Tinea capitis: An overview with emphasis on management

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichop hyton tonsurans now predominates over Microsporum audouinii. With this tran sition the utility of the Wood's light for diagnosis has been reduced since T. tonsurans infection is Wood's light negative. Griseofulvin has been the mainstay of therapy for the last 40 years. The newer antifungal agents-itr aconazole, terbinafine, and fluconazole-appear to be effective and safe for the treatment of tinea capitis. When tinea capitis is due to T. tonsurans or other endothrix species the following regimens have been used: itraconaz ole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regime n with capsules (5 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart), and itraconazole pulse regimen with oral solution (3 mg/kg/day for 1 week plus 1-3 pulses 3 weeks apart). With terbinafine tablets the continuous regimen (>40 kg body weight, 250 mg/day; 20-40 kg, 125 mg/day; and <20 kg, 125 mg/ day) is given for 2 to 4 weeks. Fluconazole tablets or oral suspension (6 m g/kg/day) were administered for 20 days in one trial. Another possibility m ay be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An ex tra week of therapy (6 mg/kg/day) can be administered if clinically indicat ed at that time, A once-weekly regimen may also be effective. When ectothri x organisms (e.g., Microsporum canis) are present, a longer duration of the rapy may be required. The data suggest that the newer agents are effective, safe with few adverse effects, and have a high benefit:risk ratio. It rema ins to be seen to what extent griseofulvin will be superseded for the treat ment of tinea capitis, Adjunctive therapies may help decrease the risk of i nfection to other individuals. Appropriate measures should be taken to redu ce the possibility of reinfection.