An RCT54 reported that 75% of griseofulvin-treated patients with uncomplicated T. tonsurans tinea capitis had sterile hair sample cultures 4 weeks after initiation of griseofulvin. By contrast, 94% of patients who received griseofulvin together with biweekly selenium sulphide shampoos had sterile hair cultures at 4 weeks. Another RCT55 of 54 patients receiving griseofulvin 15 mg/kg/day for T. tonsurans tinea capitis, compared selenium sulphide 2-5% lotion or 1% shampoo with a bland non-medicated shampoo. Patients were observed every 2 weeks until they were clinically and mycologically cured. The selenium sulphide products were statistically superior to the non-medicated shampoo for time required to eliminate shedding and viable fungi. However, no difference was noted between the two selenium products.
I found an RCT56 performed in a very depressed area of Africa where griseofulvin is not generally available. It compared 6 weeks of miconazole cream with 6 weeks of Whitfield's ointment (6% benzoic acid plus 3% salicylic acid) in T. violaceum and M. audouinii tinea capitis and found no significant cure rates. A small open study57 of children with T. tonsurans tinea capitis treated solely with 2% ketoconazole shampoo daily for 8 weeks reported a clinical cure in 93%
but at 6-month follow up only 33% showed a mycological cure and remained cured during the 1 year follow up.
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