From the Guidelines
The primary treatment for fungal hair loss, specifically tinea capitis, is oral antifungal medications, 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.
Key Considerations
- Griseofulvin is more effective against Microsporum species, while terbinafine is more efficacious against Trichophyton species 1.
- The dosage of griseofulvin is 15-20 mg/kg/day for children under 50 kg and 1 g/day for those over 50 kg, for 6-8 weeks 1.
- The dosage of terbinafine is 625 mg/day for children under 20 kg, 125 mg/day for those between 20-40 kg, and 250 mg/day for those over 40 kg, for 2-4 weeks 1.
- Topical therapy alone is not recommended for the treatment of tinea capitis, but antifungal shampoos can be used to reduce spore shedding and prevent transmission to others 1.
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery 1.
- Index cases due to T. tonsurans warrant screening of all family members and close contacts and 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 treatment for fungal hair loss, specifically tinea capitis, is griseofulvin (PO). The recommended treatment period is 4 to 6 weeks 2. The dosage for adults is 0.5 g daily, and for pediatric patients (older than 2 years), it is 10 mg/kg daily 2.
- Key points:
- Accurate diagnosis of the infecting organism is essential
- Medication must be continued until the infecting organism is completely eradicated
- Griseofulvin is not effective in bacterial infections, candidiasis, or other non-dermatophyte infections 2
From the Research
Treatment Options for Fungal Hair Loss (Tinea Capitis)
The treatment for fungal hair loss, specifically tinea capitis, typically involves the use of oral antifungal agents. The most commonly used treatments include:
- Griseofulvin: considered the drug of choice by many experts 3, 4, 5
- Terbinafine: shown to be effective in treating tinea capitis, with a shorter treatment course compared to griseofulvin 3, 4, 6, 5
- Itraconazole: also effective in treating tinea capitis, with a shorter treatment course compared to griseofulvin 3, 4, 6
- Fluconazole: can be used to treat tinea capitis, but may have lower cure rates compared to other options 3, 4, 6, 5
Adjunctive Therapy
In addition to oral antifungal agents, adjunctive therapy may be beneficial in treating tinea capitis. This can include:
- Sporicidal shampoos, such as selenium sulfide, to aid in removing adherent scales and hasten the eradication of viable spores from the scalp 3, 6
- Corticosteroids, which may be used to treat kerions, although their use is controversial 3
Treatment Duration and Efficacy
The duration of treatment for tinea capitis can vary depending on the antifungal agent used. Griseofulvin is typically administered for 6-8 weeks, while terbinafine, itraconazole, and fluconazole may be administered for 2-4 weeks 3, 4, 5. The efficacy of these treatments can also vary, with cure rates ranging from 84% to 96% 4, 5.
Considerations for Treatment
When selecting a treatment for tinea capitis, it is essential to consider the causative organism, the age and weight of the patient, and the potential for adverse effects 3, 4, 7. Regular epidemiological surveillance of causative fungal organisms in the community and their antifungal susceptibility is also crucial in managing this condition 6.