What is the treatment for tinea capitis (ringworm of the scalp)?

From the Guidelines

Tinea capitis treatment involves oral antifungal therapy, as topical therapy alone is not recommended.

Treatment Overview

• The choice of systemic therapy should be 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.

First-line Therapy

• Griseofulvin dose: 15-20 mg/kg/day for 6-8 weeks for children < 50 kg, and 1 g/day for 6-8 weeks for children > 50 kg 1.
• Terbinafine dose: 625 mg/day for 2-4 weeks for children < 20 kg, 125 mg/day for 2-4 weeks for children 20-40 kg, and 250 mg/day for 2-4 weeks for children > 40 kg 1.

Second-line Therapy

• Itraconazole is a safe and effective alternative, with a dose of 50-100 mg/day for 4 weeks or 5 mg/kg/day for 2-4 weeks 1.

Additional Measures

• Children receiving treatment should be allowed to attend school or nursery, and index cases due to T. tonsurans warrant screening and treatment of family members and close contacts 1.
• The end point of treatment is mycological clearance, and repeat mycology sampling is recommended until clearance is achieved 1.

From the Research

Treatment Options for Tinea Capitis

The treatment for tinea capitis, a fungal infection of the scalp, typically involves oral antifungal therapy. The following options are available:

• Griseofulvin: considered the drug of choice for tinea capitis by many experts 2, 3
• Terbinafine: shown to be effective and safe, with a shorter treatment duration compared to griseofulvin 2, 4, 5
• Itraconazole: also effective and safe, with a shorter treatment duration compared to griseofulvin 2, 4, 5
• Fluconazole: may be used, although there is less evidence available compared to the other options 2, 4, 5

Adjuvant Therapy

In addition to oral antifungal therapy, adjuvant topical therapy may be recommended, including:

• 2% ketoconazole shampoo 2
• 1% selenium sulfide shampoo 2, 3

Treatment Duration and Efficacy

The treatment duration and efficacy of the different options vary:

• Griseofulvin: typically given for 6-8 weeks 2, 3, 5
• Terbinafine: given for 2-4 weeks 4, 5
• Itraconazole: given for 2-6 weeks 2, 4, 5
• Fluconazole: given for 2-4 weeks 4, 5 The efficacy of the different options is similar, with cure rates ranging from 84% to 94% 4, 5