Treatment of Tinea Capitis Progressing to Impetigo

Diagnostic Approach

For tinea capitis, the British Journal of Dermatology recommends collecting scalp scrapings, hair pluck, brush samples or swabs for microscopy and culture to confirm the infection 1
For impetigo, swabs from pustular lesions should be taken for bacterial culture, as suggested by the British Journal of Dermatology 3
Microscopy using 10-30% potassium hydroxide can provide a rapid preliminary diagnosis of fungal elements, according to the British Journal of Dermatology 1
Culture on Sabouraud agar is necessary to identify the specific dermatophyte species, as recommended by the British Journal of Dermatology 1

The British Journal of Dermatology suggests that griseofulvin remains the only licensed treatment for tinea capitis in children in many countries, with a dosage of 20-25 mg/kg/day for 6-8 weeks 2
Alternative oral antifungals, such as terbinafine, may be considered if griseofulvin is unavailable or ineffective, with weight-based dosing for 4 weeks, as recommended by the British Journal of Dermatology 4
Topical antibiotics, such as flucloxacillin, cephalexin, or clindamycin, may be used for localized impetigo, while oral antibiotics may be necessary for extensive impetigo or when topical treatment fails, as suggested by the British Journal of Dermatology 2

Kerion is commonly seen with zoophilic species but can occur with endothrix infections like T. tonsurans, according to the British Journal of Dermatology 3

The British Journal of Dermatology recommends monitoring for mycological cure, not just clinical improvement, and repeating mycology sampling at the end of the standard treatment period 6
Treatment should continue until mycological clearance is documented, as suggested by the British Journal of Dermatology 6
Family members should be screened for asymptomatic carriage, particularly for anthropophilic infections like T. tonsurans, as recommended by the British Journal of Dermatology 6

The British Journal of Dermatology suggests cleansing combs, brushes, and other fomites with disinfectant to prevent recurrence and transmission 6
Antifungal shampoo may be used for household contacts to prevent spread, as recommended by the British Journal of Dermatology 6
Sharing of personal items like combs, hats, and pillowcases should be avoided to prevent transmission, as suggested by the British Journal of Dermatology 6