Oral Griseofulvin Remains the Treatment of Choice for Tinea Capitis in Children

Abstract

Tinea capitis is one of the most common infections of children. The standard treatment is griseofulvin. Itraconazole and terbinafine have in large part replaced griseofulvin in the treatment of onychomycosis and, in addition to fluconazole and ketoconazole, are evolving treatments for tinea capitis. The purpose of this review is to compare the efficacy, safety, and cost of oral antifungal agents for tinea capitis. Small, open-label studies of itraconazole, terbinafine, and fluconazole have reported encouraging results, suggesting that these drugs may be effective alternatives to griseofulvin; however, in large controlled studies griseofulvin continues to exhibit greater or equal efficacy. Ketoconazole appears to be the least efficacious. All five drugs appear relatively safe, however, only griseofulvin has a long track record of safety, is Food and Drug Administration (FDA) approved for the treatment of tinea capitis in children, and has the least known drug interactions. Fluconazole is FDA approved for use in children more than 6 months of age, yet not for the treatment of tinea capitis. Oral griseofulvin and terbinafine tablets are the least expensive of the antifungal agents; griseofulvin suspension is, however, more expensive than fluconazole suspension. For the combined reasons of efficacy, safety, and cost, and a long track record of use, we feel oral griseofulvin is still the present treatment of choice for tinea capitis. Newer antifungals are currently under investigation, and their role in treating tinea capitis in children is still being defined.

Treatment of Tinea Capitis

“…Griseofulvin has an excellent safety profile and no laboratory monitoring is required [21]. In a randomized clinical trial, the frequency of adverse events attributed to griseofulvin when used to treat tinea capitis was found to be 8.3 versus 9.2% for terbinafine [22].…”

Poly(lactide)‐poly(ethylene glycol) micelles as a carrier for griseofulvin

“…It remains the drug of choice for tinea capitis in children. 25 Due to its very low aqueous solubility, griseofulvin exhibits a slow, erratic and incomplete absorption following oral administration. 26 Formulation strategies, such as preparation of solid dispersions, 27 association…”

A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis

“…Since that time, a multitude of diverse selective pressures including the availability of contemporary diagnostic tests, migratory phenomena, changing lifestyle habits, 4 and decades of griseofulvin use have led to griseofulvin-tolerant Trichophyton tonsurans, accompanying increases in the incidence of this organism such that it now accounts for more than 95% of tinea capitis cases in the United States 5,6 and a steadily increasing incidence of tinea capitis over the past 30 years. [7][8][9][10] The tolerance of T tonsurans to griseofulvin is manifest in comparison of past and present treatment recommendations. In 1974, a griseofulvin dose of 10 mg/kg per day for a duration of 4 weeks was sufficient for the treatment of most cases of tinea capitis.…”