Optimizing Antifungal Therapy for Pediatric Tinea Capitis: A Narrative Review of Species-Specific Efficacy, Dosing Strategies, and Clinical Implications.

Pediatric tinea capitis, a common superficial fungal infection of the scalp, is primarily caused by Trichophyton and Microsporum species. While oral antifungal therapy remains the cornerstone of treatment, clinical outcomes vary considerably owing to differences in dosing practices and the species-specific response of the infecting organism. This narrative review synthesizes the existing literature to emphasize contemporary dosing regimens and species-directed efficacy on four widely used agents: griseofulvin, terbinafine, itraconazole, and fluconazole. Across studies published between 1997 and 2025, griseofulvin consistently demonstrated strong performance for both Trichophyton and Microsporum infections when administered at the recommended 20-25 mg/kg/day, confirming its enduring role in pediatric care. Terbinafine achieved reliable results for Trichophyton but was markedly less effective for Microsporum, with wide variability in reported cure rates. Though less extensively studied in children, itraconazole and fluconazole emerged as effective alternatives, while both warrant careful use owing to potential hepatotoxicity and other adverse effects. The evidence underscores the importance of species identification and optimal dosing in guiding antifungal selection. Empirical treatment without microbiologic confirmation risks reduced cure rates and may contribute to emerging antifungal resistance. Future investigations should prioritize long-term follow-up and the potential role of combination therapy to refine and sustain effective management strategies for pediatric tinea capitis.