From the Guidelines
Oral antifungal medications, specifically griseofulvin or terbinafine, are the recommended treatment for Tinea capitis, with the choice of therapy directed by the causative dermatophyte and/or local epidemiology. The treatment of Tinea capitis should be guided by the most recent and highest quality evidence, which suggests that oral therapy is generally indicated to achieve both clinical and mycological cure 1.
Treatment Options
- Griseofulvin is a suitable option, with a recommended dose of 15-20 mg/kg/day for children weighing less than 50 kg, and 1 g per day for children weighing more than 50 kg, for a duration of 6-8 weeks 1.
- Terbinafine is also effective, with a recommended dose of 625 mg per day for children weighing less than 20 kg, 125 mg per day for children weighing 20-40 kg, and 250 mg per day for children weighing more than 40 kg, for a duration of 2-4 weeks 1.
- Itraconazole can be considered as a second-line therapy, with a recommended dose of 50-100 mg per day for 4 weeks, or 5 mg/kg/day for 2-4 weeks 1.
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery, and index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
- The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.
- Adjunctive therapy with antifungal shampoos can help reduce spore shedding and prevent transmission, although this is not explicitly mentioned in the provided evidence, it is a common practice in clinical settings.
Treatment Failure
- In cases of treatment failure, it is essential to consider lack of compliance, suboptimal absorption of the drug, relative insensitivity of the organism, and reinfection, and adjust the treatment plan accordingly 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 scalp) 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 scalp, typically involves oral antifungal medications. The current standard of care for the treatment of tinea capitis in the USA is oral griseofulvin 3, 4, 5, 6. However, evidence is accumulating that some of the newer antifungal agents, such as terbinafine, itraconazole, and fluconazole, may also be effective and safe for the treatment of tinea capitis 3, 4, 5, 7, 6.
Oral Antifungal Medications
Some of the oral antifungal medications used to treat tinea capitis include:
- Griseofulvin: considered the drug of choice for tinea capitis, highly efficacious, and has an excellent long-term safety record 5
- Terbinafine: shown to be effective and well-tolerated in the treatment of tinea capitis, particularly against Trichophyton tonsurans 4, 7
- Itraconazole: effective and safe for the treatment of tinea capitis, with a shorter treatment duration compared to griseofulvin 3, 4, 6
- Fluconazole: also effective and safe for the treatment of tinea capitis, although fewer trials have been conducted using this medication 3, 4, 6
Adjuvant Topical Therapy
In addition to oral antifungal medications, adjuvant topical therapy may be recommended to reduce surface colony counts of dermatophytes in infected individuals. Some options include:
Treatment Duration and Efficacy
The treatment duration and efficacy of these medications may vary depending on the specific medication and the causative organism. For example, terbinafine has been shown to be effective against Trichophyton tonsurans with a shorter treatment duration compared to griseofulvin 7. In contrast, griseofulvin may be more effective against Microsporum canis 7.