What is the treatment for tinea capitis?

Treatment for Tinea Capitis

Oral antifungal therapy is the standard of care for tinea capitis, with the choice of medication depending on the causative organism and local epidemiology. 1, 2

Diagnosis and Initial Assessment

• All specimens from suspected tinea capitis cases should be processed for microscopy and culture where possible to identify the causative agent 1
• In high-risk populations or when clinical features strongly suggest tinea capitis (scaling, lymphadenopathy, alopecia, kerion), treatment can be started immediately before culture results 1
• Accurate diagnosis through scalp lesion sampling via scraping, hair pluck, brush, or swab is essential for proper management 2

First-Line Treatment Options

Oral Antifungal Therapy

• Griseofulvin is the only licensed antifungal specifically for tinea capitis in children in many countries 2, 3

  • Dosage: 20 mg/kg/day for 6-8 weeks (may need up to 25 mg/kg/day in resistant cases) 1
  • For pediatric patients: 10 mg/kg daily (125-250 mg daily for 30-50 lbs; 250-500 mg daily for >50 lbs) 3
  • More effective against Microsporum species (88.5% response rate) than Trichophyton species (67.9%) 1, 2
  • Should be taken with fatty food to increase absorption 1

• Terbinafine

  • Dosage: 62.5 mg daily for children <20 kg for 2-4 weeks 2
  • More effective against Trichophyton species than Microsporum species 2, 4
  • Not licensed for use in children in the UK but widely used 1

• Itraconazole and Fluconazole are alternative options with shorter treatment courses 5, 4

Treatment Selection Algorithm

1. If causative organism is known:

   • For Trichophyton species: Terbinafine is preferred 2, 4
   • For Microsporum species: Griseofulvin is preferred 2, 4

2. If organism is unknown:

   • Consider local epidemiology to guide initial therapy 1
   • Griseofulvin remains a good first choice due to its broad efficacy and established safety profile 6, 7

Adjunctive Therapy

• Topical therapy alone is not recommended for tinea capitis 1, 2
• Topical antifungal shampoos (povidone-iodine, ketoconazole 2%, selenium sulfide 1%) help reduce transmission of spores 1, 5
• These shampoos should be used as adjunctive therapy to systemic treatment 2, 7

Treatment Duration and Monitoring

• Treatment should continue until mycological cure is achieved, not just clinical improvement 1, 2
• Follow-up should include both clinical and mycological assessment 2
• If clinical improvement occurs but mycology remains positive, continue current therapy for an additional 2-4 weeks 2

Common Pitfalls and Caveats

• Treatment failure may be due to poor compliance, suboptimal absorption, or relative insensitivity of the organism 2
• Terbinafine is less effective for Microsporum infections and may lead to treatment failures if used as first-line therapy for these infections 2, 4
• Children receiving appropriate therapy can attend school or nursery 2
• Family members and close contacts should be screened if T. tonsurans is identified 2

Prevention of Spread and Recurrence

• Implement preventive measures including cleaning contaminated combs and brushes with disinfectant 2
• Screen and treat family members if infection is caused by anthropophilic species 2