Chan Yuin-Chew, Friedlander Sheila Fallon
National Skin Centre, 1 Mandalay Road, Singapore 308205.
Curr Opin Infect Dis. 2004 Apr;17(2):97-103. doi: 10.1097/00001432-200404000-00005.
Tinea capitis, a dermatophyte infection involving the hair shaft on the scalp, is primarily a disease of preadolescent children. The predominant pathogen varies according to the geographical location. Trichophyton tonsurans and Microsporum canis account for the majority of infections in north America and certain parts of Europe. The current standard of care for the treatment of tinea capitis in the USA is oral griseofulvin, but evidence is accumulating that some of the newer antifungal agents may also be useful.
The newer oral antifungal agents such as terbinafine, itraconazole and fluconazole seem to be effective, safe, and have the advantage of a shorter treatment duration. Although a significant number of clinical studies and reports have documented experience with terbinafine and itraconazole for the treatment of tinea capitis, it should be noted that only a few trials have been conducted utilizing fluconazole. Both 2% ketoconazole and 1% selenium sulfide shampoos are often recommended as adjuvant topical therapy.
Currently, many experts consider griseofulvin to be the drug of choice for tinea capitis. Short-term terbinafine, itraconazole and fluconazole therapy have been shown to be comparable in efficacy and safety with griseofulvin. Regular epidemiological surveillance of causative fungal organisms in the community and their antifungal susceptibility is an essential component in the management of this condition.
头癣是一种累及头皮毛发干的皮肤癣菌感染，主要发生于青春期前儿童。主要病原体因地理位置而异。断发毛癣菌和犬小孢子菌在北美和欧洲某些地区的感染中占大多数。美国目前治疗头癣的标准护理方法是口服灰黄霉素，但越来越多的证据表明一些新型抗真菌药物可能也有用。
新型口服抗真菌药物如特比萘芬、伊曲康唑和氟康唑似乎有效、安全，且具有治疗时间较短的优势。虽然大量临床研究和报告记录了特比萘芬和伊曲康唑治疗头癣的经验，但应注意的是，使用氟康唑进行的试验较少。2%酮康唑和1%硫化硒洗发水常被推荐作为辅助局部治疗。
目前，许多专家认为灰黄霉素是头癣的首选药物。短期特比萘芬、伊曲康唑和氟康唑治疗在疗效和安全性方面已被证明与灰黄霉素相当。对社区中致病真菌及其抗真菌药敏性进行定期流行病学监测是管理这种疾病的重要组成部分。
