From the Guidelines
Tinea capitis should be treated with oral antifungal therapy, with griseofulvin and terbinafine being the most widely used first-line treatments, as recommended by the British Association of Dermatologists' guidelines for the management of tinea capitis 2014 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 in the treatment of tinea capitis include:
- The dose of griseofulvin should be 15-20 mg/kg/day for children weighing less than 50 kg, and 1 g/day for children weighing more than 50 kg, for a duration of 6-8 weeks 1.
- The dose of terbinafine should be 625 mg/day for children weighing less than 20 kg, 125 mg/day for children weighing 20-40 kg, and 250 mg/day for children weighing more than 40 kg, for a duration of 2-4 weeks 1.
- Topical therapy alone is not recommended for the treatment of tinea capitis, but may be used in addition to oral antifungal therapy to reduce spore shedding 1.
- Family members and close contacts should be screened for the infection, and treated if necessary, to prevent transmission 1.
- The end point of treatment is mycological rather than clinical cure, and repeat mycology sampling is recommended until mycological clearance is achieved 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Representative treatment periods are tinea capitis, 4 to 6 weeks; INDICATIONS AND USAGE ... Tinea capitis
- Treatment Duration: The recommended treatment period for Tinea capitis is 4 to 6 weeks 2.
- Indication: Griseofulvin is indicated for the treatment of Tinea capitis when caused by certain species of fungi 2.
From the Research
Tinea Capitis Treatment Options
- Tinea capitis is a common fungal infection of childhood, and various treatment options are available, including griseofulvin, terbinafine, itraconazole, and fluconazole 3, 4, 5, 6, 7.
- Griseofulvin has been the mainstay of management, but newer oral antifungal agents are being used more frequently due to their shorter treatment duration and comparable efficacy 3, 6, 7.
Efficacy of Treatment Options
- A study comparing griseofulvin, terbinafine, itraconazole, and fluconazole found that griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2-3 weeks 3.
- Another study found that griseofulvin had a cure rate of 96%, terbinafine had a cure rate of 88%, and fluconazole had a cure rate of 84% 4.
- Terbinafine was found to be significantly better than griseofulvin for all cure rates among patients with Trichophyton tonsurans, but not Microsporum canis 5.
Safety and Adverse Effects
- Adverse effects were reported only in the griseofulvin group, including gastrointestinal effects and nausea 3.
- Approximately 50% of patients in each group reported an adverse event, but most were mild or moderate in severity 5.
- No drug-related serious adverse events, deaths, or significant effects on weight or laboratory parameters were reported 5.
Current Recommendations
- Griseofulvin is currently considered the drug of choice for tinea capitis, but terbinafine, itraconazole, and fluconazole are effective alternatives 6, 7.
- The use of antifungal shampoos is recommended as adjuvant therapy to decrease the viability of fungal spores present on the hair and prevent infection or eliminate the carrier state 7.