Tinea Capitis - Scalp Ringworm

[Lannette]

Dear DermaTalk,

I am very happy to have found this wonderful site. I hope that you can offer me some advice.

My 4 year old daughter had spots coming out on her scalp since October. After MANY trips to the doctor and MANY different creams, she was diagnosed with Tinea Capitis, Scalp Ringworm, as the doctor performed a culture. He prescribed a cream to apply two times a day. During the beginning days of December, my daughter got pneumonia and a heavy dose of antibiotics. The follow week, the ringworm flared up unbelievably. I was getting very concerned and showed the doctor again on her follow up appointment...another cream was prescribed. Long story short, the 'spots' turned into crusty pussed filled mounds and a new spot was developing practically every day. I started my own research and discovered that this type of ringworm was practically impossible to clear up without oral treatment. The appointment with the dermatologist confirmed this and she started my daughter on Ketoconazole 100mg per day...but only could start this medicine after having a TGP test to test the liver function and a follow up TGP blood test every 15 days as long as she is taking the medicine. This medicine seems very scary to me but after asking three different dermatologists, they confirmed that this was the treatment in severe cases of Tinea Capitis. I also wash her hair with Ketoconazole shampoo and apply an anti-fungal cream. After 45 days of treatment, the spots look so much better but the dermatologist said that it wasn't completely gone and prescribed another 30 days of treatment. All of this has been stressful enough...but this week my daughter got a high fever and after a trip to the doctor, she was prescribed Amoxicllin for a throat infection (2.5ml 3x/day for ten days). I kept asking him if there will be any negative interaction with the Ketoconazole and he said no. But, something was sitting right with me and I started to look online but unable to find anything. Can you please offer some advice? Is this combination of drugs safe? The ketoconazole already has me stressed out and now to add another medicine to the mix...any adive?

Thanks,
Lannette

[Dr.Deepak]

Welcome to the forum lannette..sorry to hear about ur daughter condition... There is no interaction between the drugs.. So these drugs can be taken safely...
but on the other side, we usually don't prescribe ketoconazole because of its toxic effect on liver...being said that, sometime it is required to prescribe ketoconazole because some species of fungus are better killed with ketoconazole than other antifungal..so ur daughter might have the fungus that required ur Derm to prescribe ketoz...Further, what I usually do but better coverage is use different antifungal agents.. Like in your case.. Oral ketoz, selinium shampoo and terbinafine cream..Get checked regularly for liver toxicity..

[Lannette]

Dear Dr. Deepak,

Thanks so much for your reply. I greatly appreciate your input and to hear that the two medicines can be taken together safely. My daughter has been having the blood test every 15 days to check for toxicity. In your opinion is this sufficient? I am curious to know what oral anti fungal you would prescribe. The Ketoconazol was the only available option here. I will be so relieved when this treatment is finished. Thanks again.

[Dr.Deepak]

I don't usually prescribe oral ketoz..i would only use when other medication don't work. I would go with ketoz shampoo and oral terbinafine or itraconazole. For whose who can't afford i would go for oral griseofulvin which is cheap and works better or equal to the rest of the oral antifungal.