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.

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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