TREATMENT OF TINEA-CAPITIS

OBJECTIVE: TO review the epidemiology, pathogenesis, mycology, clinica l presentation, and pharmacotherapy of tinea capitis, and describe the role of newer antimycotic agents. DATA SOURCES: A MEDLINE search rest ricted to English-language articles published from 1966 through 1996 a nd journal references were used in preparing this review. DATA EXTRACT ION: The data on mycology, pharmacokinetics, adverse effects, and drug interactions were obtained from controlled studies and case reports a ppearing in the literature. Both open-label and comparative studies we re evaluated to assess the efficacy of antimycotics in the treatment o f this infection. DATA SYNTHESIS: Griseofulvin is the drug of choice i n the treatment of tinea capitis. Newer agents with greater efficacy o r shorter treatment durations continue to be explored. Ketoconazole, t he first azole studied for efficacy in tinea capitis, has not demonstr ated any clinical advantage over griseofulvin in several controlled cl inical trials. Itraconazole is effective, but the available data are l imited to case reports and a single uncontrolled study. Terbinafine si milarly has shown promise in the treatment of tinea capitis, but the o ral formulation was only recently approved in the US. Existing studies reflect the results in infection with pathogens not seen in the US. B oth itraconazole and terbinafine achieve high concentrations in the ha ir and stratum corneum that persist for several weeks following drug a dministration. This may enable shorter courses of therapy; however, co mparative studies need to be conducted in the US. CONCLUSIONS: Tinea c apitis remains the most common dermatophyte infection in young urban c hildren. Oral antifungal therapy is required for effective treatment, often for several months. The combination of griseofulvin with a selen ium sulfide shampoo continues to be the mainstay of therapy until more experience is gained with the newer antimycotics.