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Tinea%20capitis%20(pediatric) Treatment
Principles of Therapy
- Therapy aims to eradicate the infection and its symptoms in a safe and quick manner, to reduce long-term effects (ie scarring), and 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 - 1st-line Agents
Itraconazole
Fluconazole
Topical Antifungals
Corticosteroids
- Systemic antifungals penetrate and become incorporated into growing hairs, thus preventing the invasion of new fungal hyphae into hair
- Treatment of choice for tinea capitis, but length of therapy can affect patient compliance
- Preferred for patients infected with Microsporum sp (M canis, M audouinii)
- Fungistatic and inhibits the mitosis of dermatophytes by interacting with microtubules and disrupting the mitotic spindle
- Effects: Has been used for many decades with proven safety and efficacy in treating pediatric tinea capitis
- Clinical response is assessed after 6-8 weeks and treatment is continued for 2 weeks after obtaining negative cultures and negative KOH
- Fungicidal as it inhibits the membrane-bound enzyme in the biosynthetic pathway of sterol synthesis of the fungal cell membrane
- Preferred for patients infected with Trichophyton sp (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 with Griseofulvin
- Treatment for 8-10 weeks may be needed if used to treat Microsporum tinea capitis
Itraconazole
- Fungistatic and fungicidal as it inhibits ergosterol synthesis
- Treatment option for patients infected with Microsporum sp (M canis, M audouinii) or Nannizzia gypsea
- Effects: Studies have shown it to be as effective as Griseofulvin and Terbinafine
- Duration of treatment is shorter than with Griseofulvin
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
- 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)
Topical Antifungals
- Eg Clotrimazole 2%, Ciclopirox 1%, Ketoconazole 2%, Selenium sulfide 1% shampoo, Povidone-iodine
- Topical agents are used as adjunctive therapy to control spore loads in patients and asymptomatic carriers
Corticosteroids
- A short course may be given for kerions and severely inflamed lesions
- May reduce symptoms, speed up healing, lessen scarring and minimize risk of persistent alopecia
- Further studies are needed in regards to the use of this drug for tinea capitis
