Template:Tinea management: Difference between revisions
Ostermayer (talk | contribs) (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]] | |||
*Topical antifungal treatment for all except tinea capitis | *Topical antifungal treatment for all except tinea capitis | ||
*[[Terbinafine]] 1% BID x2- | *[[Terbinafine]] 1% BID x2-3weeks or | ||
*[[Clotrimazole]] 1% BID x2- | *[[Clotrimazole]] 1% BID x2-3weeks or | ||
*[[Ketoconazole]] 1% BID x2-3weeks | |||
**Must use for 7-10d beyond resolution of lesions | **Must use for 7-10d beyond resolution of lesions | ||
===Capitis=== | |||
**[[Griseofulvin]] 20-25mg/kg/d | **[[Griseofulvin]] 500mg-1000mg PO once daily (20-25mg/kg/d) | ||
***Usually requires 8wk of treatment | ***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, clinical trials. Pediatrics. 2004;114(5):1312-1315. doi:10.1542/peds.2004-0428</ref> | **[[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> | ||
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**[[Selenium sulfide]] or [[ketoconazole]] shampoos are adjunct treatment | **[[Selenium sulfide]] or [[ketoconazole]] shampoos are adjunct treatment | ||
**Okay for child to go to school | **Okay for child to go to school | ||
* | ===[[Kerion]]=== | ||
**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 | **[[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 | **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 | |||
Revision as of 06:58, 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
- Topical antifungal treatment for all except tinea capitis
- Terbinafine 1% BID x2-3weeks or
- Clotrimazole 1% BID x2-3weeks or
- Ketoconazole 1% BID x2-3weeks
- Must use for 7-10d 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
- Okay for child to go to school
- Griseofulvin 500mg-1000mg PO once daily (20-25mg/kg/d)
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.
- 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
- ↑ 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
- ↑ Andrews MD, Burns M: Common tinea infections in children. Am Fam Physician 2008;77(10):1415-1420.
- ↑ Gnanasegaram M. Kerion. DermNet NZ. 2012. http://www.dermnetnz.org/fungal/kerion.html