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ONCISE REVIEWS OF PEDIATRIC INFECTIOUS DISEASES Systemic Antifungal Therapy for Cutaneous Infections Aisha Sethi, MD,* and Richard Antaya, MD† Key Words: onychomycosis, tinea capitis,
amined for the presence of tinea capitis or 4-week course of terbinafine is at least as (Pediatr Infect Dis J 2006;25: 643– 644) griseofulvin for the treatment of tinea ca- pitis caused by Trichophyton spp. How- ever, griseofulvin appears to be superior to The skin, hair and nails are common sites temic treatment. For this reason, the diag- terbinafine for the 5% of cases caused by for superficial dermatophyte infection in indicated for a variety of cutaneous disor- rum canis can be more recalcitrant to ther- ders in the pediatric population. In this of therapy, and the rate of recurrence is apy. A study by Ginter-Hanselmayer et al4 article, we review the common indications high. Currently in North America, there is for the use of systemic antifungal therapy, azole in 163 children with M. canis tinea including terbinafine, ketoconazole, itra- mycosis in children. However, terbinafine, capitis. Fifty-five patients had previously failed treatment with terbinafine. The dos- ally well-tolerated and safe and have few liver function in patients treated with these either as a capsule (116 patients) or as an therapy include tinea capitis and onycho- agents is prudent. Griseofulvin, although oral suspension (47 patients). In all chil- mycosis. Tinea capitis, which is most of- considered the treatment of choice for der- ten caused by Trichophyton tonsurans, is logic cure after a mean treatment period of 39 Ϯ 12 days (range, 10–77 days). Eleven omycosis given the long duration of treat- primarily in the prepubertal age group.
children (6.7%) had side effects, including diarrhea in 5, cutaneous eruption in 4 and suspension; however, terbinafine is avail- able only in tablet form. Although itracon- ease and the likelihood of recurrence are tinea capitis caused by M. canis.
capitis caused by T. tonsurans. Patients conazole is also available as an oral sus- efficacy in the treatment of tinea capitis pension, but is not FDA-approved for der- REVIEW OF CLINICAL STUDIES
IN CHILDREN
ported in this study, which suggests that chomycosis include Trichophyton rubrum Tinea Capitis. Although the currently la- and Trichophyton mentagrophytes. Chil- beled pediatric dose of griseofulvin micro- therapeutic alternative for the treatment label dose of 20 –25 mg/kg/d for 6 – 8 From the *Departments of Dermatology and †Pe- effectively. Although oral griseofulvin is center, third party-blind trial to identify diatrics, Yale University School of Medicine, tinea capitis, terbinafine has been shown Copyright 2006 by Lippincott Williams & to be variably effective in several compar- ISSN: 0891-3668/06/2507-0643DOI: 10.1097/01.inf.0000227528.89030.a6 The Pediatric Infectious Disease Journal • Volume 25, Number 7, July 2006 The Pediatric Infectious Disease Journal • Volume 25, Number 7, July 2006 62.5 mg/d (1/4 tablet); 20-40 kg, 125 mg/d caused by Microsporum species.
treatment is 6 weeks for fingernails and 12 weeks for toenails.8 Jones et al9 reported terbinafine when compared with adults.
gest that although the efficacy of fluconazole T. tonsurans, is the most common fungal griseofulvin, it may still be useful in select infection in children. Although griseoful- patients with a contraindication to or intol- Onychomycosis. Griseofulvin, although clude terbinafine, fluconazole and itracon- REFERENCES
caused by T. rubrum, T. mentagrophytes 1. Bolognia JL, Jorizzo JL, Rapini R. Dermatology. and Epidermophyton floccosum and is 1st ed: St. Louis, MO: Elsevier Mosby; 2003.
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6. Solomon BA, et al. Fluconazole for the treat- gernail involvement and 3 pulses for toe- KEY CONCEPTS
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2006 Lippincott Williams & Wilkins

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