Fluconazole pulse therapy: effect on inflammatory tinea capitis [kerion and agminate folliculitis]

ABSTRACT

Tinea capitis, a fungal infection of scalp hair, can be caused by any species of either Trichophyton or Microsporum genera. It requires systemic antimycotic therapy. Griseofulvin is the only FDA approved drug for the treatment of this dermatophyte infection. Fluconazole pulse therapy is cost effective in tinea capitis. The study was aimed to assess the efficacy of fluconazole pulse therapy in patients with inflammatory [kerion and agminate folliculitis] tinea capitis and to study fluconazole as an alternative therapy to griseofulvin. Patients and methods The open clinical trial was carried out in the outpatient department of "Baqai Institute Skin Diseases", Baqai Medical University, Karachi and Ziauddin Medical University, Karachi, from 1st February, 2003 till 31st January, 2004 over a period of 1 year. Clinically suspected cases of tinea capitis, suffering from inflammatory lesions [kerion and agminate folliculitis], were included in the study. Specimens were taken from the affected scalp along with hair for light microscopy and subsequent inoculation onto Sabouraud's media for fungal culture. All the mycologically confirmed patients fulfilling the inclusion criteria were given weekly oral pulses of fluconazole, 150mg for a period of 6 weeks. The patients were followed up weekly, during therapy and then fortnightly to look for clinical improvement as well as any side effects for a period of 16 weeks [10 weeks after completion of the therapy]. The clinical signs [erythema, scaling, edema, pustules, pruritus and hair loss] were assessed on four-point scale graded from 0-3 [0= absent, 1= mild, 2= moderate, 3 = severe]. Results Of the 16 patients [kerion and agminate folliculitis] completing the study, there were 9 [56.3%] males and 7 [43.7%] females, the age range being 7-14 years. The clinical findings included erythema, scaling, edema, pustules, pruritus and hair loss. Fungal culture revealed Microsporum canis in all patients. Clinical improvement was apparent by the end of 3rd week of therapy. Regrowth of hair was evident by the end of 10th week and progressed slowly by the end of follow up period i.e. 16th week. Clinical cure rate was 69% and mycological cure rate 81.2% by the end of 6th week. At the end of 10th week, the clinical and mycological cure rates were 75% and 87.5%, respectively. At final evaluation, the relevant cure rates were 93.5% and 100%, respectively. Intermittent short duration therapy with fluconazole is effective for the inflammatory types [kerion and agminate folliculitis] of tinea capitis