Therapeutic Options for the Treatment of Tinea Capitis Caused by Trichophyton Species: Griseofulvin Versus the New Oral Antifungal Agents, Terbinafine, Itraconazole, and Fluconazole

Authors

  • Aditya K. Gupta M.D., F.R.C.P.(C),

    1. Division of Dermatology, Department of Medicine, Sunnybrook and Women’s College Health Sciences Center (Sunnybrook site), Toronto, Canada
    2. University of Toronto, Toronto, Canada
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  • Paul Adam M.D., F.R.C.P.(C),

    1. University of Toronto, Toronto, Canada
    2. Division of Dermatology, Department of Medicine, St. Michael’s Hospital, Toronto, Canada
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  • Ncoza Dlova M.D.,

    1. Department of Dermatology, King Edward VII Hospital and University of Natal, Durban, South Africa
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  • Charles W. Lynde M.D., F.R.C.P.(C),

    1. University of Toronto, Toronto, Canada
    2. Division of Dermatology, Department of Medicine, Toronto Western Hospital, Toronto, Canada
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  • Sophie Hofstader M.D., F.R.C.P.(C),

    1. Division of Dermatology, Department of Medicine, Sunnybrook and Women’s College Health Sciences Center (Sunnybrook site), Toronto, Canada
    2. University of Toronto, Toronto, Canada
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  • Nilesh Morar M.D.,

    1. Department of Dermatology, King Edward VII Hospital and University of Natal, Durban, South Africa
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  • Jamila Aboobaker M.D.,

    1. Department of Dermatology, King Edward VII Hospital and University of Natal, Durban, South Africa
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  • Richard C. Summerbell Ph.D.

    1. Centraalbureau voor Schimmelcultures, Baarn, The Netherlands
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Aditya K. Gupta M.D., F.R.C.P.(C) 490 Wonderland Road South, Suite 6, London, Ontario, Canada N6K 1L6, or e-mail: agupta@execulink.com.

Abstract

Tinea capitis is a relatively common fungal infection of childhood. Griseofulvin has been the mainstay of management. However, newer oral antifungal agents are being used more frequently. A multicenter, prospective, randomized, single-blinded, non-industry-sponsored study was conducted in centers in Canada and South Africa to determine the relative efficacy and safety of griseofulvin, terbinafine, itraconazole, and fluconazole in the treatment of tinea capitis caused by Trichophyton species. The regimens for treating tinea capitis were griseofulvin microsize 20 mg/kg/day × 6 weeks, terbinafine [> 40 kg, one 250 mg tablet; 20–40 kg, 125 mg (half of a 250 mg tablet); < 20 kg, 62.5 mg (one-quarter of a 250 mg tablet)] × 2–3 weeks, itraconazole 5 mg/kg/day × 2–3 weeks, and fluconazole 6 mg/kg/day × 2–3 weeks. Patients were asked to return at weeks 4, 8, and 12 from the start of the study. Griseofulvin was administered for 6 weeks and the final evaluation was at week 12. Terbinafine, itraconazole, and fluconazole were administered for 2 weeks and the patient evaluated 4 weeks from the start of therapy. At this time, if clinically indicated, one extra week of therapy was given. There were 200 patients randomized to four treatment groups (50 in each group). At the final evaluation at week 12, the number of evaluable patients were griseofulvin, 46; terbinafine, 48; itraconazole, 46; and fluconazole, 46. Patients who discontinued therapy or were lost to follow-up were griseofulvin, 1/3; itraconazole, 0/4; terbinafine, 0/4; and fluconazole, 0/4. The causative organisms were Trichophyton tonsurans and T. violaceum species. Patients were regarded as effectively treated at week 12 if there was mycologic cure and either clinical cure or only a few residual symptoms. Effective treatment was recorded in, intention to treat, griseofulvin (46 of 50, 92.0%), terbinafine (47 of 50, 94.0%), itraconazole (43 of 50, 86.0%), and fluconazole (42 of 50, 84.0%) (p=0.33). Adverse effects were reported only in the griseofulvin group (gastrointestinal effects in six patients). Discontinuation from therapy due to adverse effects occurred only in the griseofulvin group (nausea in one patient). For the treatment of tinea capitis caused by the Trichophyton species, in this study, griseofulvin given for 6 weeks is similar in efficacy to terbinafine, itraconazole, and fluconazole given for 2–3 weeks. Each of the agents has a favorable adverse-effects profile.

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