Template:Tinea management: Difference between revisions

(Created page with "*Topical antifungal treatment for all except tinea capitis *Terbinafine 1% BID x2-3wk *Clotrimazole 1% BID x2-3wk **Must use for 7-10d beyond resolution of lesions *Capitis **Griseofulvin 20-25mg/kg/d or BID ***Usually requires 8wk of treatment **Terbinafine for 2-4 weeks is as effective of 6-8 weeks of griseofulvin<ref>Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, c...")
 
 
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''Coverage for Trichophyton and Epidermophyton'' and all treatment should be at lease 1 week past resolution of lesions
===Topical Therapy===
'''Applies to [[Tinea corporis]], [[Tinea pedis|pedis]], [[Tinea cruris|cruris]], and [[Tinea manus|manus]] '''
Must use a topical therapy for 7-10days beyond resolution of lesions
*Topical antifungal treatment for all except tinea capitis
*Topical antifungal treatment for all except tinea capitis
*[[Terbinafine]] 1% BID x2-3wk
*[[Terbinafine]] 1% BID x2-3weeks or
*[[Clotrimazole]] 1% BID x2-3wk
*[[Clotrimazole]] 1% BID x2-3weeks or
**Must use for 7-10d beyond resolution of lesions
*[[Ketoconazole]] 1% BID x2-3weeks
*Capitis
 
**[[Griseofulvin]] 20-25mg/kg/d or BID
===Capitis===
***Usually requires 8wk of treatment
*[[Griseofulvin]] 500mg-1000mg PO once daily (20-25mg/kg/d)
**[[Terbinafine]] for 2-4 weeks is as effective of 6-8 weeks of [[griseofulvin]]<ref>Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004;114(5):1312-1315. doi:10.1542/peds.2004-0428</ref>
**Usually requires 8wk of treatment
***62.5mg/day in children <20kg
*[[Terbinafine]] for 2-4 weeks is as effective of 6-8 weeks of [[griseofulvin]]<ref>Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004;114(5):1312-1315. doi:10.1542/peds.2004-0428</ref>
***125mg/day in children 20-40kg
**62.5mg/day in children <20kg
***250mg/day in children >40kg<ref>Andrews MD, Burns M: Common tinea infections in children. Am Fam Physician 2008;77(10):1415-1420.</ref>
**125mg/day in children 20-40kg
**[[Selenium sulfide]] or [[ketoconazole]] shampoos are adjunct treatment
**250mg/day in children >40kg<ref>Andrews MD, Burns M: Common tinea infections in children. Am Fam Physician 2008;77(10):1415-1420.</ref>
**Okay for child to go to school
*[[Selenium sulfide]] or [[ketoconazole]] shampoos are adjunct treatment
*Kerion<ref>Gnanasegaram M. Kerion. DermNet NZ. 2012. http://www.dermnetnz.org/fungal/kerion.html</ref>
*Children can return to school during treatment
**Oral griseofulvin, itraconazole, or terbinafine for 6-8 wks
 
**[[Cephalexin]] 40mg/kg/d in 4 divided doses in addition to systemic antifungal treatment if there is evidence or high risk of bacterial secondary infection
===Kerion===
**Ketoconazole shampoo, isolated towels decrease spread to household members
*Oral griseofulvin, itraconazole, or terbinafine for 6-8 wks<ref>Gnanasegaram M. Kerion. DermNet NZ. 2012. http://www.dermnetnz.org/fungal/kerion.html</ref>
*[[Cephalexin]] 40mg/kg/d in 4 divided doses in addition to systemic antifungal treatment if there is evidence or high risk of bacterial secondary infection
*Ketoconazole shampoo, isolated towels decrease spread to household members
 
===[[Tinea corporis]]===
First line should be topical therapy. For refractory cases or severe bullous disease the below anti-fungals are all equivalent options.
*[[Fluconazole]] 150mg (6mg/kg) PO once  a week x 2 weeks or
*[[Itraconazole]] 200mg (5mg/kg) PO daily q12hrs for 1 week or
*[[Griseofulvin]] 500-1000mg (20mg/kg) PO daily for 2-4 weeks

Latest revision as of 07:01, 12 February 2023

Coverage for Trichophyton and Epidermophyton and all treatment should be at lease 1 week past resolution of lesions

Topical Therapy

Applies to Tinea corporis, pedis, cruris, and manus

Must use a topical therapy for 7-10days beyond resolution of lesions

Capitis

  • Griseofulvin 500mg-1000mg PO once daily (20-25mg/kg/d)
    • Usually requires 8wk of treatment
  • Terbinafine for 2-4 weeks is as effective of 6-8 weeks of griseofulvin[1]
    • 62.5mg/day in children <20kg
    • 125mg/day in children 20-40kg
    • 250mg/day in children >40kg[2]
  • Selenium sulfide or ketoconazole shampoos are adjunct treatment
  • Children can return to school during treatment

Kerion

  • Oral griseofulvin, itraconazole, or terbinafine for 6-8 wks[3]
  • Cephalexin 40mg/kg/d in 4 divided doses in addition to systemic antifungal treatment if there is evidence or high risk of bacterial secondary infection
  • Ketoconazole shampoo, isolated towels decrease spread to household members

Tinea corporis

First line should be topical therapy. For refractory cases or severe bullous disease the below anti-fungals are all equivalent options.

  1. ↑ Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of tinea capitis: a meta-analysis of randomized, clinical trials. Pediatrics. 2004;114(5):1312-1315. doi:10.1542/peds.2004-0428
  2. ↑ Andrews MD, Burns M: Common tinea infections in children. Am Fam Physician 2008;77(10):1415-1420.
  3. ↑ Gnanasegaram M. Kerion. DermNet NZ. 2012. http://www.dermnetnz.org/fungal/kerion.html
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