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

Microsporum Tinea Capitis — When Oral Itraconazole Has Not Achieved Mycological Clearance

This protocol applies to patients with tinea capitis in whom scalp mycology or culture has confirmed a Microsporum species (with Trichophyton species not identified), and in whom the preceding treatment course with oral itraconazole did not result in mycological clearance.

Clinical situation

Scalp mycology has identified a Microsporum species, with no evidence of Trichophyton. Species identification is clinically significant in tinea capitis: antifungal agents differ in their efficacy against Microsporum versus Trichophyton species, and this distinction directly informs treatment selection.

Previous treatment — goal not achieved

The prior line involved oral itraconazole. The required endpoint — mycological clearance confirmed by repeat sampling — was not reached. This protocol represents the escalation step taken after that treatment has been insufficient.

Treatment approach (partial — full regimen in protocol)

For cases refractory to prior regimens, the protocol considers antifungal alternatives reserved for exceptional circumstances. Which agents apply, and under what conditions, is detailed in the full structured protocol — no dosages or sequencing are shown here.

Treatment goal

Mycological clearance — the endpoint is microbiological, not clinical. Repeat mycology sampling is required until clearance is confirmed.

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References

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).

For cases refractory to the above regimens, other modalities to be considered in exceptional circumstances include: fluconazole and voriconazole (see main text).

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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