Weekly fluconazole in the treatment of tinea capitis

Asit Mittal, AK Khar, Suresh Jain, Anupam Sharma

 Dept. of Skin, STD and Leprosy, Medical College Kota (Rajashan), India

Correspondence Address:
Asit Mittal
Dept. of Skin, STD and Leprosy, Medical College Kota (Rajashan)
India

Sir,

Tinea capitis is frequently seen before puberty in children. Griseofulvin is the most widely used drug in its treatment. There may be treatment failures because of development of resistance to the drug.[1] Various new systemic antifungal drugs have been investigated for this condition. Fluconazole may be an effective alternative based on its rapid penetration of skin yielding concentration upto 10 times those observed in plasma.[2] Fluconazole also appears to be eliminated slowly from skin, a finding that suggests that a shorter course of treatment and less frequent administration may be effective.[3] Recently there have been encouraging reports of use of weekly fluconazole in tinea capitis.[4]

We would like to share our experience with weekly fluconazole therapy in 12 patients of tinea capitis.12 children (8 male, 4 female) in age range 4 -10 years were enrolled in the trial. Of the 12 children 8 had non inflammatory lesions with patchy scaling and minimum hair loss, 2 patients had black dot type of involvement while remaining 2 had inflammatory kerion type of clinical picture. Clinical diagnosis was further confirmed by microscopic examination for arthrospores of infecting fungus located outside or inside the affected hair. However no culture studies could be undertaken. Fluconazole was used in dosage of 8mg/kg/body wt. as a single weekly dose for six weeks. Patient did not take any other concomitant theraphy. Weekly clinical assessment was made. Post treatment follow up assessments were performed upto 10 weeks after the end of therapy. Treatment was well tolerated by all the patients. 4 out 12 patients reported excellent response with complete clinical cure. 5 patients showed partial response while remaining 3 cases neither showed any significant response nor the worsening of clinical condition. Mycological cure was also achieved in clinical responders. At 10 weeks post treatment assessment no relapses were seen. This study demonstrates the safety and efficasy of fluconazole in cases of tinea capitis in children. Moreover administration of weekly dosage greatly facilitates patient′s compliance. However, additional larger studies are needed before one can recommend this form of therapy as a routine medication in clinical practice.

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