What is the recommended management for Tinea capitis?

From the Guidelines

The recommended management for Tinea capitis is oral antifungal therapy, with griseofulvin and terbinafine being the most widely used first-line treatments, as they have good evidence of efficacy 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1.

• Griseofulvin dose by body weight:
  • < 50 kg: 15–20 mg kg−1 per day for 6–8 weeks

  • 50 kg: 1 g per day for 6–8 weeks

• Terbinafine dose by body weight:
  • < 20 kg: 625 mg per day for 2–4 weeks
  • 20–40 kg: 125 mg per day for 2–4 weeks

  • 40 kg: 250 mg per day for 2–4 weeks It is reasonable to commence treatment while awaiting confirmatory mycology in the presence of a kerion or when one or more of the cardinal clinical signs is present, such as scale, lymphadenopathy, or alopecia 1. Topical therapy alone is not recommended for the treatment of tinea capitis, as oral therapy is generally indicated to achieve both clinical and mycological cure 1. Additional measures include allowing children receiving appropriate therapy to attend school or nursery, and screening of all family members and close contacts for infection, with treatment for those positive cases 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

DOSAGE AND ADMINISTRATION Accurate diagnosis of the infecting organism is essential. Identification should be made either by direct microscopic examination of a mounting of infected tissue in a solution of potassium hydroxide or by culture on an appropriate medium Medication must be continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination. Representative treatment periods are tinea capitis, 4 to 6 weeks; INDICATIONS AND USAGE 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

The recommended management for Tinea capitis includes:

• Accurate diagnosis of the infecting organism
• Treatment with griseofulvin (PO) for 4 to 6 weeks 2
• Concomitant use of appropriate topical agents may be required
• General measures in regard to hygiene should be observed to control sources of infection or reinfection
• Dosage should be individualized, with a recommended dosage of 10 mg/kg daily for pediatric patients older than 2 years 2

From the Research

Tinea Capitis Management

The recommended management for Tinea capitis includes:

• Oral antifungal agents as the primary treatment option 3, 4, 5, 6, 7
• Griseofulvin, terbinafine, itraconazole, and fluconazole are commonly used oral antifungal agents for the treatment of Tinea capitis 3, 4, 5, 6
• Griseofulvin is often considered the drug of choice, but its availability has declined, and alternative treatments are now required 7
• Terbinafine, itraconazole, and fluconazole have been shown to be effective and safe, with the advantage of shorter treatment durations 3, 4, 6
• The choice of antifungal agent may depend on factors such as the causative fungus, patient age, and treatment tolerance 3, 5, 7

Adjunctive Therapy

Adjunctive therapy may be beneficial in the management of Tinea capitis, including:

• Sporicidal shampoos, such as selenium sulfide, to aid in removing adherent scales and hasten the eradication of viable spores from the scalp 3, 4, 6
• Topical corticosteroids for the treatment of kerions, although their use is controversial 3
• Topical treatment as an adjunctive treatment for Tinea capitis, with support for its use highlighted in recent studies 7

Treatment Considerations

Treatment considerations for Tinea capitis include:

• Monitoring for liver enzyme elevations, particularly with the use of oral antifungal agents 3
• Regular epidemiological surveillance of causative fungal organisms and their antifungal susceptibility to guide treatment decisions 4
• The need for alternative treatments due to the decline in availability of griseofulvin 7