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)

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-*Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetrating of hair follicles and may miss sites of subclinical infection
+*Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetration of hair follicles and may miss sites of subclinical infection
-*[[Griseofulvin]] (first line)
+*{{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)
 **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
+**Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
-***Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 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)
-**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
+**{{AntibioticDose|drug=Fluconazole|dose=6mg/kg PO daily (max 400mg) x 3-6 weeks|context=Second line|disease=Tinea capitis|population=Pediatric}}
-**[[Itraconazole]] 3-5mg/kg PO (max daily dose 400mg) per day x 4-6 weeks
+**{{AntibioticDose|drug=Itraconazole|dose=3-5mg/kg PO daily (max 400mg) x 4-6 weeks|context=Second line|disease=Tinea capitis|population=Pediatric}}
 *Adjunctive interventions
-** Selenium sulfide 1 or 2.5%, ciclopirox 1%, or ketoconazole 2% shampoo at least twice weekly to decrease shedding of fungal spores
+**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
+**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)