A new, higher dose of itraconazole was safe and effective for treating tinea capitis in 4 pediatric patients, according to findings from a case series published in Clinical Cosmetic Investigative Dermatology.

Investigators treated 4 children who had tinea capitis with oral itraconazole 6 to 10 mg/kg/d, waiting 3 weeks between consecutive pulses. Investigators determined the number of itraconazole pulses for each patient by mycologic examination and symptoms presentation. Investigators monitored patients’ hepatic function monthly. Therapy was discontinued upon evidence clinical and mycologic cure.

Investigators also treated the patients with topical terbinafine hydrochloride cream twice daily, and patient 4 received oral prednisone 45 mg/d for 2 weeks to control inflammation. Fungal cultures from the patients’ lesional hairs yielded Microsporum canis (3 patients) and Nannizzia gypsea (1 patient).


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After 2 to 3 doses of pulse therapy, signs and symptoms resolved in all patients. There were no adverse reactions or incidents of hepatic dysfunction throughout the treatment period, and no relapse was reported during follow-up.

As previous studies showed itraconazole pulse therapy effective at a lower dose but for a longer duration, investigators felt that “the increased dose of itraconazole might improve the clinical efficacy.” Increasing the dose and shortening the treatment time can also lead to “a high degree of compliance for children,” they wrote, but the increased dose still requires further study within larger numbers of patients.

Reference

Zhou YB, Xiao YY, Chao JJ, Ma L. A novel itraconazole pulse therapy schedule in the treatment of tinea capitis in children. Clin Cosmet Investig Dermatol. Published online November 25, 2021. doi:10.2147/CCID.S342203