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Fungal skin infection - scalp - Evidence
Evidence on oral antifungal treatments for scalp ringworm
A Cochrane systematic review of systemic treatments for scalp ringworm in children (search date: June 2005) included 21 studies (n = 1812) [González et al, 2007].
- For Trichophyton infections:
- Terbinafine compared with placebo: no randomized controlled trials (RCTs) were found.
- Griseofulvin compared with placebo: no RCTs were found.
- Terbinafine compared with griseofulvin: three studies (n = 382) showed that terbinafine for 4 weeks and griseofulvin for 8 weeks were of similar efficacy (relative risk [RR] 1.09, 95% CI 0.95 to 1.26).
- Griseofulvin compared with itraconazole:
- In one study (n = 100), there was no significant difference in cure rates between 2 weeks' treatment with itraconazole and 6 weeks' treatment with griseofulvin (RR 0.89, 95% CI 0.76 to 1.04).
- Another study of 35 children found similar cure rates between 6 weeks' treatment with itraconazole compared with 6 weeks' griseofulvin (RR 1.06, 95% CI 0.81 to 1.39).
- Terbinafine compared with itraconazole:
- There was no difference between itraconazole and terbinafine for treatment periods of 2–3 weeks in two studies (n = 160) (RR 0.93, 95% CI 0.72 to 1.19).
- For Microsporum infections:
- Terbinafine or griseofulvin compared with placebo: no RCTs were found.
- Terbinafine compared with griseofulvin: one small study (n = 29) found no significant difference in cure rates between terbinafine and griseofulvin (RR 0.64, 95% CI 0.19 to 2.20).
A subsequent, industry-supported RCT compared treatment with terbinafine (n = 1040) or griseofulvin (n = 509) [Elewski et al, 2008].
- After 6 weeks of treatment, rates of complete and mycologic cure were significantly higher for terbinafine than griseofulvin (p = 0.05):
- Complete cure, 45.1% compared with 39.2% (p = 0.24).
- Mycologic cure, 61.5% compared with 55% (p = 0.29).
- Subgroup analysis revealed that terbinafine was significantly better than griseofulvin for all cure rates among people with Trichophyton tonsurans:
- Terbinafine compared with griseofulvin:
- Complete cure rate, 52.1% compared with 35.4% (p < 0.0001).
- Mycologic cure rate, 66.5% compared with 49.8% (p < 0.0001).
- Clinical cure rate, 70% compared with 57.2% (p = 0.0004).
- For Microsporum canis, mycological and clinical cure rates were significantly better with griseofulvin than with terbinafine:
- Terbinafine compared with griseofulvin:
- Mycologic cure rate, 46.1% compared with 59.8% (p = 0.045).
- Clinical cure rate, 39.5% compared with 57.3% (p = 0.009).
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