Efficacy and Safety of Monotherapies for Tinea Capitis

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• The authors performed a network meta-analysis of monotherapies used to treat tinea capitis. Griseofulvin, terbinafine, ketoconazole, itraconazole, and fluconazole were compared. When Microsporum canis was the causative organism, griseofulvin was most efficacious in eliciting mycologic cure (SUCRA = 66.1%) and complete cure (SUCRA = 80.6%). When the causative organism was of the Trichophytongenus, terbinafine was most efficacious (SUCRA, 75.2% and78.2% for mycologic and complete cure, respectively). The relative risk of adverse effects did not differ significantly among the five antifungal medications compared.

• When cure rates alone are considered, this network meta-analysis demonstrated an increased efficacy against Microsporum canis with griseofulvin and against members of the Trichophyton genus with terbinafine. The statistical evaluation used in this meta-analysis did not take into account varied dosing regimens or level of evidence. Factors other than efficacy may also impact a clinician's choice of treatment for tinea capitis. However, the results of this meta-analysis may serve as a guide in choosing an antifungal regimen for tinea capitis.

– Margaret Hammond, MD

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Karen A. Chernoff MD

This network meta-analysis compares the efficacy of five different systemic monotherapies for tinea capitis. Although no agent showed a statistically significant advantage over its alternatives overall, the pooled data found terbinafine superior for the treatment of tinea capitis due to Trichophyton species and griseofulvin most effective for cases due to Microsporum species. This is consistent with previously published reports. However, due to the heterogeneity of the data analyzed, particularly in terms of duration of treatment, further study is needed to better clarify the optimal use and indications of these medications, ideally through a double-blind randomized trial.

Abstract 

Various monotherapies exist for tinea capitis; however, their relative efficacies have never been determined using a statistical approach which compares treatments' efficacy simultaneously. The goal of this study was to determine the relative efficacy (mycologic and complete cure rates) of monotherapies for the treatment of tinea capitis. On October 5, 2019, searches were performed in Scopus, PubMed, EMBASE, MEDLINE (Ovid), and CINAHL; there were no date restrictions. For the main network meta-analysis, eligible studies were randomized trials that investigated the effect of tinea capitis monotherapies on subjects' mycological and complete cure rates. Network meta-analyses were conducted in accordance with the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for network meta-analyses. Mycological cure rate was the primary outcome; complete cure rate and adverse events were secondary outcomes. Twelve studies met the eligibility criteria for the main network; five systemic monotherapies were identified, griseofulvin, ketoconazole, terbinafine, itraconazole, and fluconazole. When the causative species was of the Microsporum genus, griseofulvin was most efficacious in terms of mycological cure (SUCRA = 66.1%) and complete cure (SUCRA = 80.6%). For tinea capitis caused by the Trichophyton species, terbinafine was the most efficacious in terms of both mycological and complete cure (SUCRA values of 75.2% and 78.2%, respectively). Risk of adverse events did not significantly differ across the interventions. Our results are congruent with those of previous pairwise meta-analyses; our findings also corroborate clinical experience and anecdotal evidence.

Pediatric Dermatology

A Network Meta-Analysis on the Efficacy and Safety of Monotherapies for Tinea Capitis, and an Assessment of Evidence Quality

Pediatr Dermatol 2020 Sep 08;[EPub Ahead of Print], AK Gupta, MA Bamimore, HJ Renaud, NH Shear, V Piguet 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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