What is the treatment for fungal skin and hair infections in children?

Treatment of Fungal Skin and Hair Infections in Children

The treatment of choice for tinea capitis (fungal scalp infection) in children is oral griseofulvin, while topical antifungal agents are generally recommended for superficial fungal skin infections. 1

Diagnosis

Before initiating treatment, proper diagnosis is essential:

• Collect appropriate specimens for laboratory testing (KOH preparation, fungal culture, or biopsy) 2
• For tinea capitis, examine the scalp for:
  • Black dots (broken hair shafts)
  • Scaling
  • Kerion (painful, boggy inflammatory mass)
  • Regional lymphadenopathy 1
• Use Wood's lamp examination to identify certain types of fungal infections (particularly M. canis) 1

Treatment Algorithm for Fungal Infections in Children

1. Tinea Capitis (Scalp Infection)

First-line treatment:

• Oral griseofulvin:
  • Dosage based on weight and severity
  • Treatment duration typically 6-8 weeks or until mycological clearance 1
• Adjunctive therapy:
  • Anti-fungal shampoo (e.g., selenium sulfide or ketoconazole) to reduce spore shedding 1

Alternative treatments:

• Terbinafine (for Trichophyton species)
• Fluconazole (for children >10 years) 1, 3
• Itraconazole (in specific cases) 1

Important considerations:

• The endpoint of treatment is mycological rather than clinical cure; repeat mycology sampling until clearance 1
• Screen and treat family members as >50% may be affected, often with occult disease 1
• Children with tinea capitis can attend school while receiving appropriate treatment 1

2. Superficial Fungal Skin Infections (Tinea Corporis, Tinea Cruris, Tinea Pedis)

First-line treatment:

• Topical antifungal agents:
  • Azoles (clotrimazole, miconazole)
  • Allylamines (terbinafine)
  • Apply for 1-2 weeks beyond clinical resolution 4, 5

For extensive or resistant infections:

• Consider oral antifungal therapy:
  • Griseofulvin
  • Terbinafine
  • Fluconazole (for children >10 years) 3, 5

3. Fungal Nail Infections (Onychomycosis)

• For mild cases: Topical ciclopirox 8% nail lacquer 6
• For moderate to severe cases: Oral terbinafine or itraconazole 6
• Children generally respond better and faster to treatment than adults 6

Special Considerations

Neonates and Infants

• Tinea capitis is rare in neonates but requires special attention
• Topical antifungals may be considered in very young infants when systemic therapy poses risks 7
• For neonates with fungal skin infections, monitor closely for signs of systemic spread 1

Prevention of Recurrence

• Cleanse hairbrushes and combs with disinfectant (2% aqueous solution of sodium hypochlorite) 1
• Wear protective footwear in public areas
• Apply absorbent powder and antifungal powders in shoes
• Wear cotton, absorbent socks
• Keep nails short 6

Monitoring and Follow-up

• Regular follow-up to assess treatment response
• Repeat mycological testing until clearance for tinea capitis 1
• Monitor for adverse effects of systemic antifungals
• For oral antifungals, be aware of potential drug interactions, particularly with azoles 8

Common Pitfalls to Avoid

• Treating tinea capitis with topical therapy alone (insufficient penetration into hair follicles)
• Discontinuing treatment prematurely based on clinical improvement rather than mycological cure
• Failing to screen and treat family members in cases of tinea capitis
• Misdiagnosing kerion as bacterial abscess 1
• Using systemic antifungals without proper diagnosis confirmation 2

By following these evidence-based guidelines, most fungal skin and hair infections in children can be effectively treated with minimal complications and reduced risk of recurrence.