Treatment of Tinea Around Lips and Cheeks in Pediatric Patients
For tinea infections around the lips and cheeks (tinea faciei), topical antifungal therapy alone is appropriate and effective, unlike scalp infections which require systemic treatment. 1
Recommended Topical Treatment Regimen
Apply terbinafine 1% cream once daily for 1-2 weeks for both children. 2 This fungicidal agent provides high cure rates with short treatment duration and is well-tolerated in pediatric patients ages 2-15 years. 2
Dosing for Both Patients:
- 10-year-old female (35 kg): Terbinafine 1% cream applied once daily to affected areas
- 5-year-old male (18 kg): Terbinafine 1% cream applied once daily to affected areas
The dosing is the same regardless of weight for topical therapy, as absorption is minimal and treatment is based on affected surface area. 2
Treatment Duration and Monitoring
Continue treatment for at least 1 week after complete clinical resolution to ensure mycological cure. 1 This typically means:
- Minimum treatment duration: 1 week of daily application 2
- Total duration: Continue for 1 additional week after lesions clear (usually 2-3 weeks total) 1
- Reassessment point: If no improvement after 2 weeks, reassess diagnosis or consider oral antifungal therapy 1
Clinical improvement should be evident within the first week, with efficacy rates of 92% for complete cure or significant improvement. 2
Critical Adjunctive Measures
Implement these infection control measures to prevent treatment failure and reinfection:
- Wash hands thoroughly after applying medication 1, 3
- Do not share towels, clothing, or bedding between family members 1
- Wash all clothing, bedding, and towels in hot water 1, 3
- Screen and treat family members showing signs of infection 1, 3
When Systemic Therapy Is Required
Consider oral antifungal therapy if:
- No improvement after 2 weeks of appropriate topical treatment 1
- Extensive or severe infection
- Immunocompromised status
- Recurrent infections despite adequate topical therapy
If systemic therapy becomes necessary, the choice depends on the causative organism (though this is rarely identified in facial tinea):
For Trichophyton species (most common):
For Microsporum species (less common):
- Griseofulvin:
- Both children (<50 kg): 15-20 mg/kg/day for 6-8 weeks 4
- 18 kg child: 270-360 mg daily
- 35 kg child: 525-700 mg daily
Common Pitfalls to Avoid
Do not discontinue treatment when symptoms improve but before completing the full course plus one additional week. 1 This is the most common cause of treatment failure and recurrence. 1, 3
Do not fail to address environmental contamination. Fungal spores persist on fomites and cause reinfection even with successful initial treatment. 1, 3
Do not assume treatment failure without ensuring compliance. Verify that medication is being applied daily and that infection control measures are being followed. 4
Adverse Effects Monitoring
Topical terbinafine is well-tolerated with minimal side effects. In pediatric studies, adverse reactions included itching (3%), itching with erythema (1%), and contact dermatitis (1%). 2 These are generally mild and do not require treatment discontinuation.