The use of itraconazole to treat cutaneous fungal infections in children.
BACKGROUND
Cutaneous mycoses such as tinea capitis, onychomycosis and some cases of tinea corporis/cruris, and tinea pedis/manus require oral antifungal therapy. There is relatively limited data regarding the use of the newer oral antifungal agents, e.g. itraconazole, in the treatment of these mycoses in children.


OBJECTIVE
We wished to determine the efficacy and safety of itraconazole continuous therapy in the management of cutaneous fungal infections in children.


METHODS
Children with cutaneous mycoses were treated with itraconazole in an open-label manner in 4 studies. For tinea capitis, the treatment regimens using itraconazole continuous therapy were: study 1, 3 mg/kg/day for 4 or 8 weeks; study 2, 5 mg/kg/day for 6 weeks, and study 3, 5 mg/kg/ day for 4 weeks. In a different trial, study 4, itraconazole continuous therapy 5 mg/kg/day was used to treat toenail onychomycosis (duration: 12 weeks), tinea corporis/ cruris (duration: 1 week) and tinea pedis/manus (duration: 2 weeks).


RESULTS
The efficacy rates at follow-up 12 weeks from the start of therapy in children with tinea capitis treated using the itraconazole continuous regimen were: clinical cure (CC) and mycological cure (MC) in study 1 (n = 10, Trichophyton violaceum all patients), CC 50%, MC 86%; in study 2 (n = 35, Microsporum canis 22 patients, Trichophyton sp. 12 patients), CC 82.8%, MC 80%, and in study 3 (n = 16, M. canis 11 patients, Trichophyton sp. 5 patients), (CC 66.7%, MC 78.5%. Itraconazole was also effective in the treatment of dermatomycoses in 24 children (study 4). The CC and MC rates at the follow-up 8 weeks from the start of therapy in children with dermatomycoses and 12 months in children treated for onychomycosis were: onychomycosis (n = 1, T. rubrum), CC 100%, MC 100%; tinea corporis (n = 12, M. canis 10 patients), CC 100%, MC 90%; tinea cruris (n = 3, Trichophyton sp. 2 patients), CC 100%, MC 100%; tinea manus (n = 1, T. rubrum), CC 100%, MC 100%, and tinea pedis (n = 7, T. rubrum), CC 100%, MC 100%). Adverse effects consisted of a cutaneous eruption in 1 (1.2%) of the 85 children, with mild, transient, asymptomatic elevation of liver function tests (less than twice the upper limit of normal) in 2 (3.4%) of 58 children in whom monitoring was performed.


CONCLUSIONS
Itraconazole is effective and safe in the treatment of tinea capitis and other cutaneous fungal infections in children.
Gupta
A K
AK
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Sciences Center (Sunnybrook site), and the University of Toronto, Toronto, Canada. agupta@execulink.com
Nolting
S
S
de Prost
Y
Y
Delescluse
J
J
Degreef
H
H
Theissen
U
U
Wallace
R
R
Marynissen
G
G
De Doncker
P
P
D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003881:Dermatomycoses / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D003875:Drug Eruptions / Q000209:etiology; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000188:drug therapy / Q000382:microbiology; D005756:Gastritis / Q000139:chemically induced; D006261:Headache / Q000139:chemically induced; D006801:Humans; D007223:Infant; D017964:Itraconazole / Q000009:adverse effects / Q000627:therapeutic use*; D008864:Microsporum / Q000187:drug effects; D014009:Onychomycosis / Q000188:drug therapy / Q000382:microbiology; D010352:Patient Dropouts; D012867:Skin / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D013997:Time Factors; D014005:Tinea / Q000188:drug therapy / Q000382:microbiology; D014006:Tinea Capitis / Q000188:drug therapy / Q000382:microbiology; D014008:Tinea Pedis / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014249:Trichophyton / Q000187:drug effects
D000935:Antifungal Agents; D017964:Itraconazole