Treatment of Dermatophyte Infections in Children
For dermatophyte infections in children, the recommended treatment is oral antifungal therapy with selection based on the specific dermatophyte species, with griseofulvin being the only licensed treatment for tinea capitis in children in the UK. 1
Diagnosis and Initial Assessment
Laboratory diagnosis is essential before treatment:
- Collect samples via scalpel scraping, hair pluck, brush or swab
- Process specimens for microscopy and culture
- Susceptibility testing is not indicated 1
In cases with kerion or cardinal clinical signs (scale, lymphadenopathy, alopecia), treatment can begin while awaiting confirmatory mycology 1
Treatment Algorithm by Infection Type
Tinea Capitis
First-line therapy (based on causative organism):
Second-line therapy:
- Itraconazole: 50-100 mg/day for 4 weeks, or 5 mg/kg/day for 2-4 weeks 1
Alternative agents (for refractory cases):
- Fluconazole or voriconazole in exceptional circumstances 1
Tinea Pedis
- Mild to moderate: Topical antifungal agents
- Extensive or severe: Oral terbinafine 250 mg once daily for 1 week 3
- Similar efficacy to 4 weeks of topical clotrimazole but with faster clinical resolution
Tinea Corporis/Cruris
- Localized: Topical antifungals (allylamines or azoles)
- Extensive: Consider oral therapy with terbinafine or griseofulvin 4, 5
Important Clinical Considerations
Topical therapy alone is not recommended for tinea capitis - oral therapy is generally indicated to achieve both clinical and mycological cure 1
Treatment duration:
Treatment failure may be due to:
- Lack of compliance
- Suboptimal absorption of drug
- Relative insensitivity of the organism
- Reinfection 1
Additional measures:
- Children receiving appropriate therapy can attend school or nursery 1
- For T. tonsurans infections, screen all family members and close contacts 1
- For asymptomatic carriers with high spore load, systemic treatment is justified 1
- The endpoint of treatment is mycological rather than clinical cure; repeat mycology sampling until clearance 1
Medication Profiles
Griseofulvin
- Advantages: Licensed for use in children in the UK; extensive experience; suspension more palatable to children; allows accurate dosage adjustments 1, 2
- Disadvantages: Prolonged treatment required; increasingly expensive 1
- Side effects: Gastrointestinal disturbances and rashes (<8%); very few (0.8%) require discontinuation 1
- Contraindications: Lupus erythematosus, porphyria, severe liver disease 1
Terbinafine
- Advantages: Shorter treatment course (may increase compliance); fungicidal action 1, 6
- Limitations: Less effective against Microsporum species; not excreted in sweat or sebum of prepubertal children; cannot be incorporated into hair shaft in children 1
- Monitoring: Baseline liver function tests and complete blood count recommended 3
Itraconazole
- Profile: Safe and effective with activity against both Trichophyton and Microsporum species 1
- Use: Second-line therapy or for cases refractory to first-line treatments 1
Prevention Strategies
- Thoroughly dry between toes after bathing
- Change socks daily
- Clean athletic footwear regularly
- Use foot powder after bathing (reduces infection rates from 8.5% to 2.1%) 3
Remember that the choice of systemic therapy should be directed by the causative dermatophyte and/or local epidemiology, with treatment continued until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination 1, 2.