What is the treatment for Tinea capitis?

Treatment of Tinea Capitis

The first-line treatment for tinea capitis is oral griseofulvin at a dose of 10-20 mg/kg/day for 4-6 weeks, with appropriate diagnosis confirmation through KOH preparation or fungal culture. 1

Diagnosis Before Treatment

• Confirm diagnosis through:
  • Microscopic examination (KOH preparation)
  • Fungal culture
  • Scalp samples via scalpel scraping, hair pluck, brush or swab 2
• Treatment can be initiated while awaiting confirmatory mycology if clinical signs are present:
  • Scale
  • Lymphadenopathy
  • Alopecia
  • Kerion 2

Treatment Options

First-Line Treatment

• Oral griseofulvin:
  • Dosage: 10-20 mg/kg/day 1
  • Duration: 4-6 weeks 1
  • For children: 10 mg/kg daily (125-250 mg daily for 30-50 lbs; 250-500 mg daily for >50 lbs) 1
  • For adults: 0.5 g daily (125 mg four times daily, 250 mg twice daily, or 500 mg once daily) 1
  • More severe cases may require higher starting doses (0.75-1.0 g/day) 1

Alternative Treatment Options

When griseofulvin fails or is not tolerated, consider:

1. Terbinafine:

   • 250 mg daily for adults
   • Duration: 1-2 weeks
   • Particularly effective for Trichophyton species infections 2

2. Itraconazole:

   • 5 mg/kg/day or 50-100 mg daily
   • Duration: 4 weeks
   • Effective for both Trichophyton and Microsporum species 2

3. Fluconazole:

   • 6 mg/kg/day
   • Duration: 2-3 weeks
   • May be used in exceptional circumstances 2, 3

Treatment Considerations by Causative Organism

• Trichophyton species: Griseofulvin (6 weeks), terbinafine (2-3 weeks), itraconazole (2-3 weeks), or fluconazole (2-3 weeks) all show comparable efficacy 3
• Microsporum species: Griseofulvin (15-20 mg/kg/day for 6-8 weeks) is particularly effective 2

Adjunctive Therapy

• Sporicidal shampoos (selenium sulfide) to remove scales and reduce spore viability 4
• Topical antifungal agents may be used concurrently with systemic therapy 1

Treatment Duration and Follow-up

• Continue treatment until mycological cure is achieved 2
• Clinical improvement typically expected within 1-2 weeks 2
• Treatment should continue for at least one week after clinical resolution 2
• Follow-up mycological examination is recommended until clearance is achieved 2

Prevention of Reinfection

• Screen and treat all household members for anthropophilic infections 2
• Cleanse personal items (combs, brushes) with disinfectant 2
• Avoid sharing personal items 2
• Apply antifungal powders to prevent reinfection 2

Safety Profiles

• Griseofulvin: Generally well-tolerated with extensive safety data in children; side effects include gastrointestinal disturbances and rashes in <8% of patients 2
• Terbinafine: Generally well-tolerated but can cause gastrointestinal and dermatological events; rare serious adverse reactions include Stevens-Johnson syndrome and hepatic toxicity 2
• Itraconazole: Generally well-tolerated with primarily gastrointestinal side effects, cutaneous eruptions, and occasional headache 2

Common Pitfalls and Caveats

• Failure to confirm diagnosis before treatment can lead to inappropriate therapy
• Inadequate treatment duration is a common cause of treatment failure
• Not treating household contacts can lead to reinfection
• Monitoring for liver enzyme elevations is generally unnecessary if therapy is limited to ≤4 weeks 4
• Clinical relapse will occur if medication is not continued until the infecting organism is eradicated 1