Difference between revisions of "Tinea capitis"

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Latest revision as of 01:54, 28 September 2019

Background

  • Infection caused by dermatophytes that feed on keratin

Tinea Types

Clinical Features

Tinea Capitis

Differential Diagnosis

Neonatal Rashes

Evaluation

  • Clinical diagnosis
  • Can be complicated by development of kerion

Management

  • 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)

Disposition

  • Discharge

See Also

References