tinea capitis

Tinea capitis (tin'-eah cap'-ih-tiss) is an infection of the scalp with a fungus (Tricophyton tonsurans). It is, in point of fact, the most common fungal infection in children. Some children may develop an allergic reaction to the fungus that causes a large, boggy, oozing sore called a kerion (as in carry-on, nurse).

Although sometimes Selsun® or other antifungal shampoo such as 2% ketoconazole is used to help things along, the main treatment has to be oral medication; griseofulvin is the drug most commonly used. Griseofulvin is given once a day with a fatty meal (ice cream, whole milk, cheese, french fries, etc.) for about six to eight weeks total therapy. The dose should be about 10 mg per pound of body weight. Because of concerns about possible toxicity from such long term therapy, your doctor may get some blood work and a urine test about four weeks into treatment to check the blood, urinary system and liver functions, but many pediatric dermatologists don't bother because the treatment is only six to eight weeks and side effects are rare. If the child experiences side effects from the medication such as headache or nausea, the dose can be split and given twice a day.

Shampooing the child's hair three times a week with selenium sulfide 2.5% shampoo (Selsun®) improves the success rate for oral treatment by eliminating fungus spores from the scalp.

Other family members should be checked for infection and can be also easily treated with selenium sulfide 2.5% shampoo for a few days if signs of infection are found. About half of symptom-free family members are found to be carriers of the fungus when culture tests are done, so this treatment is a good idea.

Resistance to tinea capitis infection is reduced if tightly braided hairstyles are worn, or if heavy, greasy pomades are used for hairstyling. Avoid these risk factors if your child gets this infection.

Other medications sometimes used by dermatologists for treating difficult cases of tinea capitis include fluconazole (Diflucan®), terbinafine (Lamisil®), and itraconazole. They are technically better but more expensive, and in the case of terbinafine, not officially approved for use in children.

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