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