Monday, January 25, 2016

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Symptoms resolution appears slower and poor side-effect profile thus oral ketoconazole was withdrawn from use both in UK and Europe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

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