of fluconazole has not been established in infants less than 6 months of age.
The FDA drug label does not provide information on the treatment of facial fungal infections in children. However, it does provide information on the treatment of other types of fungal infections in children, such as:
- Oropharyngeal candidiasis: fluconazole has been shown to be effective in children 6 months to 13 years of age.
- Cryptococcal meningitis: the use of fluconazole in children is supported by efficacy shown in adults and small noncomparative pediatric clinical studies. It is essential to consult a healthcare professional for the appropriate treatment of facial fungal infections in children, as the FDA drug label does not provide direct information on this topic 2.
From the Research
Treatment Options for Facial Fungal Infections in Children
- Topical therapies, such as creams, lotions, or sprays, can be effective in treating facial fungal infections in children, as they can penetrate the stratum corneum to kill or inhibit fungal growth 3.
- Azole drugs, such as miconazole, clotrimazole, and ketoconazole, are commonly used to treat fungal infections, but may not be as effective for dermatophytic infections 3.
- Allylamines and benzylamines, such as terbinafine, naftifine, and butenafine, are fungicidal and can be preferred for treating dermatophytic infections 3.
- For yeast infections, such as those caused by Candida albicans, azole drugs may be preferred 3.
Considerations for Treatment
- The choice of treatment may depend on the type of fungal infection, the age and immunologic status of the child, and the cost of the treatment 3, 4.
- Topical treatments may not be effective for infections that occur under the nail or in hair follicles, and systemic treatments may be required 3.
- Antifungal agents can be compounded into different types of vehicles, and patients may prefer certain formulations, such as sprays, over others 3.
Specific Treatments for Facial Fungal Infections
- Nystatin and miconazole are commonly used topical antifungal drugs for treating oral candidiasis, but may require long treatment durations 5.
- Fluconazole can be effective in treating oral candidiasis that does not respond to topical treatment, and can be used systemically 5, 6.
- Other systemic treatment alternatives, such as itraconazole, voriconazole, and posaconazole, may be used for recalcitrant infections 5.