Department of Dermatology, Medical University of Graz, Austria.
J Dtsch Dermatol Ges. 2011 Feb;9(2):109-14. doi: 10.1111/j.1610-0387.2010.07554.x. Epub 2010 Oct 25.
Griseofulvin has been introduced in 1958, ever since it remained the gold standard for the treatment of tinea capitis in the United States. Despite the availability of new antifungals like terbinafine, itraconazole and fluconazole -with few exceptions not licensed for their use in children - duration of tinea capitis treatment could not be shortened. The reasons therefore are the anatomic structure of the hair follicle, the dormant sebum-production before onset of puberty, and the way of action of the new antifungals. Although data concerning the pharmacokinetics of allylamines and triazoles in childhood-populations are lacking, some experience confirms a correlation of the way of action of modern antifungals and the causative pathogen. In children the treatment of Microsporum infections of the scalp is crucial. That may be explained by the unique pharmacokinetic features of the substance of terbinafine: Terbinafine neither can be excreted by sweat nor by sebum before onset of puberty. Terbinafine is incorporated in the keratin of mature terminal hair in the anagen phase. In children it will not be built in the hair shaft and therefore it will not reach the surface of the scalp where the sheets of arthro-conidia in microsporosis are located. This peculiar fact was not yet considered in clinical studies.
灰黄霉素于 1958 年问世，自此一直是美国治疗头癣的金标准。尽管有新的抗真菌药物，如特比萘芬、伊曲康唑和氟康唑——除了极少数被批准用于儿童——但头癣的治疗时间不能缩短。原因是毛囊的解剖结构、青春期前皮脂分泌的休眠以及新抗真菌药物的作用方式。虽然关于儿童人群中烯丙胺类和三唑类药物的药代动力学数据缺乏，但一些经验证实了现代抗真菌药物的作用方式与病原体之间存在相关性。在儿童中，治疗头皮的小孢子菌感染至关重要。这可以用特比萘芬的独特药代动力学特征来解释：特比萘芬在青春期前既不能通过汗液也不能通过皮脂排泄。特比萘芬结合在处于生长期的成熟终毛的角蛋白中。在儿童中，它不会在毛发轴中形成，因此不会到达头皮表面，而微孢子病的关节孢子在那里形成薄片。这一特殊事实在临床研究中尚未得到考虑。
