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tinea%20capitis%20(pediatric)
TINEA CAPITIS (PEDIATRIC)
Treatment Guideline Chart
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.

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
  • Systemic antifungals penetrate and 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 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
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 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
Oral Antifungals - 2nd-line Agent
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
Oral Antifungals - 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 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
Other Therapy
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
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