What is the treatment for tinea capitis?

Treatment of Tinea Capitis

Oral antifungal therapy is required for the treatment of tinea capitis, with the choice of agent depending on the causative dermatophyte species. 1

Diagnosis

• Confirm diagnosis before treatment through:
  • Scalp scrapings, hair pluck, brush or swab samples
  • Microscopy with 10-30% potassium hydroxide
  • Culture on Sabouraud agar (with cycloheximide)

First-line Treatment

Oral Antifungal Therapy

1. For Trichophyton species infections:

   • Terbinafine is first-line due to higher cure rates 2
   • Adults: 250mg daily for 1-2 weeks
   • Children: Based on weight (typically 62.5-250mg daily)

2. For Microsporum species infections:

   • Griseofulvin is more effective 2
   • Adults: 0.5g daily (125mg four times daily, 250mg twice daily, or 500mg once daily) 3
   • Children: 10-20mg/kg/day for 6-8 weeks 2, 3
   • Treatment duration: 4-6 weeks 3

When to Start Treatment

• In high-risk populations or with typical clinical features (scaling, lymphadenopathy, alopecia, kerion), start treatment immediately without waiting for culture results 1
• Otherwise, ideally wait for microscopy or culture confirmation 1

Adjunctive Topical Therapy

• Topical therapy alone is not recommended for tinea capitis 1
• Use as adjunctive therapy to reduce transmission of spores:
  • Selenium sulfide 1% shampoo
  • Ketoconazole 2% shampoo
  • Povidone-iodine shampoo 1

Second-line Treatment Options

• Itraconazole: 50-100mg daily for 4 weeks 2
• Fluconazole: Consider only in exceptional circumstances 2

Treatment Duration

• Continue treatment until the infecting organism is completely eradicated 3
• Typical duration for tinea capitis: 4-6 weeks 3
• Treatment should continue for at least one week after clinical resolution 2

Monitoring and Follow-up

• Clinical improvement expected within 1-2 weeks of starting treatment
• The endpoint of treatment should be mycological cure, not just clinical improvement 2
• Consider follow-up mycological examination in resistant or recurrent cases 2

Treatment Failure Considerations

If treatment fails, consider:

• Poor compliance
• Suboptimal absorption
• Relative insensitivity of the organism
• Reinfection 2

Prevention Measures

• Avoid sharing personal items (combs, brushes, hats)
• Screen and treat family members for anthropophilic infections
• Clean shared items with disinfectant 2

Important Caveats

1. Although newer antifungals like terbinafine have shorter treatment durations, griseofulvin remains the only FDA-approved treatment for tinea capitis in children 3
2. The causative organism should guide treatment choice - this may require adjusting therapy once culture results are available
3. Topical antifungal monotherapy is not effective for tinea capitis 4
4. Kerions (inflammatory lesions) may benefit from short-term corticosteroids in addition to antifungal therapy 5