tinea%20capitis%20(pediatric)
TINEA CAPITIS (PEDIATRIC)
Tinea capitis lesions are a type of contagious dermatophytosis that are found on the scalp, hair follicles and/or surrounding skin.
It is most common in the crowded areas as infection originates from contact with a pet or an infected person and asymptomatic carriage persists indefinitely.
It primarily affects children 3-7 year of age.
The causative agents are the genus Trichophyton and Microsporum.
Cardinal clinical feature is the combination of inflammation with hair breakage and loss.

Principles of Therapy

  • Therapy aims to eradicate the infection & its symptoms in a safe & quick manner, to reduce long-term effects (ie scarring), & to prevent further transmission
  • May start treatment based on symptomatology while waiting for diagnostic confirmation
  • Treatment of choice is based on main pathogen

Pharmacotherapy

Oral Antifungals
First-line Agents
  • Systemic antifungals penetrate & become incorporated into growing hairs, thus preventing the invasion of new fungal hyphae into hair
Griseofulvin
  • Treatment of choice for tinea capitis, but length of therapy can affect patient compliance
  • Preferred for patients infected w/ Microsporum species (M. canis, M. audounii)
  • Fungistatic & inhibits the mitosis of dermatophytes by interacting w/ microtubules & disrupting the mitotic spindle
  • Effects: Has been used for many decades w/ proven safety & efficacy in treating pediatric tinea capitis
  • Clinical response is assessed after 6-8 weeks & treatment is continued for 2 weeks after obtaining negative cultures & negative KOH
Terbinafine
  • Fungicidal as it inhibits the membrane-bound enzyme in the biosynthetic pathway of sterol synthesis of the fungal cell membrane
  • Preferred for patients infected w/ Trichophyton species (T. tonsurans, T. violaceum, T. soudanense)
  • Safety in children for tinea capitis has been established
  • Effects: Has been shown to be at least as effective as Griseofulvin
  • Duration of treatment is shorter than w/ Griseofulvin
    • Treatment for 8-10 weeks may be needed if used to treat Microsporum tinea capitis
Second-line Agent
Itraconazole
  • Fungistatic & fungicidal
  • Effects: Studies have shown it to be as effective as Griseofulvin & Terbinafine
  • Duration of treatment is shorter than w/ Griseofulvin
Alternative Agents
Fluconazole
  • Fungistatic triazole
  • Effects: Some small studies in children have shown that it may be an effective alternative to Griseofulvin
  • Duration of treatment is typically shorter than Griseofulvin
Voriconazole
  • A 2nd generation triazole antifungal agent
  • More potent against dermatophytes but not commonly used due to its undesirable side effects (ie visual disturbances, respiratory problems, headache, abdominal pain, etc)
Adjunctive Therapy
Topical Antifungals
  • Eg Ketoconazole 2%, Selenium sulfide 1% shampoo, Povidone-iodine
  • Topical agents are used as adjunctive therapy to control spore loads in patients & asymptomatic carriers
Other Therapy
Corticosteroids
  • A short course may be given for kerions & severely inflamed lesions
  • This may reduce symptoms & lessen scarring
  • Further studies are needed in regards to the use of this drug for Tinea capitis
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Jairia Dela Cruz, 13 Oct 2016
Children born to obese mothers are at increased risk of developing autism spectrum disorder (ASD) compared with children born to normal-weight mothers, according to data from a review and meta-analysis.
Yap Te-Lu, Anette Sundfor Jacobsen, 01 Oct 2013

Antenatal hydronephrosis (ANH) is a general term used to describe the dilatation of the fetal renal pelvis and/or its calyces. In pelviectasis, there is only dilatation of the renal pelvis; while in caliectasis, there is dilatation of the calyces. ANH is the most commonly diagnosed congenital urinary tract anomaly, which is detected by prenatal screening in 1–5% of all pregnancies

Yap Te-Lu, Anette Sundfor Jacobsen, 01 Dec 2012

Antenatal hydronephrosis (ANH) is a general term used to describe the dilatation of the fetal renal pelvis and/or its calyces. In pelviectasis, there is only dilatation of the renal pelvis; while in caliectasis, there is dilatation of the calyces. ANH is the most commonly diagnosed congenital urinary tract anomaly, which is detected by prenatal screening in 1–5% of all pregnancies.

Yap Te-Lu, Anette Sundfor Jacobsen, 01 Apr 2011

Antenatal hydronephrosis (ANH) is a general term used to describe the dilatation of the fetal renal pelvis and/or its calyces. In pelviectasis, there is only dilatation of the renal pelvis; while in caliectasis, there is dilatation of the calyces. ANH is the most commonly diagnosed congenital urinary tract anomaly, which is detected by prenatal screening in 1–5% of all pregnancies.