tinea%20capitis
TINEA CAPITIS
Tinea capitis  is a contagious dermatophytosis affecting the hair shaft and follicles of the scalp, eyebrows and eyelashes.
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 years 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 Treatment

Principles of Therapy

  • Therapy aims to eradicate the infection & its symptoms in a safe & quick manner, to reduce long-term effects (eg 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

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. audouinii)
  • 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 should be discontinued after obtaining negative cultures & negative potassium hydroxide (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

Oral Antifungals - Second-line Agent

Itraconazole

  • Fungistatic & fungicidal
  • Effects: Studies have shown it to be as effective as Griseofulvin & Terbinafine
  • May be used against both Trichophyton & Microsporum species
  • Duration of treatment is shorter than w/ 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 (eg visual disturbances, respiratory problems, headache, abdominal pain, etc)

Adjunctive Therapy

Topical Antifungals

  • Eg Ciclopirox 1%, Ketoconazole 2%, Selenium sulfide 2.5% 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 together with antifungal agents
  • 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 Infectious Diseases - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Roshini Claire Anthony, 13 Nov 2020

Diabetes is a key risk factor for heart failure (HF), which is the leading cause of hospitalization in patients with or without diabetes. SGLT-2* inhibitors (SGLT-2is) have been shown to reduce the risk of hospitalization for HF (HHF) regardless of the presence or absence of diabetes.

5 days ago
Vitamin D deficiency may be a contributing factor to the mortality rate among patients with the novel coronavirus disease (COVID-19), reports a new study.
Pearl Toh, 4 days ago
Inhaled corticosteroid (ICS) should be the mainstay of long-term asthma management — such is the key message of the latest Singapore ACE* Clinical Guidance (ACG) for asthma, released in October 2020.
17 Nov 2020
Invasive fungal infections, particularly those caused by Candida species, are common in hospitalized, immunocompromised, or critically ill patients and are associated with considerable morbidity and mortality.