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Tinea capitis: an overview with emphasis on management.
Pediatr Dermatol. 1999 May-Jun; 16(3):171-89.PD

Abstract

Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichophyton tonsurans now predominates over Micro-sporum audouinii. With this transition 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-itraconazole, 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: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen 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 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once-weekly regimen may also be effective. When ectothrix organisms (e.g., Microsporum canis) are present, a longer duration of therapy 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 It remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection.

Authors+Show Affiliations

Division of Dermatology, Department of Medicine, Sunnybrook Health Science Center, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. agupta@execulink.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10383772

Citation

Gupta, A K., et al. "Tinea Capitis: an Overview With Emphasis On Management." Pediatric Dermatology, vol. 16, no. 3, 1999, pp. 171-89.
Gupta AK, Hofstader SL, Adam P, et al. Tinea capitis: an overview with emphasis on management. Pediatr Dermatol. 1999;16(3):171-89.
Gupta, A. K., Hofstader, S. L., Adam, P., & Summerbell, R. C. (1999). Tinea capitis: an overview with emphasis on management. Pediatric Dermatology, 16(3), 171-89.
Gupta AK, et al. Tinea Capitis: an Overview With Emphasis On Management. Pediatr Dermatol. 1999 May-Jun;16(3):171-89. PubMed PMID: 10383772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tinea capitis: an overview with emphasis on management. AU - Gupta,A K, AU - Hofstader,S L, AU - Adam,P, AU - Summerbell,R C, PY - 1999/6/26/pubmed PY - 1999/6/26/medline PY - 1999/6/26/entrez SP - 171 EP - 89 JF - Pediatric dermatology JO - Pediatr Dermatol VL - 16 IS - 3 N2 - Tinea capitis is perhaps the most common mycotic infection in children. In North America the epidemiology of tinea capitis has changed so that Trichophyton tonsurans now predominates over Micro-sporum audouinii. With this transition 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-itraconazole, 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: itraconazole continuous regimen (5 mg/kg/day for 4 weeks), itraconazole pulse regimen 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 mg/kg/day) were administered for 20 days in one trial. Another possibility may be 6 mg/kg/day for 2 weeks and evaluating the scalp 4 weeks later. An extra week of therapy (6 mg/kg/day) can be administered if clinically indicated at that time. A once-weekly regimen may also be effective. When ectothrix organisms (e.g., Microsporum canis) are present, a longer duration of therapy 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 remains to be seen to what extent griseofulvin will be superseded for the treatment of tinea capitis. Adjunctive therapies may help decrease the risk of infection to other individuals. Appropriate measures should be taken to reduce the possibility of reinfection. SN - 0736-8046 UR - https://www.unboundmedicine.com/medline/citation/10383772/Tinea_capitis:_an_overview_with_emphasis_on_management_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0736-8046&amp;date=1999&amp;volume=16&amp;issue=3&amp;spage=171 DB - PRIME DP - Unbound Medicine ER -