What is the first-line therapy for Tinea Capitis (ringworm of the scalp)?

From the Guidelines

The first-line therapy for Tinea Capitis is oral Griseofulvin or Terbinafine, with the choice of therapy directed by the causative dermatophyte and/or local epidemiology. According to the British Association of Dermatologists' guidelines for the management of Tinea Capitis 2014 1, both Griseofulvin and Terbinafine have good evidence of efficacy and remain the most widely used first-line treatments. The guidelines recommend Griseofulvin as the preferred treatment for Microsporum species, while Terbinafine is more efficacious against Trichophyton species.

Key Considerations

• The dosage of Griseofulvin is 15-20 mg/kg/day for patients weighing less than 50 kg, and 1 g per day for patients weighing more than 50 kg, taken for 6-8 weeks 1.
• The dosage of Terbinafine is 625 mg per day for patients weighing less than 20 kg, 125 mg per day for patients weighing 20-40 kg, and 250 mg per day for patients weighing more than 40 kg, taken for 2-4 weeks 1.
• Treatment should continue until the infection is clinically cleared and fungal cultures are negative.
• Adjunctive therapy includes antifungal shampoo containing ketoconazole 2%, selenium sulfide 2.5%, or povidone-iodine, which should be used 2-3 times weekly to reduce spore shedding and prevent transmission 1.

Alternative Therapies

• Itraconazole is considered a second-line therapy, with a dosage of 50-100 mg per day for 4 weeks, or 5 mg/kg/day for 2-4 weeks 1.
• Fluconazole has been used as an alternative to Terbinafine, but its use is limited due to side effects and lack of cost advantage 1.

Monitoring and Follow-up

• Treatment success should be monitored through clinical improvement of symptoms and resolution of scalp lesions.
• Repeat mycology sampling is recommended until mycological clearance is achieved 1.

From the Research

First-Line Therapy for Tinea Capitis

The first-line therapy for Tinea Capitis is a crucial aspect of treatment. According to the studies, the following points are relevant:

• Griseofulvin is currently considered the first-line therapy for Tinea Capitis 2, 3, 4, 5.
• The recommended dosage of griseofulvin is 20-25 mg/kg/day for 8 weeks 2.
• Other antifungal agents such as terbinafine, itraconazole, and fluconazole have shown promise in treating Tinea Capitis, but are not considered first-line therapy 2, 3, 4, 6, 5.
• These alternative agents may be used in cases of treatment failure or recurrent noncompliance with griseofulvin 2, 4.

Treatment Options

The treatment options for Tinea Capitis are:

• Griseofulvin: considered first-line therapy, with a recommended dosage of 20-25 mg/kg/day for 8 weeks 2, 4.
• Terbinafine: may be used as an alternative, particularly in cases of treatment failure or recurrent noncompliance with griseofulvin 2, 4.
• Itraconazole: has been shown to be effective in treating Tinea Capitis, but is not considered first-line therapy 3, 6.
• Fluconazole: has been studied as a potential treatment option, but its efficacy is comparable to standard-dose griseofulvin 5.
• Butenafine: is not mentioned as a treatment option for Tinea Capitis in the provided studies.

Answer to the Question

Based on the studies, the correct answer is: c. Griseofulvin