I. More common in kids than adolescents or adults because of fungistatic effects of sebum found in older persons

II. Primary causative organisms: Trichophyton tonsurans, T. rubrum, Microsporum audouinii, M.canis

III. Diagnosis

  1. Typical clinical features: itchy, scaly rash of scalp, often w/patchy alopecia and/or occipital or posterior auricular lymphadenopathy

IV. Tx

  1. Griseofulvin--the most costly tx
    1. Ass'd with about 6% incidence of elevated transaminases
    2. Can cause some GI side f/x (n/v, abdominal pain)
  2. Azole antifungals
    1. Itraconazole
    2. Fluconazole
    3. Ketoconazole--Probably less effective than Griseofulvin (cited in review article JABFP 12:236, 1999--AFP)
  3. Terbinafine (daily x 1-4wks or "pulse" therapy of 1wk on-2wks off for 1-3 cycles)
  4. Intralesional steroids--no good evidence to support this tx as of 2000
  5. Adjunctive use of selenium sulfide shampoo (1% or 2.5%) along with systemic antifungals shortens time to eliminate shedding of spores