Tinea%20capitis Treatment

• 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

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