What treatment is recommended for a child with ringworm?

Treatment of Ringworm in Children

For a child with ringworm (tinea capitis), oral griseofulvin is the first-line treatment at a dosage of 10-20 mg/kg/day for 6-8 weeks, combined with topical antifungal therapy. 1

Diagnosis Confirmation

Before initiating treatment, confirm the diagnosis through:

• Direct microscopic examination using potassium hydroxide (KOH) preparation
• Culture on appropriate medium when possible

Systemic Treatment Options

First-line Treatment:

• Griseofulvin (oral):
  • Dosage: 10-20 mg/kg/day (single or divided doses) 1, 2
  • Duration: 6-8 weeks 1
  • For children 30-50 lbs: 125-250 mg daily
  • For children >50 lbs: 250-500 mg daily 2
  • Continue until mycological cure is achieved 1

Second-line Treatment (if griseofulvin fails):

• Terbinafine:

  • For <20 kg: 62.5 mg/day for 2-4 weeks
  • For 20-40 kg: 125 mg/day for 2-4 weeks
  • For >40 kg: 250 mg/day for 2-4 weeks 1
  • More effective for Trichophyton species infections

• Itraconazole:

  • 5 mg/kg/day in two divided doses for 2-4 weeks 1
  • Effective against both Trichophyton and Microsporum species

Treatment Selection Based on Causative Organism

• For Trichophyton species: Terbinafine is preferred as second-line (after griseofulvin)
• For Microsporum species: Griseofulvin remains most effective 1

Additional Measures

• Topical therapy: Apply antifungal creams or shampoos to reduce spore shedding
• School attendance: Children receiving appropriate therapy can attend school 1
• Family screening: Screen all family members, especially for T. tonsurans infections 1
• Fomite cleansing: Clean hairbrushes and combs with disinfectant (bleach solution) 1

Treatment Monitoring

• Follow-up: Continue treatment until mycological cure is achieved
• Repeat mycology sampling: Perform until clearance is documented 1
• Treatment failure considerations:
  • Check compliance
  • Consider suboptimal absorption
  • Evaluate for organism insensitivity
  • Rule out reinfection 1

Important Considerations

• Treatment must continue until the infecting organism is completely eradicated 2
• Clinical appearance may improve before mycological cure is achieved
• If clinical improvement occurs but mycology remains positive, continue current therapy for an additional 2-4 weeks 1
• If no clinical improvement occurs, switch to second-line therapy 1

Common Pitfalls to Avoid

1. Inadequate treatment duration: Stopping treatment based on clinical improvement alone rather than mycological cure
2. Failure to screen family members: Especially important with T. tonsurans infections
3. Neglecting topical therapy: Combination of systemic and topical treatment is more effective
4. Missing asymptomatic carriers: High spore load carriers require systemic treatment even without clinical signs 1