First-line systemic therapy for tinea capitis?

First-line systemic therapy for tinea capitis?

• A. Topical terbinafine cream
• B. Oral itraconazole
• C. Oral griseofulvin
• D. Oral fluconazole

Answer: (C)

Tinea capitis involves infection of the hair shaft and follicles, so topical antifungals alone can’t reliably eradicate it—the medicine must reach the hair within the follicle. Oral griseofulvin is the best first-line systemic option because it concentrates in keratin and interferes with fungal cell division, effectively eradicating dermatophytes in hair and nails. In children, it’s started at a weight-based dose and typically continued for several weeks (often around six to eight weeks), with the course chosen to cover the time needed for infected hairs to be shed and replaced. It’s a well-established, proven therapy for scalp ringworm. Topical terbinafine isn’t adequate on its own for tinea capitis since it doesn’t penetrate to the hair shaft well enough. Other systemic antifungals like itraconazole or fluconazole can treat the infection but are not considered the first choice in many guidelines due to less pediatric experience and different safety considerations; they’re often used if griseofulvin isn’t suitable.

Tinea capitis involves infection of the hair shaft and follicles, so topical antifungals alone can’t reliably eradicate it—the medicine must reach the hair within the follicle. Oral griseofulvin is the best first-line systemic option because it concentrates in keratin and interferes with fungal cell division, effectively eradicating dermatophytes in hair and nails. In children, it’s started at a weight-based dose and typically continued for several weeks (often around six to eight weeks), with the course chosen to cover the time needed for infected hairs to be shed and replaced. It’s a well-established, proven therapy for scalp ringworm.

Topical terbinafine isn’t adequate on its own for tinea capitis since it doesn’t penetrate to the hair shaft well enough. Other systemic antifungals like itraconazole or fluconazole can treat the infection but are not considered the first choice in many guidelines due to less pediatric experience and different safety considerations; they’re often used if griseofulvin isn’t suitable.