Tinea Capitis: An Overview with Emphasis on Management

Abstract

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichophyton tonsurans now predominates over Micro-sporum audouinii. With this transition the utility of the Wood's light for diagnosis has been reduced since T. tonsurans infection is Wood's light negative. Griseofulvin has been the mainstay of therapy for the last 40 years. The newer antifungal agents-itraconazole, terbinafine, and fluconazole-appear to be effective and safe for the treatment of tinea capitis. When tinea capitis is due to T. tonsurans or other endothrix species the following regimens have been used: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen with capsules (5 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart), and itraconazole pulse regimen with oral solution (3 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart). With terbinafine tablets the continuous regimen (>40 kg body weight, 250 mg/day; 20-40 kg, 125 mg/day; and <20 kg, 125 mg/day) is given for 2 to 4 weeks. Fluconazole tablets or oral suspension (6 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once-weekly regimen may also be effective. When ectothrix organisms (e.g., Microsporum canis) are present, a longer duration of therapy may be required. The data suggest that the newer agents are effective, safe with few adverse effects, and have a high benefit:risk ratio. It remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection.

Tinea capitis in Brussels: Epidemiology and New Management Strategy

“…Fluconazole oral solution is safe and well accepted by the youngsters. Its efficacy has mainly been proven in TC due to Trichophyton spp., but it has also scored good results in cases due to Microsporum canis [2]. We previously used fluconazole oral solution with good clinical results in children infected by Microsporum langeronii and not willing to take tablets or capsules.…”

“…Itraconazole is a good therapeutic option for M. langeronii and M. canis [2, 3]. It was used at the dose of 5 mg/kg daily.…”

The New Species Concept in Dermatophytes—a Polyphasic Approach

“…The latter fungus to some extent evades drug exposure by forming arthroconidia outside the hair shaft, while the former forms arthroconidia inside the hair shaft where contact with conventional anti-fungal drugs is relatively high [2].…”

Microepidemia familiar por Trichophyton tonsurans

“…14 The infant, on the other hand, was treated with griseofulvin. According to Gupta, this drug is the first choice for children, as long as there is dosage adjustment and treatment monitoring.…”