What is the treatment for tinea capitis (ringworm of the hair)?

From the Guidelines

To treat tinea capitis, oral antifungal medication is the recommended treatment, with terbinafine and griseofulvin being the most widely used first-line treatments, as topical therapy alone is not effective 1. The choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1. Some key points to consider when treating tinea capitis include:

• The dosage of terbinafine is weight-based: < 20 kg: 625 mg per day for 2–4 weeks, 20–40 kg: 125 mg per day for 2–4 weeks, and > 40 kg: 250 mg per day for 2–4 weeks 1.
• The dosage of griseofulvin is also weight-based: < 50 kg: 15–20 mg kg−1 per day for 6–8 weeks, and > 50 kg: 1 g per day for 6–8 weeks 1.
• Treatment failure should be initially considered due to lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and second-line therapy with itraconazole may be necessary 1.
• Additional measures such as using antifungal shampoo and washing all combs, brushes, and headwear are also important to reduce spore shedding and prevent reinfection 1. It is essential to continue treatment for the full prescribed duration, even if symptoms improve earlier, to ensure mycological clearance and prevent recurrence 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 tinea capitis (ringworm of the hair) is griseofulvin (PO), with a treatment period of 4 to 6 weeks 2. The dosage is 10 mg/kg daily for pediatric patients older than 2 years, and 0.5 g daily for adults 2.

From the Research

Treatment Options for Tinea Capitis

The treatment for tinea capitis, also known as ringworm of the hair, typically involves the use of systemic antifungal agents. The following are some of the treatment options:

• Griseofulvin: This is a traditional antifungal agent that has been used for many years to treat tinea capitis 3, 4, 5. The recommended dosage is 20-25 mg/kg/day for 6-8 weeks.
• Terbinafine: This is a newer antifungal agent that has been shown to be effective in treating tinea capitis 3, 4, 6, 5. The recommended dosage is 250 mg/day for 6 weeks for children over 40 kg, 125 mg/day for 6 weeks for children between 20-40 kg, and 62.5 mg/day for 6 weeks for children under 20 kg.
• Itraconazole: This is another newer antifungal agent that has been used to treat tinea capitis 3, 6, 7. The recommended dosage is 5 mg/kg/day for 2-3 weeks.
• Fluconazole: This antifungal agent has also been used to treat tinea capitis 3, 6, 7. The recommended dosage is 6 mg/kg/day for 2-3 weeks.

Adjunctive Therapy

In addition to systemic antifungal agents, adjunctive therapy may be beneficial in treating tinea capitis. This includes:

• Sporicidal shampoos: These can aid in removing adherent scales and hasten the eradication of viable spores from the scalp 3.
• Corticosteroids: These may be used to treat kerions, which are inflammatory masses that can occur in tinea capitis 3. However, their use is controversial and should be approached with caution.

Efficacy and Safety

The efficacy and safety of these treatment options have been studied in several clinical trials. One study found that griseofulvin, terbinafine, itraconazole, and fluconazole were all effective in treating tinea capitis, with cure rates ranging from 84-94% 6. Another study found that itraconazole and terbinafine were equally or more effective than griseofulvin in treating tinea capitis, with fewer side effects 7. Overall, the choice of treatment will depend on the specific needs of the patient and the severity of the infection.