Tinea capitis
ICD-10 B35.0 · ICD-11 1F28.0

Treatment of Tinea Capitis with Microsporum Species After Griseofulvin Has Not Achieved Mycological Clearance

This protocol addresses tinea capitis in which scalp mycology or culture has confirmed a Microsporum species and Trichophyton species have not been identified — and where first-line oral griseofulvin has not met its definitive treatment goal.

Clinical Scenario

Microsporum species have been identified on scalp mycology or culture; Trichophyton species are not identified. As a general rule, griseofulvin shows greater efficacy against Microsporum species (M. canis, M. audouinii) than terbinafine. A next-line approach becomes necessary when mycological clearance — the definitive endpoint — is not reached.

Previous Treatment — Goals Not Achieved

Treatment failure

Oral griseofulvin was the first-line therapy for this Microsporum tinea capitis. The required goals of that course — clinical improvement of scalp lesions and mycological clearance — were not achieved. Because the definitive endpoint is mycological rather than clinical cure, failure confirmed on repeat mycology sampling triggers escalation to this next-line protocol.

Next-Line Approach (Partial Overview)

This protocol employs oral itraconazole, an antifungal with established activity against both Trichophyton and Microsporum species. The complete regimen — including dosing strategy and duration — is available in the full protocol. The treatment goal is mycological clearance, verified by repeat scalp mycology sampling until clearance is achieved.

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References

  1. As a general rule, terbinafine is more efficacious against Trichophyton species (T. tonsurans, T. violaceum, T. soudanense), and griseofulvin more effective against Microsporum species (M. canis, M. audouinii).
  2. Itraconazole is safe, effective and has activity against both Trichophyton and Microsporum species.
  3. Itraconazole, 50-100 mg per day for 4 weeks, or 3 mg kg⁻¹ per day for 2-4 weeks.
  4. The end point of treatment is mycological rather than clinical cure; therefore repeat mycology sampling is recommended until mycological clearance is achieved.
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