Template:Tinea capitis treatment: Difference between revisions

Latest revision as of 20:13, 26 February 2020

Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetrating of hair follicles and may miss sites of subclinical infection
Griseofulvin (first line)
- No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
- Microsize formulation: 20-25 mg/kg per day (max daily dose 1000mg per day) for 6-12 weeks
  - Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 weeks
- Ultramicrosize formulation: 10-15 mg/kg (max daily dose 750mg per day) per day for 6-12 weeks
  - Typical initial dose 10mg/kg per day for 6-8 weeks, if partial response increase to 15mg.kg per day for 12 weeks
- Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
Terbinafine is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
- 10 to 20 kg: 62.5 mg daily for four to six weeks
- 20 to 40 kg: 125 mg daily for four to six weeks
- Above 40 kg: 250 mg daily for four to six weeks
Second line (both below with limited efficacy data):
- Fluconazole 6mg/kg PO (max daily dose 400mg)per day x 3-6 weeks
- Itraconazole 3-5mg/kg PO (max daily dose 400mg) per day 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)

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-===Antifungals===
+*Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetrating of hair follicles and may miss sites of subclinical infection
-*Coverage for Trichophyton and Microsporum and should use both topical and systemic therapy simultaneously
+*[[Griseofulvin]] (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====
+**Microsize formulation: 20-25 mg/kg per day (max daily dose 1000mg per day) for 6-12 weeks
-*Selenium sulfide 2.25% shampoo daily x 2 weeks
+***Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 weeks
-*Ketoconazole 2% shampoo daily x 2 weeks
+**Ultramicrosize formulation: 10-15 mg/kg (max daily dose 750mg per day) per day for 6-12 weeks
-====Systemic====
+***Typical initial dose 10mg/kg per day for 6-8 weeks, if partial response increase to 15mg.kg per day for 12 weeks
-*Fluconazole 150mg (6mg/kg) PO once a week x 8 weeks
+**Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
-*Griseofulvin 500mg (20mg/kg suspension) PO daily x 6 weeks
+*[[Terbinafine]] is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
-*Itraconazole 200mg (5mg/kg) PO daily x 4 weeks
+** 10 to 20 kg: 62.5 mg daily for four to six weeks
+** 20 to 40 kg: 125 mg daily for four to six weeks
+** Above 40 kg: 250 mg daily for four to six weeks
+*Second line (both below with limited efficacy data):
+**[[Fluconazole]] 6mg/kg PO (max daily dose 400mg)per day x 3-6 weeks
+**[[Itraconazole]] 3-5mg/kg PO (max daily dose 400mg) per day 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)