From the Guidelines
Tinea capitis should be treated with oral antifungal medication, with terbinafine being a preferred first-line therapy due to its shorter treatment course and higher efficacy against Trichophyton species, as recommended by the British Association of Dermatologists' guidelines 1.
Treatment Overview
The treatment of tinea capitis typically involves oral antifungal medication, with the choice of therapy directed by the causative dermatophyte and/or local epidemiology 1.
- Griseofulvin and terbinafine are the most widely used first-line treatments, with terbinafine being more efficacious against Trichophyton species and griseofulvin more effective against Microsporum species 1.
- The dosage of griseofulvin is 15-20 mg/kg/day for 6-8 weeks for children weighing less than 50 kg, and 1 g/day for 6-8 weeks for children weighing more than 50 kg 1.
- The dosage of terbinafine is 625 mg/day for 2-4 weeks for children weighing less than 20 kg, 125 mg/day for 2-4 weeks for children weighing 20-40 kg, and 250 mg/day for 2-4 weeks for children weighing more than 40 kg 1.
Additional Measures
- Children receiving appropriate therapy should be allowed to attend school or nursery 1.
- Index cases due to T. tonsurans warrant screening of all family members and close contacts and treatment for those positive cases 1.
- Asymptomatic carriers with a high spore load may require systemic treatment 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 3.
From the Research
Definition and Causes of Tinea Capitis
- Tinea capitis is a common superficial fungal infection of the scalp in children, particularly in those of African descent 4.
- Trichophyton tonsurans, an anthropophilic dermatophyte, is responsible for the majority of cases in North America 4.
- The predominant pathogen varies according to the geographical location, with Trichophyton tonsurans and Microsporum canis accounting for the majority of infections in North America and certain parts of Europe 5, 6.
Clinical Presentations
- The clinical presentations of tinea capitis are variable and include: + A "seborrheic" form that is scaling, often without noticeable hair loss + A pustular, crusted pattern, either localized or more diffuse + A "black dot" variety characterized by small black dots within areas of alopecia + A kerion, which is an inflammatory mass + A scaly, annular patch 4.
Treatment Options
- The current standard of care for the treatment of tinea capitis is oral griseofulvin, but evidence is accumulating that some of the newer antifungal agents may also be useful 5, 6.
- Newer oral antifungal agents such as terbinafine, itraconazole, and fluconazole seem to be effective, safe, and have the advantage of a shorter treatment duration 4, 7, 5.
- Terbinafine, itraconazole, and fluconazole have been shown to be comparable in efficacy and safety with griseofulvin 7, 8.
- Adjunctive therapy with sporicidal shampoos, such as selenium sulfide, can aid in removing adherent scales and hasten the eradication of viable spores from the scalp 4.
Comparison of Treatment Options
- Terbinafine for four weeks and griseofulvin for eight weeks showed similar efficacy for the primary outcome of complete cure in children with Trichophyton species infections 8.
- Itraconazole and griseofulvin have similar effects for the treatment of tinea capitis caused by Trichophyton species 8.
- Fluconazole has been shown to be effective in the treatment of tinea capitis, but more data is needed to determine its efficacy compared to other treatment options 7, 8.
- Ketoconazole may be less effective than griseofulvin in children infected with Trichophyton species 8.