Tinea%20capitis Treatment

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

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