Tinea capitis
Revisión del 10:37 11 may 2016 de Rossdonaldson1 (discusión | contribs.)
Background
- Infection caused by dermatophytes that feed on keratin
Tinea Types
- Tinea capitis (head)
- Tinea corporis (body)
- Tinea pedis (foot)
- Tinea cruris (groin)
Clinical Features
- Scaly, variable pruritus
- Patchy alopecia
Differential Diagnosis
Neonatal Rashes
- Acne
- Atopic dermatitis
- Candidiasis
- Contact dermatitis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Impetigo
- Mastitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Perianal streptococcal dermatitis
- Psoriasis
- Pustular melanosis
- Seborrheic dermatitis
- Sucking blisters
- Tinea capitis
Diagnosis
- Clinical diagnosis
Treatment
- Treatment involves oral antifungal with topical antifungals not effective due to inadequate penetration of hair follicles and may miss sites of subclinical infection
- Griseofulvin Microsize: 20-25 mg/kg/day (max 1000mg) x 6-12 weeks; Ultramicrosize: 10-15 mg/kg/day (max 750mg) x 6-12 weeks (first line)
- No labs needed before griseofulvin treatment. However if repeat courses or if therapy continued beyond 8 weeks then obtain CBC and LFTs.
- Give with fatty food (like peanut butter, ice cream) for better absorption. Therapy can fail due to lack of absorption.
- Terbinafine 10-20kg: 62.5mg daily; 20-40kg: 125mg daily; >40kg: 250mg daily x 4-6 weeks is alternative first line however need LFTs prior to therapy (can be taken without regard to meals)
- Second line (both below with limited efficacy data):
- Fluconazole 6mg/kg PO daily (max 400mg) x 3-6 weeks
- Itraconazole 3-5mg/kg PO daily (max 400mg) 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)
Disposition
- Discharge