Practice guidelines for the treatment of
tinea capitis (TC) from the European Society for Pediatric Dermatology are presented.
Tinea capitis always requires systemic treatment because topical
antifungal agents do not penetrate the hair follicle. Topical treatment is only used as adjuvant
therapy to systemic antifungals. The newer oral
antifungal agents including
terbinafine,
itraconazole, and
fluconazole appear to have efficacy rates and potential adverse effects similar to those of
griseofulvin in children with TC caused by Trichophyton species, while requiring a much shorter
duration of treatment. They may be, however, more expensive (Grading of recommendation A; strength of evidence 1a).
Griseofulvin is still the treatment of choice for cases caused by Microsporum species. Its efficacy is superior to that of
terbinafine (Grading of recommendation A; strength of evidence 1b), and although its efficacy and
treatment duration is matched by
fluconazole (Grading of recommendation A; strength of evidence 1b) and
itraconazole (Grading of recommendation A; strength of evidence 1b),
griseofulvin is cheaper. It must be noted, however, that
griseofulvin is nowadays not available in certain European countries (e.g., Belgium, Greece, Portugal, and Turkey).