If griseofulvin-resistant tinea capitis occurs, which oral antifungals may be used?

If griseofulvin-resistant tinea capitis occurs, which oral antifungals may be used?

• A. Itraconazole
• B. Terbinafine
• C. Both itraconazole and terbinafine
• D. Neither

Answer: (C)

When griseofulvin no longer works for tinea capitis, you switch to oral antifungals that act differently and have solid activity against the dermatophytes causing scalp infections. Terbinafine is a squalene epoxidase inhibitor, which disrupts fungal cell membranes and tends to have high cure rates for scalp infections with good hair follicle penetration, often allowing a relatively short course in children. Itraconazole blocks ergosterol synthesis by inhibiting a fungal cytochrome P450 enzyme, offering broad dermatophyte coverage and effectiveness in cases where griseofulvin has failed or where terbinafine use is not ideal. Both options can be employed with proper safety considerations: terbinafine is generally well tolerated in pediatric patients, while itraconazole requires liver function monitoring and attention to potential drug interactions. So, in griseofulvin-resistant tinea capitis, either itraconazole or terbinafine may be used depending on the specific clinical context.

When griseofulvin no longer works for tinea capitis, you switch to oral antifungals that act differently and have solid activity against the dermatophytes causing scalp infections. Terbinafine is a squalene epoxidase inhibitor, which disrupts fungal cell membranes and tends to have high cure rates for scalp infections with good hair follicle penetration, often allowing a relatively short course in children. Itraconazole blocks ergosterol synthesis by inhibiting a fungal cytochrome P450 enzyme, offering broad dermatophyte coverage and effectiveness in cases where griseofulvin has failed or where terbinafine use is not ideal. Both options can be employed with proper safety considerations: terbinafine is generally well tolerated in pediatric patients, while itraconazole requires liver function monitoring and attention to potential drug interactions. So, in griseofulvin-resistant tinea capitis, either itraconazole or terbinafine may be used depending on the specific clinical context.