From the Guidelines
The effects of antifungal medications for tinea barbae/capitis typically begin to appear within 2-4 weeks of starting treatment, though complete resolution usually requires 6-12 weeks of therapy. According to the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 1, oral antifungals are the standard treatment, with griseofulvin and terbinafine being the most widely used first-line treatments. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology 1.
Treatment Options
- Griseofulvin: 15-20 mg/kg/day for children < 50 kg, and 1 g per day for adults or children > 50 kg, for 6-8 weeks 1
- Terbinafine: 250 mg per day for adults or children > 40 kg, 125 mg per day for children 20-40 kg, and 62.5 mg per day for children < 20 kg, for 2-4 weeks 1
Adjunctive Therapy
Patients should also use antifungal shampoos containing ketoconazole, selenium sulfide, or ciclopirox as adjunctive therapy 2-3 times weekly. It's essential to complete the full course of treatment even if symptoms improve earlier to prevent recurrence. The lengthy treatment duration is necessary because these fungal infections affect the hair follicles deeply, requiring time for the medication to penetrate the affected areas and for new, uninfected hair to grow. Regular follow-up appointments are recommended to monitor treatment effectiveness and potential side effects. A study published in Pediatrics in 2017 1 also supports the use of oral antifungals, such as itraconazole, in the treatment of tinea corporis, which can be applicable to tinea barbae/capitis. However, the most recent and highest quality study, the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 1, should be prioritized.
From the Research
Treatment Duration for Tinea Capitis
The duration of treatment for tinea capitis, a fungal infection of the scalp, can vary depending on the antifungal medication prescribed.
- Griseofulvin is typically prescribed for 6 to 8 weeks 2
- Terbinafine is usually prescribed for 6 weeks, but some studies have shown that shorter durations of treatment, such as 2 to 4 weeks, can be effective 3, 4
Effectiveness of Treatment
The effectiveness of treatment for tinea capitis can be evaluated through clinical and mycological assessments.
- Studies have shown that terbinafine is an effective and well-tolerated antifungal agent for the treatment of tinea capitis, with clinical cure rates ranging from 78.3% to 100% 3, 4
- Griseofulvin has also been shown to be effective, with clinical cure rates of 100% in some studies 4
Time to See Effects
The time to see effects of antifungal treatment for tinea capitis can vary, but some studies have reported the following:
- Clinical improvement can be seen as early as 2 weeks after starting treatment with terbinafine 3
- Mycological cure can be achieved in as little as 4 weeks with terbinafine treatment 3
- Clinical cure rates can continue to improve over time, with some studies reporting 100% cure rates after 1 year of follow-up 4