Comparative Study of Oral Griseofulvin vs Oral Fluconazole in Tinea Capitis

Objectives: Tinea capitis is the most common fungal infection in childhood, usually affecting school age children. It is contagious and communicable. Our aim was to compare the efficacy, safety and optimal dose and duration of Fluconazole and Griseofulvin in the treatment of tinea capitis and to compare the side effect profiles of these two drugs.

Methods: The study group included patients with tinea capitis attending the dermatology OPD. These patients were aged 3 years or older. After base line evaluation selected patients were randomly divided in two groups of 30 patients each.

Group A-The patients were put on Griseofulvin 10 mg/ kg/day either in single or in divided dose for 6 weeks.

Group B-In this group patients were put on fluconazole 5 mg/kg/day for 6 week as single dose.

Patients were instructed not to use hair grooming practices such as combs, oils, etc. and advised to take medication at approximately the same time every day with a liquid or semisolid food. Patients were scheduled for dermatology OPD visit at the end of 2, 4 and 6 week and 12 weeks. The severity of disease was assessed by 8 clinical parameters erythema, scaling, papules, pustules, pruritus, swelling, crusts and alopecia. These were summed for each patient at every visit to obtain a total signs and symptoms score (TSSS) with a maximum value of 24.

Results: A total of 60 patients of tinea capitis fulfilling the inclusion criteria were studied on an outpatient basis. All the patients were children and in the range of 3-16 years. Males (58.33%) out-numbered females (41.67%) with sex ratio of 1.4:1. Majority of patients (36.67%) presented in the months of May-July i.e. in summer and monsoon. In present study at the end of 12 weeks the number of patients responding to treatment (≥ 50% reduction in baseline TSS Score) was higher in Fluconazole group (98.14%) as compared to Griseofulvin group (94.43%). Percentage of patients showing improvement in signs and symptoms was higher in Fluconazole group than in Griseofulvin group at each point of assessment. At the end of study the number of clinically cured patients was significantly higher in fluconazole group than griseofulvin group (83.87%, vs 58.62%,). Treatment related adverse effects were observed only in 6 (20%) patients of Griseofulvin group.

Conclusion: The present study puts forth Fluconazole as a better alternative to Griseofulvin in the systemic therapy of tinea capitis. It clearly highlights better efficacy, greater and faster improvement in signs and symptoms, better compliance and more favourable adverse effect profile of Fluconazole as compared to Griseofulvin and thus establishes the superiority of Fluconazole over Griseofulvin in systemic therapy of tinea capitis.