Treatment of Tinea Capitis

Aim of treatment: 

1. Eradication of symptoms
2. Alleviation of symptoms
3. Prevention of scarring and reduction of transmission to others

Treatment:

• Treat when there is presence of kerion or clinical symptoms such as scaling, enlargement of lymph nodes, or hair loss present in order to prevent further spread.

Kerion :

                                                       

TREATMENT	OPTIONS AND DOSING	COMMENTS
Topical treatment	Povidone Iodine              Ketoconazole              Selenium Sulfide 1% shampoo	Topical therapy alone is not recommended
Oral Therapy -    Varies according dermatophytes	Griseofulvin             Terbinafine           Itaconazole           Fluconazole            Voriconazole            Ketoconazole	Prolonged course or change of agent may be needed if treatment fails or if an unexpected fungus is identified

Medication	Treatment Dosing/ Comments		Availability
	Adult	Children
Griseofulvin - Treatment for 7-8 weeks	>50kg : 1g/day  <50kg : 15mg/kg -20mg/kg in single or divided doses	>1mth and >50kg : 1g/day >1mth and <50kg : 15mg/kg -20mg/kg in single or divided doses	Griseofulvin (Ultramicrosize 125mg = 250mg Microsize) Tablet
Terbinafine -More effective against Trichophyton species than Microsporum -Treatment for 2-4 weeks	<20kg : 62.5mg/day 20-40kg :125mg/day >40kg : 250mg/day	<20kg : 62.5mg/day 20-40kg : 125mg/day >40kg : 250mg/day	Terbinafine HCl 250mg tablet
Itraconazole	50-100mg/day for 4 weeks	5mg/kg daily for 2-4 weeks	Itraconazole 100mg capsule
Fluconazole -For 3 to 6 weeks for daily dosing - For 6-12 weeks for weekly dosing	6mg/kg/day or 6mg/kg once weekly	6mg/kg stat then 3mg/kg daily	Fluconazole 50mg, 100mg capsule
Voriconazole	No data		Voriconazole 200mg tablet
Ketoconazole	Symptoms resolution appears slower and poor side-effect profile thus oral ketoconazole was withdrawn from use both in UK and Europe		Ketoconazole 200mg tablet

AVAILABILITY IN HOSPITAL KENINGAU

• T. Griseofulvin
• C. Itraconazole 100mg
• C. Fluconazole 50mg 
• T. Ketoconazole 200mg

FISRT LINE

• Griseofulvin, Terbinafine
• General rule : Griseofulvin  more effective against Microsporum species while Terbinafine more effective against Trichophyton

SECOND LINE

• Itraconazole (effective against both species)

TREATMENT FAILURE

• Ensure compliance, if there is clinical improvement but positive mycology (fungi is still isolated) continue the current treatment for another 2-4 weeks. 
• If no clinical improvement proceed to second line

REFERENCES

1. British Association of Dermatologists 2014

2. www.uptodate.com

3. Drug Doses