Treatment of tinea capitis with itraconazole
Authors: Elewski Boni E. 
Published: August 2010

This trial examined tiie use of itraconazole in patients with tinea capitis who were eitiier unresponsive to or unable to tolerate griseofulvin therapy.

An estimated 800 patients from muitipie counties throughout Ohio were seen by this clinic for the treatment of tinea capitis from 1992 to 1995. Patients were referred by dermatologists, pediatricians, or primary care physicians, or sought treatment on their own. Of these 800 patients, 659 had cultures performed at our ciinic; computer records were maintained for aii these patients. The remaining patients had cultures taken elsewhere and computer records were not maintained. Of the totai complement of patients, 120 had a previous unsuccessful trial with griseofuivin (liquid suspension or ultramicronized) and were either intolerant or nonresponsive and desired alternative therapy. Many of these patients had a history of an eruption while on griseofuivin therapy. It was unclear if this was an id or hypersensitivity reaction as opposed to a true aiiergy, but the patients refused further therapy. Other reasons for griseofuivin intoierance or nonresponsiveness were nausea, headache, photosensitivity, drug interactions, and simply patient exasperation with months of oral antifungal drug therapy. Failure to comply with hygienic measures and low dosage regimens also may have contributed to the high number of patients who were nonresponsive to griseofulvin. One hundred and twenty patients were treated with oral itraconazoie. Subjects ranged in age from 2.5 years to adult, with the majority of patients failing between the ages of 5 and 12 years. Most of those treated were black, with men and women approximately equally represented. All but one patient cultured positive for Trichophyton tonsurans; the remaining patient cultured positive for Microsporum canis. Patients were treated with itraconazole capsules for 30 days and dosage was proportioned to body weight, calculated at 3–5 mg/kg per day. Patients were told to take their medication with food or a cola beverage on the schedule given in Table 1.

Patients were also instructed to apply ketoconazole 2% shampoo, left on for 5 min, two to three times a week, in addition to the itraconazole regimen. Other family members were also instructed to use ketoconazole shampoo two to three times a week.

If insurance practices allowed, patients were evaluated at baseline, after 2 weeks of therapy, on completion of therapy (30 days), and at 4 weeks post‐therapy. Cultures were performed at baseline and at the final visit. The patient's condition was evaluated at the second visit; if significant inflammation was still present, the dosage was increased to the next weight category. Patients were advised to inform their physician if any adverse reactions occurred which might be related to the treatment.

All patients showed clinical improvement, with a resolution of inflammation and some hair regrowth, at the completion of the 30‐day regimen of itraconazole. All patients tested negative on culture, and their clinical appearance continued to improve after cessation of therapy. All patients were considered clinically cured at the final follow‐up visit, patient with M. canis infection followed the regimen for only 21 days, and experienced another incidence of tinea capitis within 6 months of completing therapy. It was not determined if this was a relapse or a new infection. A second 30‐day course of itraconazole was effective and no subsequent episode has been reported.