From the Guidelines
Ketoconazole is not recommended as a first-line treatment for tinea capitis due to its slower resolution of symptoms and poor side-effect profile, particularly the risk of hepatotoxicity, as stated in the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 1.
Key Points to Consider
- The efficacy of ketoconazole in treating tinea capitis has been demonstrated, but its use is limited due to safety concerns 1.
- Oral antifungal medications like griseofulvin, terbinafine, itraconazole, or fluconazole are generally preferred for tinea capitis because they penetrate the hair follicles more effectively 1.
- The British Association of Dermatologists' guidelines recommend griseofulvin and terbinafine as first-line treatments, with the choice of systemic therapy directed by the causative dermatophyte and/or local epidemiology 1.
Treatment Recommendations
- For children with tinea capitis, oral griseofulvin remains a first-line treatment, with treatment typically lasting 6-12 weeks until the infection is completely cleared 1.
- Terbinafine is also a viable option, particularly for Trichophyton species, and requires a shorter course of treatment, which may increase compliance 1.
- Itraconazole is considered a second-line therapy, safe and effective, with activity against both Trichophyton and Microsporum species 1.
Important Considerations
- Topical therapy alone is not recommended for the treatment of tinea capitis, and oral therapy is generally indicated to achieve both clinical and mycological cure 1.
- The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.
From the FDA Drug Label
Ketoconazole tablets are not indicated for treatment of onychomycosis, cutaneous dermatophyte infections, or Candida infections. Ketoconazole tablets are indicated for the treatment of the following systemic fungal infections in patients who have failed or who are intolerant to other therapies: blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis.
The treatment of tinea capitis is not mentioned in the indications for ketoconazole tablets.
- Key points:
- Ketoconazole tablets are not indicated for cutaneous dermatophyte infections.
- Tinea capitis is a type of cutaneous dermatophyte infection. Therefore, ketoconazole tablets are not indicated for the treatment of tinea capitis 2.
From the Research
Treatment of Tinea Capitis
- Tinea capitis is a fungal infection of the scalp, commonly affecting pre-adolescent children 3, 4.
- The standard treatment for tinea capitis is oral griseofulvin, which remains the only FDA-approved medication for this condition 4.
- Newer oral antifungal agents, such as terbinafine, itraconazole, and fluconazole, have shown efficacy and safety in treating tinea capitis, with the advantage of shorter treatment durations 5, 3, 6, 4.
Efficacy of Ketoconazole
- There is limited information on the use of ketoconazole in treating tinea capitis.
- However, 2% ketoconazole shampoo has been recommended as an adjuvant topical therapy to reduce surface colony counts of dermatophytes in infected individuals 3, 4.
- No studies have been found that directly evaluate the efficacy of ketoconazole as a primary treatment for tinea capitis.
Comparison of Antifungal Agents
- Griseofulvin, terbinafine, itraconazole, and fluconazole have been compared in various studies, with griseofulvin remaining the drug of choice for tinea capitis 5, 6.
- Terbinafine has been shown to be an effective alternative, offering a shorter course of therapy 6.
- Itraconazole and fluconazole have also been found to be effective, but with varying degrees of success 5, 7, 6.