From the cochrane library
Systemic antifungal therapy for tinea capitis in children: An abridged Cochrane Review

https://doi.org/10.1016/j.jaad.2016.08.061Get rights and content

Background

The comparative efficacy and safety profiles of systemic antifungal drugs for tinea capitis in children remain unclear.

Objective

We sought to assess the effects of systemic antifungal drugs for tinea capitis in children.

Methods

We used standard Cochrane methodological procedures.

Results

We included 25 randomized controlled trials with 4449 participants. Terbinafine and griseofulvin had similar effects for children with mixed Trichophyton and Microsporum infections (risk ratio 1.08, 95% confidence interval 0.94-1.24). Terbinafine was better than griseofulvin for complete cure of T tonsurans infections (risk ratio 1.47, 95% confidence interval 1.22-1.77); griseofulvin was better than terbinafine for complete cure of infections caused solely by Microsporum species (risk ratio 0.68, 95% confidence interval 0.53-0.86). Compared with griseofulvin or terbinafine, itraconazole and fluconazole had similar effects against Trichophyton infections.

Limitations

All included studies were at unclear or high risk of bias. Lower quality evidence resulted in a lower confidence in the estimate of effect. Significant clinical heterogeneity existed across studies.

Conclusions

Griseofulvin or terbinafine are both effective; terbinafine is more effective for T tonsurans and griseofulvin for M canis infections. Itraconazole and fluconazole are alternative but not optimal choices for Trichophyton infections. Optimal regimens of antifungal agents need further studies.

Section snippets

Methods

Our analysis is based on a Cochrane Review most recently updated in the Cochrane Library 2016, issue 5 (www.thecochranelibrary.com).4 Full details of the methods and all the included studies are available from the Cochrane Review.

Results

We included a total of 25 RCTs7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31 with 4449 participants (Fig 1). All were parallel group studies, and 10 had a multiarm design. Sample size varied from 13 to 1549 participants. Each of the 25 studies reported the types of fungus cultured. Trichophyton species predominated over Microsporum species in the included studies; T tonsurans and M canis caused infection in the highest proportion of participants.

Discussion

Current evidence supports that both griseofulvin and terbinafine are an effective first-line choice for children with tinea capitis infected with Trichophyton or Microsporum species; however, terbinafine may be a better choice for those infected with T tonsurans, whereas griseofulvin may be a better choice for those infected with M canis. We did not find any evidence to support a difference in terms of adherence between 4 weeks of terbinafine versus 8 weeks of griseofulvin.

Limited evidence

References (36)

  • X. Chen et al.

    Systemic antifungal therapy for tinea capitis in children

    Cochrane Database Syst Rev

    (2016)
  • Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The...
  • Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane...
  • L. Dastghaib et al.

    Therapeutic options for the treatment of tinea capitis: griseofulvin versus fluconazole

    J Dermatol Treat

    (2005)
  • S. Deng et al.

    A random comparative study of terbinafine versus griseofulvin in patients with tinea capitis in Western China

    Mycopathologia

    (2011)
  • S.F. Friedlander et al.

    Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study

    Pediatrics

    (2002)
  • L.C. Fuller et al.

    A randomized comparison of 4 weeks of terbinafine vs. 8 weeks of griseofulvin for the treatment of tinea capitis

    Br J Dermatol

    (2001)
  • V.N. Gan et al.

    Epidemiology and treatment of tinea capitis: ketoconazole vs. griseofulvin

    Pediatr Infect Dis J

    (1987)
  • Cited by (55)

    • Antimicrobials and resistance part II: Antifungals, antivirals, and antiparasitics

      2022, Journal of the American Academy of Dermatology
      Citation Excerpt :

      Griseofulvin is approved for tinea capitis, extensive tinea pedis, cruris, corporis, and dermatophyte onychomycosis; however, terbinafine offers higher clinical and mycologic cure rates.6,8,21,22 Due to greater efficacy against ectothrix infections of the hair shaft compared to terbinafine, griseofulvin remains a preferred agent for Microsporum-associated tinea capitis.6,23 Griseofulvin has been associated with erythema multiforme, Stevens-Johnson syndrome, urticaria, angioedema, fixed drug eruption, drug-induced porphyria, and cutaneous lupus.

    • Disorders of the hair and nails

      2021, Pediatric Dermatology
    View all citing articles on Scopus

    This article has no funding sources. However, the original version of the Cochrane Review was funded by the Cochrane Skin Group; Cochrane Child Health Field; Alberta Research Center for Child Health Evidence; University of Alberta, Canada; Spanish Society of Dermato-Epidemiology and Evidence-based Dermatology; and the Clínica Plató, Fundació Privada of Barcelona.

    Disclosure: Professor Bennett is the proprietor of Systematic Research Ltd and derives an income from her work as a freelance researcher. She was paid for her contributions to this review by the Cochrane Skin Group. In addition, she holds an honorary chair at Coventry University, but this does not constitute a competing interest. Drs Chen, Jiang, Yang, González, Lin, Hua, Xue, and Zhang have no conflicts of interest to declare.

    This article is an abridged version of a Cochrane Systematic Review that was published in the Cochrane Library 2016, issue 5, doi: 10.1002/14651858.CD004685.pub3. (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review.

    View full text