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Article Excerpt
Tinea capitis is a fungal infection involving the hair shaft of the scalp and hair follicles caused by dermatophyte fungi (Ali, Graham, & Forgie, 2007). While it may affect any age group, tinea capitis is particularly common among school-aged children (Alvarez & Silverberg, 2006). To treat tinea capitis, systemic anti-fungal rather than topical treatment is required. Topical anti-fungal treatments are not able to adequately penetrate the hair shaft to eliminate the infection (Ali et al., 2007; Chan & Friedlander, 2004). Because of the prevalence of tinea capitis, it is essential that nurses are aware of this condition and current available treatment regimens. This article will review the recent research-based publications on the diagnosis and treatment of tinea capitis, providing valuable evidence for nursing practice.
Currently, griseofulvin (Grifulvin[R]) and terbinafine (Lamasil Granules[R]) are the only two medications approved by the United States Food and Drug Administration (FDA) for the treatment of tinea capitis (FDA, 2007; Roberts & Friedlander, 2005). There are newer anti-fungal agents available that have been shown to be safe and effective with a shorter duration of treatment, but are not yet approved by the FDA for the treatment of tinea capitis. Medications such as fluconazole and itraconazole are currently being prescribed off-label for tinea capitis.
Off-label use refers to the use of legally available medications being prescribed for a function outside of the medication's approved label. For example, fluconazole (Diflucan[R]) is currently FDA-approved to treat vaginal yeast infections but is sometimes used in pediatrics to treat tinea capitis (off-label use). Prescribing off-label-approved medications is common and often necessary in pediatric practice (Moonestime-Williams, Dickerson, & Basco, 2007; Novak & Jackson-Allen, 2007). According to the FDA (1998), the off-label use of medication cannot significantly increase the risk or decrease the acceptability of the risks associated with use of the medication. Care must be used when prescribing and administering off-label medications in pediatrics because the pharmacokinetics of medications may be different in children than in adults (Novak & Jackson-Allen, 2007). Pediatric providers should consider consulting specialists for guidance on treatment with nonapproved medications until a "community standard of practice" with the non-approved drug is attained. Parents should also be informed when a medication is being used in an off-label manner (Moonestime-Williams et al., 2007).
Epidemiology
Fungi that cause tinea capitis infections are from geophilic, zoophilic, and anthropophilic organisms. Geophilic fungi inhabit the soil, zoophilic organisms (Microsporum canis) live on animals, and anthropophilic fungi (Trichophytan tonsurans) live on humans (Fuller, Child, Midgley, & Higgins, 2003). In the past, most pediatric tinea capitis infections in the United States were caused by zoophilic fungi after exposure to an infected animal (usually cats and dogs). Although the reasons for the change in infective fungi are not known, more recently, the most prevalent organisms causing tinea capitis infections in children are anthropophilic organisms, which spread directly from person to person (Fuller et al., 2003). Most cases tend to occur in children from the age of 4 to 7 years, although it does occur in adolescents, with both boys and girls appearing to be infected equally (Chen & Friedlander, 2001). In the United States, the spread of T. tonsurans has predominantly (but not exclusively) been seen in African-American children. It is unknown whether this is related to hair type or ethnicity. African Americans may have a higher risk of developing tinea capitis, but it is important to realize that all children are susceptible to tinea capitis infections regardless of their ethnic backgrounds (Hay, 2001).
Clinical Manifestations
Tinea capitis infections have been called "the great masqueraders" (Roberts & Friedlander, 2005, p.191). Tinea capitis infections present in an assortment of...
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