In an earlier article I wrote a brief summary about ringworm treatments, so you may want to read How to Treat Ringworm first.
I wanted to do a write up about griseofulvin because it is the most used to treat ringworm in kids that need an oral treatment.
Griseofulvin (Grifulvin) is the current prescription drug of choice. Griseofulvin was first isolated in 1938 and yet, over 70 years later, it continues to be first line of treatment. Griseofulvin is available in microsize suspension and tablets (Grifulvin V) and ultramicrosize tablets (Gris-Peg). It has been approved in children older than 2 years old.
Griseofulvin works by inhibiting fungal growth and helps protect new skin from being infected. This means it stops the fungal infection from progressing, allowing the infection to clear as the infected skin dies and sheds. Because it does not kill the fungi, griseofulvin has a long length of therapy. General ringworm of the body is usually treated for two to four weeks, whereas infections involving the head or feet can be treated for as long as four to 12 weeks. Yes, that’s right, 2 to 3 months of treatment.
Griseofulvin is typically given to children in the suspension form because it allows specific weight based dosing. Both suspension and tablets are best absorbed when taken with a fatty meal. Peanut butter or ice cream are recommended, which makes administering the medication a bit easier for parents J. The ultramicrosize tablets may be crushed and mixed with 1 tablespoon of applesauce and taken right away without chewing.
Griseofulvin has a low incidence of serious side effects. The most common adverse reaction is headache. Also included are belly upset, oral thrush, sensitivity to sunlight and dizziness. Rare but serious side effects include liver toxicity and decrease in white blood cells; these often disappear even with continuation of therapy. Perhaps most interesting and pertinent is the estrogen-like effects that griseofulvin can cause in children. Estrogen-like effects in children can include bloating, depression, headaches, thyroid interference and impaired blood sugar control- once again serious but rare.
Other antifungal medications used to treat ringworm are terbinafine (Lamisil), itraconzaole (Sporanox) and fluconazole (Diflucan). These drugs appear to have similar efficacy as griseofulvin but with a shorter therapy cycle, typically four weeks.
It is imperative to treat ringworm in children. If left untreated, bacterial infections and permanent hair loss can occur. Griseofulvin remains the drug of choice for treatment of ringworm, however this is mostly based on old information. Back in the day, griseofulvin was the only treatment option available in generic formulation and was therefore bumped to first in line due to price. Nowadays, all of the medications have some dosage forms available in generic. When discussing your child’s treatment plan with her physician, be sure to consider the length of treatment, dosage forms and price of the medications.
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