Terbinafine in tinea capitis due to Microsporum canis 
Shon repon 
TERBINAFINE IN TINEA CAPITIS DUE 
TO MICROSPORUM CANIS 
V. Dragoš, B. Podrumac, B. Kralj, I. Bartenjev and M. Dolenc 
ABSTRACT 
Ten children within the age range of 3-9 years with non-intlammatory tinea capitis due to Microsporum 
canis were evaluated in an open clinical test. The pilot study ran from January to November 1994. 
Each child was given oral terbinafine (Lamisil) for 6 weeks once daily according to body weight ( dose range 
62,5 -125 mg/day). The therapy was continued with topical 1 % terbinafine cream for another 6 weeks. 
After 6 weeks of oral terbinafine application all mycological investigations remained positive, whereas 
cultures turned out to be negative in 5 cases (50% ). 
After 12 weeks the KOH and Wood tests became negative in 6 (60% ), culture was negative in 6 (60% ). 
No systemic or topical side effects were noted, so we found terbinafine safe and well tolerated. 
Further studies with longer oral terbinafine treatment in tinea capitis due to Microsporum canis are 
suggested. 
KEY WORDS 
tinea capitis, Microspornm canis, children, terbinafine, oral application, topical application 
INTRODUCTION 
The incidence of Microsporum canis (M. canis) 
infection bas been on a steep increase during the 
recent years in South Europe, Slovenia included (1). 
The majority of patients are children, scalp infections 
being not rare. M. canis usually causes dry non-
intlammatory lesions, kerion is extremely rare (2). 
For years griseofulvin was the only effective systemic 
agent for tinea capitis. Terbinafine hydrochloride 
has a fungicida! effect in vitro and was found 
effective in treatment of dermatomycoses of the 
skin, nails and scalp (3,4,5). 
acta derrnatovenerologica A.P A. Vol 4, 95, No 4 
In the present study, we tried to find out the 
efficacy and tolerability of a 6 -week treatment with 
orally administered terbinafine, followed by a 6-
week topical application of 1 % terbinafine cream 
for tinea capitis due to M. canis in children. 
MATERIALS AND METHODS 
Ten children with dry non-intlammatory tinea caP.itis 
due to M. canis were included in the open clinical 
test. The clinical diagnosis was confirmed by direct 
microscopy of hairs treated with 10% potassium 
195 
Terbinafine in tinea capitis due to Microsporum canis 
KOH positive 
WOOD positive 
Culture positive 
10 
10 
10 
hydroxide (KOH), by examination with Wood lamp 
(Wood) and by culture. The material obtained from 
the patients were cultured on the Sabouraud glucose 
agar with gentamycin and actidion added at 28°C 
for the period of 4 weeks. The identification of the 
fungi was done by assessing the colony appearance 
and microscopic morphology. 
No systemic or topical antifungal treatment was 
applied a month before starting the study. Complete 
blood cell count, urine analysis, liver and renal 
function tests were performed prior to treatment, 
patients with pathological tests were excluded from 
the study. 
Ten children, 6 boys and 4 girls, age range 3-9 
years were given terbinafine once daily according to 
body weight. Dosage was as follows: 62,5 mg/day 
for those weighing less then 20 kg, 125 mg/day for 
those weighing 20-40 kg, 250 mg/day for those 
weighing more than 40 kg. After 6 weeks, the oral 
therapy was discontinued and 1 % terbinafine cream 
was applied twice daily for another 6 weeks. 
Evaluations were done at the 6th and the 12th 
week and the results are presented in table l. 
Both oral and topical treatment were well tolerated. 
No systemic or local side effects were observed, 
laboratory data ( complete blood cell count, urine 
analysis, liver and renal function tests) were within 
normal range. 
DISCUSSION 
The treatment of tinea capitis due to M. canis in 
children presents a serious therapeutic problem. In 
vitro studies terbinafine is active against several 
10 
10 
5 
4 
4 
4 
dermatophytes (6). However, only in vivo studies 
can actually determine its clinical efficacy. 
The results of our open clinical study in a rather 
small number of patients showed that after 6 weeks 
of oral terbinafine treatment KOH and Wood tests 
remained positive in all 10 patients. However the 
culture became negative in 5. After an additional 6-
week topical application of 1 % terbinafine cream 
KOH and Wood tests became negative in 6, and 
culture as well was negative in 6 patients. 
Orally administered terbinafine may persist in 
different compartments of the skin even after 48 
days after the last day of medication in a concentration 
higher than the minimal inhibitory concentration for 
M. canis (7). The reason why it is not more 
effective remains to be elucidated. Topical antifungal 
agents are usually ineffective in the treatment of 
tinea capitis as they do not appear to reach the 
hair bulbs (2). According to our data mycological 
results (KOH, Wood) were better at 12th week, a 
negative culture was obtained in 6 patients. A 6-
week oral terbinafine treatment was more effective 
in patients with tinea capitis due to Trichophyton 
sp. (5,8) . 
CONCLUSIONS 
6-week orally administered terbinafine, followed 
by a 6-weeks topical application of 1 % terbinafine 
cream twice daily was effective in 60% of treated 
patients with tinea capitis due to M. canis. Longer 
oral terbinafine treatment and treatment duration 
finding studies are suggested in cases of M. canis 
scalp infection in children. 
REFERENCES 
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infection about to become a serious dermatological 
problem? Dermatology 1992; 184: 87-89. 
2. Hurwitz S. Skin disorders due to fungi. In: 
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Hurwitz S. Clinical pediatric dermatology. 2nd ed. 
Philadelphia. WB Sounders Comp. 1993: 374-378. 
3. Goodfield MJD. Short duration therapy for 
dermatophyte onychomycosis: A multicenter trial. Br 
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5. Haroon TS, Hussain I, Mahmood A et al. An 
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6. Clayton YM. In vitro activity of terbinafine. Ciin 
Exp Dermatol 1989; 14: 101-103. 
7. Faegemann J, Zehender H, Millerioux L. Levels 
of terbinafine in plasma, stratum comeum, dermis-
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8. Jones TJ. Overview of the use of terbinafine 
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AUTHORS ADDRESSES 
Vlasta Dragoš MD, dermatologist, Department of Dermatology, Medica! Centre, Zaloška 2 
Ljubljana, Slovenia 
Božana Podrumac MD, MSc, dermatologist, same address 
Boris Kralj MD, dermatologist, same address 
Igor Bartenjev MD, MSc, dermatologist, same address 
Mateja Dolenc MD, dermatologist, same address 
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