Version July 2025
KOH: potassium hydroxide; M. canis: Microsporum canis; PCR: polymerase chain reaction; T. tonsurans: Trichophyton tonsurans.
* Oral antifungal therapy should be started promptly to reduce risk for disease progression, permanent hair loss, and disease transmission. We do not usually wait for fungus speciation results prior to starting treatment.
¶ Both griseofulvin and terbinafine are appropriate initial empiric treatments; however, local epidemiology and clinical findings may influence treatment selection. We tend to select griseofulvin for suspected M. canis infection because of greater efficacy for M. canis infection when compared with terbinafine. We tend to select oral terbinafine for suspected T. tonsurans infection because of similar efficacy with a shorter duration of treatment. The preferred approach for infections due to other dermatophytes is less clear.
Δ Fluconazole and itraconazole are alternative oral antifungal treatments. Compared with griseofulvin and terbinafine, efficacy data for fluconazole and itraconazole in tinea capitis are more limited.
◊ We advise use of an antifungal shampoo (eg, selenium sulfide, ciclopirox, or ketoconazole shampoo) at least twice weekly (if feasible based on hair texture and washing preferences) to decrease shedding of fungal spores.
