TINEA CAPITIS

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