Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetrating of hair follicles and may miss sites of subclinical infection
Griseofulvin (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
Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 weeks
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
Itraconazole 3-5mg/kg PO (max daily dose 400mg) per day 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)
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
Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 12 weeks
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.
Typical initial dose 20mg/kg per day for 6-8 weeks, if partial response increase to 25mg/kg per day for 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
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
Fluconazole 6mg/kg PO (max daily dose 400mg)per day x 3-6 weeks
Itraconazole 3-5mg/kg PO (max daily dose 400mg) per day x 4-6 weeks
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)
Tinea capitis
Atopic dermatitis
Tinea corporis
Diaper dermatitis
Tinea cruris
Erythema toxicum neonatorum
Cutaneous larva migrans
Neonatal acne