Template:Tinea capitis treatment: Difference between revisions

Latest revision as of 22:30, 20 March 2026

Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetration of hair follicles and may miss sites of subclinical infection
Griseofulvin Microsize: 20-25 mg/kg/day (max 1000mg) x 6-12 weeks; Ultramicrosize: 10-15 mg/kg/day (max 750mg) x 6-12 weeks (first line)
- No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
- Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
Terbinafine 10-20kg: 62.5mg daily; 20-40kg: 125mg daily; >40kg: 250mg daily x 4-6 weeks is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
Second line (both below with limited efficacy data):
- Fluconazole 6mg/kg PO daily (max 400mg) x 3-6 weeks
- Itraconazole 3-5mg/kg PO daily (max 400mg) x 4-6 weeks
Adjunctive interventions
- Selenium sulfide 1 or 2.5%, ciclopirox 1%, or ketoconazole 2% shampoo at least twice weekly to decrease shedding of fungal spores
- Use of antifungal shampoo by other household members may also decrease the risk for reinfection
- Combs and hair trimming equipment be cleaned mechanically and disinfected (eg, with household bleach)

@@ Line 1: / Line 1: @@
-===Antifungals===
+*Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetration of hair follicles and may miss sites of subclinical infection
-*Coverage for Trichophyton and Microsporum and should use both topical and systemic therapy simultaneously
+*{{AntibioticDose|drug=Griseofulvin|dose=Microsize: 20-25 mg/kg/day (max 1000mg) x 6-12 weeks; Ultramicrosize: 10-15 mg/kg/day (max 750mg) x 6-12 weeks|context=First line|disease=Tinea capitis|population=Pediatric}} (first line)
-*Baseline liver function required prior to systemic antifungals
+**No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
-====Topical====
+**Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
-*[[Selenium sulfide]] 2.25% shampoo daily x 2 weeks
+*{{AntibioticDose|drug=Terbinafine|dose=10-20kg: 62.5mg daily; 20-40kg: 125mg daily; >40kg: 250mg daily x 4-6 weeks|context=Alternative first line|disease=Tinea capitis|population=Pediatric}} is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
-*[[Ketoconazole]] 2% shampoo daily x 2 weeks
+*Second line (both below with limited efficacy data):
-====Systemic====
+**{{AntibioticDose|drug=Fluconazole|dose=6mg/kg PO daily (max 400mg) x 3-6 weeks|context=Second line|disease=Tinea capitis|population=Pediatric}}
-*[[Fluconazole]] 150mg (6mg/kg) PO once a week x 8 weeks
+**{{AntibioticDose|drug=Itraconazole|dose=3-5mg/kg PO daily (max 400mg) x 4-6 weeks|context=Second line|disease=Tinea capitis|population=Pediatric}}
-*[[Griseofulvin]] 500mg (20mg/kg suspension) PO daily x 6 weeks
+*Adjunctive interventions
-*[[Itraconazole]] 200mg (5mg/kg) PO daily x 4 weeks
+**Selenium sulfide 1 or 2.5%, ciclopirox 1%, or ketoconazole 2% shampoo at least twice weekly to decrease shedding of fungal spores
+**Use of antifungal shampoo by other household members may also decrease the risk for reinfection
+**Combs and hair trimming equipment be cleaned mechanically and disinfected (eg, with household bleach)