Topical Terbinafine in Pediatric Fungal Infections

Clinical Application by Infection Type

The British Association of Dermatologists explicitly states topical treatment alone should not be used for tinea capitis, and oral antifungal therapy is mandatory for all cases of tinea capitis 1, 2, 3
For tinea capitis, topical agents, including terbinafine, may only be used as adjunctive therapy to reduce spore transmission, but never as monotherapy 3
Topical terbinafine is not recommended for pediatric onychomycosis, and systemic oral terbinafine is the recommended treatment, with dosing based on weight: 62.5 mg/day for weight <20 kg, 125 mg/day for 20-40 kg, 250 mg/day for >40 kg 4, 5, 6
Treatment duration for onychomycosis is 6 weeks for fingernails and 12 weeks for toenails 4, 5, 6

Never use topical terbinafine alone for tinea capitis, as this will result in treatment failure and continued transmission 1, 2
Do not assume topical therapy is adequate for nail infections in children, despite thinner nail plates, and systemic therapy is required 4, 5, 6
For extensive skin infections or those involving hair follicles, consider systemic therapy rather than topical treatment 2
If topical treatment for skin infections shows no response within 2 weeks or spreads to scalp/hair, switch to oral therapy immediately 2

For suspected fungal infection in a child, identify infection location, and for scalp/hair, oral therapy is mandatory, while for nails, oral therapy is required, and for skin only, topical terbinafine is appropriate 1, 2, 4, 5, 6
Monitor response at 2 weeks, and if no improvement or spreading, switch to oral therapy 1, 2