What oral liquid medication is approved for a 7-year-old female with widespread tinea corporis (ringworm) unresponsive to topical treatments?

From the Guidelines

For a 7-year-old female with widespread ringworm (tinea corporis) that has not responded to topical treatments, oral griseofulvin is the recommended treatment, with a dosage of 15-20 mg/kg/day given once daily for 6-8 weeks, as it is the only licensed treatment for tinea capitis in children in the U.K. The treatment should be chosen based on the causative dermatophyte and/or local epidemiology 1. Griseofulvin is a fungistatic drug that inhibits nucleic acid synthesis, arrests cell division at metaphase, and impairs synthesis of the cell wall 1. Although the suspension formulation is no longer licensed for use in the U.K., griseofulvin remains the treatment of choice for tinea capitis in children due to its long history of use and efficacy 1. Some key points to consider when treating this patient include:

• The importance of completing the full course of treatment, even if symptoms improve earlier, to prevent recurrence
• The need to administer the medication with fatty foods to enhance absorption
• The potential for common side effects such as headache, nausea, or rash
• The possibility of reevaluation and consideration of alternative treatments if the infection does not improve after 2-4 weeks of treatment It's also worth noting that other treatments, such as terbinafine and itraconazole, may be effective against certain types of dermatophytes, but griseofulvin remains the only licensed treatment for tinea capitis in children in the U.K. 1.

From the FDA Drug Label

Griseofulvin oral suspension, USP is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: Note: Prior to therapy, a dermatophyte should be identified as responsible for the infection Prior to initiating treatment, appropriate specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy) should be obtained to confirm the diagnosis

The oral liquid medication approved for this child is Griseofulvin.

• Key points:
  • Griseofulvin is indicated for dermatophyte infections of the skin not adequately treated by topical therapy.
  • A dermatophyte should be identified as responsible for the infection before initiating treatment.
  • Laboratory testing should be obtained to confirm the diagnosis 2

From the Research

Oral Liquid Medication for Ringworm

The oral liquid medication approved for a 7-year-old female with ringworm uncontrolled by topicals is:

• Griseofulvin (Grifulvin) 3, 4
• Terbinafine (Lamisil Granules) 3, 5, 6

Key Points

• Griseofulvin is usually taken for 6 to 8 weeks 3
• Terbinafine requires 6 weeks of treatment 3
• Terbinafine is more efficacious than griseofulvin in treating tinea capitis caused by Trichophyton species 5, 6
• Griseofulvin is more efficacious than terbinafine in treating tinea capitis caused by Microsporum species 5, 6

Considerations

• The choice of medication may depend on the specific type of fungus causing the infection 5, 6
• Other medications, such as itraconazole and fluconazole, may also be effective in treating ringworm, but are not FDA-approved for this use in children 4, 7